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Home My Public Portal About5039 HELEO AVE_Plumbing__ • � WORKERS' COMPENSATION DECLARATION I APPLICATION FOR PLUMBING PERMIT hereby*affirm that I have a certificate of consent to self 200026 DPW 6/87 insure, qr a certificate of Workers' Compensation Insurance, 76A667A or a 4rtiiieM copy thereof (Sec. 3800, Lob.. C.) G /` COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS P li No. ,,ZCompany L1�ATL-T Certified copy is hereby furnished. 1 FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING _ hw__ Certified copy i5 filed with the county building inspec- ADDRESS _ i tion department. NUMBER FIXTURE OR ITEM @ FEE .LOCALITY Date Applicant WATER CLOSET NEAREST (� CERTIFICATE OF EXEMPT!16N FROM WORKERS' BATH TUB CROSS 5T. 1` COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work Involved by MAIL the permit is for one hundred dollars ($100) or less.) LAVATORY ADDRESS �. E 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 _ _ TEL NO a1 so as to become subject to the Workers Compensation Laws. DISHWASHER /] CONTRACTOR S S `" Date Applicant CLOTHES WASHER ADDRESS 5 G NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR /�� Compensation provisions of the Labor Code, you must forth- CITY •� with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE /'AUG LIC. Q deemed revoked. WATER HEATER LICENSE NO. 7 p CLASS U LICENSED CONTRACTORS DECLARATION // STRICT NO.!J( OC ED BY I hereby affirm?hot I am licensed under provisions of Chapter 9 / GAS SYSTEMS OUTLETS b Cy (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER } and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION p: ��// (/ 16 DATE 0' License Number T 7S• E 7� Lic. Class Q. r /4'_ Q�j FINAL � Contractor l Date fG_f'� BY ❑ I am exempt under Sec. �Ul� B.BP.C. for this reason LL, Plan check fee Date: PLUMBING PERMIT ISSUING FEES Signature TOTAL FEE V Plan check applicant SINGLE FAMILY 5 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License ACCT.AT Law for the following reason (Section 7031.5, Business and Address Professions Code): City Tel. No. 3307 16.511 ❑ I, as owner of the property, will do the work and the 1 ITERS structure is not intended or offered for sale (Section , TOTAL 16.50 pwe,5Q 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CHECK 56.50 1 hereby affirm that there is a construction lending agency for The performance of the work for which this permit is issued CHANGE .011 (Sec. 3097, Civ. C.). Lender's Nome 0000—CMI 6/ 9/89 Lender's Address 3875 i AM 9:35 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 authorrepresentatives of this County to enter upon the abov entioned p aperty, or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i Signature of Permittee Date Gr(ir l O ERS `GMPE"SAT'°" DECL"RAT'°" APPLICATION FOR PLUMBING PERMIT 3c s 20-0026 DPW 4/8] - n I ItPe , afitrm It have-a certificate,of consent to self in ]6A66]A 'fUl sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV.8/86) - certified copy thereof (Sec. 3800, lab. C.) - Policy No. Company :SW7 � r�> .COUNTY OF LOS ANGELES .DEPT. OF PUBLIC WORKS - Certified copy isherebyfurnished. - - FOR APPUCANT'TO FILL IN(PRIM OR TYPE) BUILDING 5b• �• _ Certified copy is filed with the county'building inspection , ADDRESS e O departmem. NUMBER FIXTURE OR ITEM @ FEE �77 i l WATER CLOSET(TOILET) LOCALITY' / -Date �L Applicant t Ct. / t �� NEAREST , CERTIFICATE OF EXEMPTION FROM WCRKE4J BATH TUB COMPENSATION INSURANCE SHOWER OWNERZ ��2fLC e(This.section need not be completed if the work involved by '� n j MAIL the permit is for one hundred dollars ($100)or less.) .G: LAVATORY ;(I� ADDRESS I certify that in the performance of the'work for which this per- �'9 SINK Z.O D CITY�_� TEL N _ mit is issued, I shall not employ any person in any manner so G as to become subject to the Workers'Compensation Laws, DISHWASHER U Q J CONTRACTOR Gb{y�' [ Date Applicant CLOTHES WASHER ADDRESS L e NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- - CITY TEL. safion provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit sholl.be deemed revok- STATE LIC. ed. - WATER HEATER LICENSE NO. 2 CLASS LICENSED CONTRACTORS DECLARATIONDISTRICT NOPROCEED BY GAS SYSTEM 5- OUTLET I hereby affirm that I am licensed under provisions of Chapter � �-v v /o 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fed Professions Code, and my license is in full force and at- 5 PER SYSTEM FINAL _ ,r— fJ VALID' TION a Q� DATE p n. License Nu bet Lic Class�'/ U G FINA S Contract ate ''� r2nI BY v , 0 r am exempt under Sec. x W CIL B.BP.C. for is reason Plan check fee .> ► Z Date: PLUMBING PERMIT ISSUING FEE$ Signature - TOTAL FEE � �, X c " SINGLE FAMILY J HOME OWNER-BUILDER DECLARATION Plan check applicant - s AC(T. I hereby affirm that I am exempt from the Contractor's License Nome Law for the following reason (Section 7031.5,'Business and leu) l)'(7 82 0 Professions Code): - Addressi I- NE I, as owner of the property, will do the work and the City. TeL N .. TOTAL .4..–y structure is not intended or offered for sale(Section 7044; - ��,s� HECK Business and Professions Code). G/J r•Y , { s `7 rn CONSTRUCTION LENDING AGENCY .•�,CC.' �-NAN'GE 013 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). tr Ilfl�lll'OCll�i ?I i,'��'j 3Ct, Lender's Name - - I}3W ' A1110=48 ' Lender's Address I certify that I have read this.applicotion and state that the _ above information is correct. I agree to comply with all County ► ordinances and State laws regulating Plumbing, and.hereby o ize representatives of this County to enter upon the - abo enf'on property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE - Signature of P mit a Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0403290002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUI DI G TR: 13329 LT: 1 UN: .002 5039 HELEO AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803825 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LA ROSA 8590-023-001 01 PERMIT ISSUANCE FEE - 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY 25 LAVATORIES/SINKS 1.00 FIX 16.20 TENANT: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 ISSUED N: PROCESSED BY: PLAN BY: RES TOTAL FEES 60.15 04/02/04 VG 09/29/04 OWNER: TEL. N0: FINAL DATE FINAL BY: CODE: CHEN;KENT (626) 282-1389- 5039 HELEC AV TEMP 917803825 DESCRIP IO F WORK PLUMBING FOR NEW BATHROOM APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: OME AS OR: TEL. N0: APPROVALS DATE (NSP CTOR SIGNATURE SAME AS OWNER - LIC. NO UNDER SLAB WORK WATER S RVI CE ARCHITECT OR ENGINEER:: TEL. NO: PLASTIC Y/N METAL Y/N LIC. NO: ROUGH PLUMBING GTS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST (UTILITY COMPANY NOTIFIED WV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508