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Home My Public Portal About8600 HERMOSA DR_Plumbing__ WORKERS'•COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT {.V herebg, affirm)yet "fTave a'certificate of consent to self in- 6APW^/B] \ sure,ar a certirccne of Workers'Compensation Insurance,or a CE 817(REV. 8/86) - certified copy thereof{Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company F-]] Certified copy is hereby furnished: FOR APPLICANT TO FILL IN(PRINT OR TYPE) 'BUILDING. Certified copy is filed with the county building inspection ADDRESS department. _ NUMBER FIXTURE OR ITEM @ FEE LOCALITY Dote Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CR05S ST. COMPENSATION INSURANCE SHOWER OWNER,r%-TT��MRELA"S wZA S}IAI�Ral (This section need not be completed if the work involved by MAIL Q /OD a .D the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS o(a h�OSI� I certify that in the performance of the work for which this per- SINK �pj p f -�r-p qC mit is issued, shall not employ any person in any a der o CITY S�('NGAV I\r�L -TEL. Ny I(J/-15D1� as to become subject to the Workers'Co- pensct n w DISHWASHER CONTRACTOR Date ApplicaN CLOTHES WASHER NOTECE TO APPLICANT: If, after making this Certificate of x- ADDRESS emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR cation provisions of the Labor Code,you must forthwith comp- CITY TEL. NO. LAWN SPRINKLER SYSTEM iy with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT P CESSED BY I hereby affirm?hot I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER y fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALI TION G DATE C License Number Lic. Class AU FI /// cc Contractor Dote O It- ❑ I am exempt under Sec. W B.BP.C. for this reason Plan check fee , g Date: PLUMBING PERMIT ISSUING FEE $ Signature TOTAL FEE - a.•� ,Q 8 A SINGLE FAMILY applicant Plan check a HOME OWNER-BUILDER DECLARATION PPP #re e e e.e rj 1 hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and 'EI °'O 1 CO Q Professions Code): Address / .e e e (a rj Q I, as owner of The property, will do the work and the City Tel. No. - structure is not intended or offered for sale(Section 7044, . I Q1� 4 a 817 Business and Professions Code). poolCONSTRUCTION LENDING AGENCY - I heieby affirm that there is a construction lending agency for the performance of the work for which this permit is issued , (Sec. 3097, Civ. C.). Lender's Name Lender's Address I 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 represen t s of this County to enter upon the above-mntip ed ro rt for inspection purposes. r r SEE REVERSE FOR EXPLANATORY LANGUAGE \ Signature of Permittee Date ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0106050012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ESS:' TR: 3623 LT: 118 UN: .003 8600 HERMOSA DR E • � FEE DESCRIPTION: QUANTITY: LOM: AMOUNT: SGAB CA 917753007 ' ASSESSOR INFORMATION NUMBER: NEAREST- CROSS STREET: BURTON AVENUE 5387-006-024 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: G3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: 21 HOSE BIBB(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED : PLA EXP ON: 25 LAVATORIES/SINKS 1.00 FIX 16.20 06/05/01 UT 12/02/01 45 WATER CLOSET/URINAL 1.00 FIX 16.20 leq OWNER: TEL. NO: TOTAL FEES 92.55 FINALD TE/ FI Y: CODE: ROMERO, MICHAEL;LAURA (626) 309-0334- OJ 8600 HERMOSA DR SGAB 917753007 . CRf ON OF BEDROOM AND 3/4' HR OM, AND WALK-IN CLOSET APPLICANT: . NO: MASTER REMODELERS (626) 960-2951- 2149 W. GARVEY AVENU SPECIAL CONDITIONS: N WEST COVINA 91790 CONTRACTOR: TEL. N0: - MASTER REMODELERS (626) 960-2951- APPRQVA DATE INSPECTOR SIGNATURE � ' 2149 W. GARVEY AVE NORTH LIC. NO UND WEST COVINA, CA 91790 622749 B WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: . NO: - ROUGH LIC. N0: LC G PING GAS VENT HOT WATER HEATER PLUMBING F S LAWN SPRINKLERS GAS TEST UTILITY COMPANY 0 CWV _ry GRAY WATER SYSTEM * ADDITIONAL DATA ON FILE REPORT ID: DPR263 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0705230004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 3623 LT: 118UN: .003 6600v HERMOSA DR E ""� I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1' SGAB CA 917753007 1 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET: BURTON T 15367-006-024 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: G3 LOCALITY: TEMPLE CITY, Cl I III CLOTHESWASHER(S) 1.00 FIX 16.20 ITENANT: 113 DISHWASHER(S) 1.00 FIX 16.20 11SSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 125 LAVATORIES/SINKS 1.00-PIX16.20 105/23/07 SR 11/19/07 126 MISCELLANEOUS FIXTUR1.00 FIX 16.20 1 TOWNER: TEL. NO: 147 WATER HEATER(S) + —'I-oo WTH 16.20 FINAL DATE FINAL BY: CODE: ROMERO, MIKE & LORA (626), 232-1178- 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 1 18600 HERMOSA DR 160 DEW REPAIR OR ALTER 1.00 SYS 16.20 1 ISGAB 917753007 1 TOTAL FEES 141.15 IDESCRIPTION OF WORK I (PLUMBING FOR KITCHEN AND LAUNDRY ROOM 1RPPLICANT: TEL. NO: 1MASTER REMODELERS (626) 960-2951- 12149 W. GARVEY AVE. I (SPECIAL CONDITIONS: I WEST COVINA CA I I I I I I I (CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE (MASTER REMODELERS (626) 960-2951- 1 12149 W. GARVEY AVE NORTH LIC. NO IUNDER SLAB WORK / j I (WEST COVINA, CA 91790 622749 HIC *I I (WATER SERVICE I PLASTIC Y/N METAL Y/N T ARCHITECT OR ENGINEER: TEL. NO: IAQX ENGENEERING (949) 261-7741- IROUGH PLUMBING 11306 BRISTOL #260 LIC. N0: / INEWPORT BEACH 66510 C (GAS PIPING (GAS VENT I (HOT WATER HEATER I I (PLUMBING FIXTURES (LAWN SPRINKLERS I I I I I (GAS TEST I I I I 1 I I I (UTILITY COMPANY NOTIFIED( I I I I ICwv I I I I I I I I I (GRAY WATER SYSTEM I I I I I I EXPIRED goy I I I I I fI` ADDITIONAL DATA ON FILE I I I I I I (REPORT ID: DPR263 ROUTE T0: H50508 I I I I I 11