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HomeMy Public PortalAbout6109 IVAR AVE_Plumbing__ WOkKERS' COMPENSATION.DECLARATION- n j�j�p �C n M N FOR .P p U O �N GG F'E n?,�'r w 20-0026 DPW 4/87 Gil u u LL !�1 FOR L6 II L/11 II:V Ili I hereby;.affirm.that I have a certificate of consent to self in- 76A667A 1 .1 . sure or`a cer ficate'of•Workers'Compensation Insurance or a "CE 817(REV. 8/86) certified copythereof,(Sec..3800, Lab•C.) - Policy.No. Company. ' COUNTY OF LOS'ANGELES DEPT ,OF.PUBLIC WORKS, 0 Certified copy is hereby furnished: APPLICANT TO FILLBUILDING , Certified copy is filed with the county building inspection• ADDRESS I�/A department. d.. NUMBER A FIXTURETOR ITEMIN R TYPE) FEE FOR (PRINT O . 6'I O� LOCALITY. WATER CLOSET(TOILET)' - Date Applicant - I NEAREST r �- C 'CERTIFICATE OF EXEMPTION.FROM WORKERS" BATH TUB' - CROSS ST. • r . ��C.% s COMPENSATION INSURANCE r OWNER. I L I J -•'g ��� I4 t N (This section need not be completed if,.the work.involved by SHOWER MAIL the permit is for'one,h'Undred doll6rs`($100)or less.) LAVATORY ADDRESS`- 512: ,: IG I certify that in the performance of the work for which this per- SINK A mit iosSued,"I.shall not employ any person in any manner so - CITY ��N A�� �L. -TEL NO($f�) ?�^�t4 . as to become subject to,the Workers Compensation Laws. DISHWASHER CONTRACTOR - Date -•. Applicant CLOTHES WASHER ' -.- NOTICE:TO APPLICANT, If,.after ma0ng,thi,s Certificate of Ex SWIMMING POOL RECEPTOR ADDRESS emption,you should becme subject to th'e Workers'Compen- CITY TEL. NO. sation provisions,of the Labor Cade, you must forthwith comp- .. LAWN SPRINKLER SYSTEM - 1,y with•such provisions orthis permit-shall.be deemed revok ' STATE- LIC. ed - ,' NATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NQ. %ESSED BY I hereby affjrm,that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS -� �/ 9(commencing with Section 7000)of Division 3 of,the Business sOUTLETS OVER o and Professions Code, and`m license is'in full force and ef- 5•PER SYSTEM feet y - FINAL Q / V LIDATIONI DATE (��r! 1 / O License Number Lie Class U FINAL BY 0 Contrdi=tor Date . . ' F-1I am exempt•under Sec. lCL UJ B.&P.0 for this reason Plan check fee Date 'PLUMBING PERMIT ISSU.ING,FEE$ 'ia �U D Signature ' SINGLE FAMILY TOTAL FEE 5 HOMEOWNER-BUILDER DECLARATION Plan check applicant I.hereby affirm that I am exemptfrom'the Contractor's:License Name' " Law-for the following-reason, (Section 7031.5, Business and Professions Code): Address A7 58.50 37 1 ITEMS' X1.I>'as'owne_r of the property, will,do the work and the City Tel No. structure is not intended or offered for,sole'(Section-7044, Business and Professions'Cade). t _ TOTAL o50 � • D. CONSTRUCTION LENDING AGENCY ^ � 5© r :Vs:t I hereby affirm that there is,a construction lending agency for CHANGE • A�� r the performance of the work,for which this'permit is'issued 4� i9�G {Sec.-3097,CiV. C.): Lender's Name - 0000'1J� l 11/27.89. Lender's Address 3 1 R ;?o�Ie I certify that I haveyu`•1 read this application and state thdt the � � _ •• .