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HomeMy Public PortalAbout4931 HELEO AVE_Plumbing__ •W&RKERS'COMPENSATION DECLARATION � o 0 0 0 0 I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 l�l��������©� �O� ����� �� �� ��� insure, or'a'certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.'OF PUBLIC WORKS �J Policy No. -10-04896Q/mpany CNA Ins. Co. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS 3&21 ,4 HelebAve. tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Temple Cit 4-27-89 Owen Bros. Plmb. WATER CLOSET Date Appli4ant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB ' CROSS ST. COMPENSATION INSURANCE Z, SHOWER . OWNER Premier COnstruCtlOn ' CO. (This section need not be completed If the work Involved by the permit is for one hundred dollars($100)or less.) LAVATORY MAIL ADDRESS PO BOX 724 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY Rosemead. TEL. NCS 18-3OH-003 so as to become subject to the Workers' o+pe sat'art Laws. DISHWASHER CONTRACTO Ewen Bros. Plumbing Inc Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this ertificate o 4265 N. Baldwin Ave: Exemption, you sho6ld become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY El Monte TEL. N�18-443-007 with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO.23 1—74 1 CLASS C36-20 LICENSED CONTRACTORS DECLARATION DISTRICT NO. OCESSED BY I hereby affiim that I am licensed under provisions of Chapter 9f GAS SYSTEM OUTLETS ` 0 (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER J and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION d� License Number 23 1-74 1 Lic. Class C36-20 DATE11 p FINAL Contractor Owen Bros. Plmb-Date 4-27-89 BY I am exempt under Sec. VU (� Ltl B.&P.C. for this reason D Plan.check fee U) _Date: PLUMBING PERMIT ISSUING FEE$ � Signature TOTAL FEE 1 Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name ;t I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address ., 4 err='•`# Professions Code): City Tel. No. r ❑ I, as owner of the property, will do the work.and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). 1'k 5 tl? CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for - ':-• ' _ _�ai the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name ';7— Lender's ;_•Lender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws"regulating Plumbing, and hereby authorize re resentatives of.this County to enter upon the / 3me edL prop"ty o inspection purposes. SEE {REVERSE FOR EXPLANATORY LANGUAGE Signature of Permitt Date _ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1308010011 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: I IBK: 214 PG: 47 PC: 2 4931 HELEO AV I IFEE DESCRIPTION: _ QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803823 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 18590-023-036 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: JS LOCALITY: TEMPLE CITY CAI 163 WATER PIPING BR/FIX 9.00 FIX 61.20 I (TENANT: I TOTAL FEES 89.00 (ISSUED ON: PROCESSED BY: PLAN BY: I 108/01/13 SR I I I I (OWNER: TEL. NO: I (FINAL DATE FINAL BY: CODE: IBRADLE DANNY J;LINDA K (818) 287-6791- 1 14931 HELEO AV I 1 ITEMP 917803823 1 IDESCRIPTION OF WORK IPEX-REPIPE 9 PLUMBING FIXTURES I I I I (APPLICANT: TEL. NO: 1 1 IPEPANYAN, ARA (818) 295-3800- 1 1 11607 W BURBANK BLVD I (SPECIAL CONDITIONS: 1 IBURBANK CA 91506 1 1 I I I I I I I (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE IREPIPE PRO (818) 295-3804- 1 1 I 11607 W BURBANK BLVD LIC. NO I (UNDER SLAB WORK 1 1 1 IBURBANK CA 91506 695125 * 1 I 1 1 1 I I IWATER SERVICE I I I I IPLASTIC Y/N METAL Y/N 1 1ARCHITECT OR ENGINEER: TEL. NO: I I 1 I 1 1 - I (ROUGH PLUMBING I I 1 1 LIC. NO: 1 I I I 1 1 IGAS PIPING I I I I I I I I I I IGAS VENT I I I I I I I 1 IHOT WATER HEATER I I I I I I IPLUMBING FIXTURES I1 I I I I I I I 1 I / ILAWN SPRINKLERS I I I I E PI FIED( 'I r yI I I GAS TEST I 1 I 1 I 1UTILITY COMPANY NOTIFIEDI I I I I I I 1cWV I I I 1 I I 1 1 (GRAY WATER SYSTEM 1 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I* ADDITIONAL DATA ON FILE 1 I 1 I I I I 1 I I I 1 (REPORT ID: DPR263 ROUTE TO: BS0508 I I