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Home My Public Portal About9805 HOWLAND DR_Plumbing__ WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT so-Dose paw 4/e7 tlffirm that haven certy4 icate of-mnsenf4o self in- 76A667A W.drcopy certificate of Workers Compensation Insurance,ora CE 817(REV. 8/86) thereof (Sec. 3800, Lab. C.) .a' fl COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ` Policy No. Company' Certified copy is hereby furnished. - - FOR APPLICANT TO FILL IN (PRINT OR TYPE) BU�EIS _ • Certified copy is filed with the county building inspection - AD department. NUMBER FIXTURE OR ITEM @ . FEE LO WATER CLOSET (TOILET) Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL ' the permit is for one hundred dollars ($100) or less.) LAVATORY ApORESS I certify that in the performance of the work for which thispet- SINK mit is issued, I shall not employ any person in any manner so CITY / T' TEL. as to become subject to the Workers'Compensation Laws.. DISHWASHER _ CONTRACTOR ? / _ Date Applicant ".• - � � CLOTHES WASHER , NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS emotion,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR - CITY TEL N sotion provisions of the Lobor'Code, you must forthwith comp- LAWN SPRINKLER SYSTEM + ��✓ r� ly with such provisions or this permit shall be deemed revok- STATE s _ LIC ed. WATER HEATER LICENSE NO f x CLASS LICENSED CONTRACTORS DECLARATIONDI TRICT Np./ CESSE eY hereby affirm that'I am licensed under provisions,of Chapter GAS SYSTEM OUTLETS F/Y 9(commencing with Section 7000)of Division 3 of-the Business OUTLETS OVER and Professions Code, and my license is in full force and.ef- 5 PER SYSTEM FINAL/"'T V LIDATION r feet. DATE d License Number 7 11, Class �- yy _ ,p/��!J ) 0 ConIc tracto ! i Date �' �� Fi J O H 0 I,am exempt under Sec. W 6.8P.C. far this reason , y Plan check fee - Z fe' PLUMBING PERMIT ISSUING FEE$ '15 D Signature - TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant _ I hereby affirm that I am exempt from the Contractor's License - Name 7 Law for the following reason (Section 7031..5, Business and �i j_Tys Professions Code): _ Address I, as owner of the property, will do the work and the City Tel. No3$07 16.50. . structure Is not intended or offered for sale(Section 7044, 1 ITEMS Business and Professions Code). - „ ► TOTAL I a eQ -CONSTRUCTION LENDING AGENCY - - CHECK ia� c� hereby affirm that there is a constructloo lending agency.for the performance of'the work for which this permit is issued r CHARGE - .011(Sec. 3097, Civ. C.). - Lender's Name 0000-OOOi ii/ 3/ 9 Lender's Address + 6560 i pN10e47 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 representatives of this County t ' o enter upon the above-mentioned pro fort spectia urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date RKERS' COMPENSATION DECLARATION 76A667q APPLICATION FOR PLUMBING PERMIT 0 {� hr d a that I have a.certificote of consent to self LJ ;Mcerl'i; icatb of Workers' Compensation Insurance, CE 817(REV. 10/81)' or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY_ OF LOS ANGELES BUILDING AND SAFETY Policy Na. Company - .. .. .. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT. OR TYPE) BUIADDRESS LDING 11 L ❑ d C'("' E •� R Certified copy is filed with the county building inspec- tion deparlmenl. NUMBER FIXTURE OR ITEM FEE — -LOCA - - LITY DateApplicant � WATER CLOSET - - NEAREST -/ CERTIFICATE OF EXEMPTION FROM WORKERS' QBATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER Or'SA I n/� --1A (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL y ADDRESS U S 0 lA .s� III I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY f C-(f/ TEL. NO.�if� / so as to be ' to the Workers'Compensation Laws. DISHWASHER- CE4APFYCAN.T" CONTRACTOR C L Datepp Date CLOTHES WASHER ADDRESS_ NOTIIf, after making this Certificate of - - Eseryou shobecome subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY 'TEL NO. L with .comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE; LIC. deemed revoked. WATER HEATER LICENSE NO. LICENSED SONTRACTORS DECLARATION DISTRICT NO. P ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER ` and Professions Code, and my license is in full force and effect. 5 PER SYSTEM _ FINAL J VALIDATION >; License Number Llc. Class 0-1 FI 0 Contractor Date B K ❑ 0 I am exempt under Sec. B.BP.C. for this reason / W Plan check fee Date:— PLUMBING PERMIT ISSUING FEE$ U , Z Signature TOTAL FEE Plan check applicant SINGLE FAMILY t HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the fallowing reason (Section 7031.5, Business and ProfPr essions Code): City Tel. No. 2 5 7 0.3 A I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section , # e e is e e 5 7044, Business and Professions Code). * 4650 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for - - '- e is is 4 6 5 0'H the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) 1 020"86 Lender's Name Lender's Address .. . ' I certify that I have read this application and state that the 110. above information is correct. I agree to comply with all County _ ordinances and State laws regulating Plumbing, and hereby authorize epr sentatives ,I'Is Court to enter upon the above- enti ed pro t for 'fispec on purpos s. SEE REVERSE FOR EXPLANATORY LANGUAGE / G i .. _ .__ . .. .. _... ._ . _ (g ye o er t?4 Do COUNTY OF LOS ANGELES TEMPLE CITY q 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1301310030 BUILDING AND SAFETY ( LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ITR: 1 ID: FEES PAID BUILDING ADDRESS: ITR: 12830 LT:� 8 1 9805 ROWLAND DR I 1FEE DESCRIPTION: QUANTITY: POM: AMOUNT: TEMP CA 917803233 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GOLDEN WEST 18589-004-010 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY CAI I 121 HOSE BIBB(S) 1.00 FIX 16.20 1 TENANT ITOTAL FEES 44.00 (ISSUED ON: PROCESSED BY: PLAN BY: 1 101/31/13 SR IOWNER: TEL. N0: IFINAL DATE FINAL BY: CODE: IHUYNH, KIEN (626) 716-8248- 1Z /J,� 1 '*/J\/1 19805 HOWLAND DR ��/) TEMP 917803233 E ��TT//PTION pF WORK 11 (REPLACE HOSE BIBB I (APPLICANT: TEL. NO: INGO, CHINH V (626) 242-0364- 333 TOCINI DRIVE ISPECIAL CONDITIONS: 1 DUARTE CA 91010 - I 1 I I CONTRACTOR: TEL, NO: 1APPROVALS DATE INSPECTOR SIGNATURE IC J C J CONSTRUCTION CO (626) 242-0364- 1333 TOEING DRIVE LIC. NO (UNDER SLAB WORK DUARTE CA 91010 748982 1- 1 1 IWATER SERVICE IPLASTIC YIN METAL YIN ARCHITECT OR ENGINEER: TEL. NO. IROUGH PLUMBING LIC. NO: 1 1 IGAS PIPING I GAS VENT IHOT WATER HEATER 1 I IPL UMBING FIXTURES LAWN SPRINKLERS 1 I I (GAS TEST I I I 1UTILITY COMPANY NOTIFIED I Cw (GRAY WATER SYSTEM 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 II 11 I 1REPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I