- . .. . ......,_ - above,information is correct. I agree to comply with all County D ordinances.and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. ,L ,$� SEE REVERSE FOR EXPLANATORY LANGUAGE ,cc, - ' Signat re of Permittee Date a ' f..t�!S•R wr1M�l�s'it.'*4+A�1:-':7�;{r•. c».vnr.�d'i•:l- '�(+�;'I�P/�A7�'•'�•' �.�.Jli.�`"^. "�,«it-Mrt'L� ti+►1�fs DEPARPaT..0".BUILDYNG APPLICATION FORAERMI Y or L'os AivcEL�s' � :PLUMBING :.. `. K ..; ,• �a Z•tk Y ,u,,,wX&TUn OF INSTAIZA _UN i, �DISTRICT N0., OROYr No. • P[RMIT H •� ROVOM- .� T h /jam '}r�.;,,, urRI1N�' � ►I!}VRO'- ``,} COYtallTti � " • � �� 'S!� �J�f•�'�a r-�� ����/_ � ''•. IRATl1! ': :� 'Cw►ea. TA R[AOY/OR '•:R n NNl ^ IIRRT INt►iCT1ON �i•A• t j_pj//� �_j{I.� t ti t• *A�� ._ MI N[OVt .:-�'e.:lii':Lti t� -ih�'�`fk`9e1:'r."rN1' �'ur.- / J� ! �'7 t1� hira" •{ iia. - ../•.., .i, NA�f! i ADO .7r S A LOCALITY' i Y ';,•?+�'. T ••t" •� •° 1 NtA11[1T - . n�er- ti. t KAT! ,. ,. ,CONN7Y 'ri•..�.�yG,yAry ... • - ll .k�.''i��i«+... .i R[ 1 '�tsiv"Arl�,}� tNA4['. .ast ._ sif''•A.•i!_ :_ -r j LOCATION OF SEPTIc TANS.OB CEBSI'O0 Y MAIL' stai- w �., ADDR[t♦/ K f. �� 1.. w. 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'. sm IYetiailiKi4i,n:T,..L1;;,.,E,sfG.�i 7..* - '~, fwx MWAtsR OrTsdeslt i ` ��' •"+!►i>1A4id '. 41e.;ire► ;ir;' �w X011 f:11� 1fd"'���,'- �i � .�!fF�IwC^'_�'�.'s�•�C+�i'�.-�L'Sfi'�+n'+ee?�''.• •ry i�ca` pan►atii- - . c}Arre ` 'sit �• 5 }3+8t++ mac�3u�"jr�Y:twltyFr�i v�,+lZ x �,� �.lLor LINK' .;._w-•�---�noaR i,RAi>+' TINA � wRatn�.' • ;�. APPROYAL.g r iA7G k!; p+�``.:�oRINKtNA r9wu N •'�jt' 4"e ;�• >�IyRK :1w?rBrrEAT1['�ti�3 rNw[e+vw�[NAW # � 'Rl�,+.4ww'nLr'i4er�ir"lAlrfi.:J. �'.,'4+.10�'/.:�`J t i •Vi!.Mti • A'L• �� "� ATI�R MN_TfROetfTAL LAYATOR R e N - �1 e:t5. o.�! �, :a+►,e r, „a? '�. *...u �•1�►=�TiAA ... r '. < hrr.�R'rt r�.-r.�• i a.v.. .i ^- !T*.R,.��i,.�_.,,,.Q�{{1I��,�,��•`��II:.�.r..+�.tODA IOV/RAIN ' .�.. •.�:..es•..�-i r:iQr�'�!L s `"s"K' .. •, np9J.rj,'i+rraviS�MK*.rrllYlKr9. �` .. F-T'C'.W. a T i•.1.`• __ i4�J� .. J•nF� Af �n�i � ,M'�"W'ri- :.ti'a"^i:��;`e�� tt.^�s .Y.. .y r u'�TOTAL'MIIMRLR OI Ipr.VIIA+ ••'�•� ' " •{«••: .r •• ".li 4{»w..r:} -a� 'q� �t►77C TAY ��f►" ..7�r�c" '�1"!.+lML4 �."��• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1303110012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) '285-0488 EXT: (LEGAL ID: 1 FEES PAID 1 BUILDING ADDRESS: I ITR: 5904 LT: 16 BL: .001 1 1 6109 IVAR AV 1 I - IFEE-DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917801524 - I (ASSESSOR INFORMATION NUMBER: - I I NEAREST CROSS STREET: GARIBALDII 15386-010-057 .101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI 1 125 LAVATORIES/SINKS 1.00 FIX 16.20 I I (TENANT: 1 TOTAL FEES 44.00 (ISSUED ON: PROCESSED BY: PLAN BY: I 103/11/13 SR I (OWNER: TEL. NO: 1 (FINAL DATE FINA BY: CODE: 1 DUAN, YAN BIN (626) 203-8378- 1 � ` (� 6109 IVAR AV �^ ITEMP 917801524 1 IDE CRIPTION OF WORK I 11NSTALL BAR SINK ON GUEST HOUSE I 1APPLICANT: TEL. N0: (SAME AS OWNER I I I 15PECIAL CONDITIONS: I I I i I I I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I (SAME AS OWNER I LIC. NO I - (UNDER SLAB WORK I I I I I I I I I (WATER SERVICE I I I - I 'IPLASTIC Y/N METAL Y/N 1 - (ARCHITECT OR ENGINEER: TEL. NO: I IROUGH PLUMBING 1 1 LIC. NO: 1 I I I I IGAS PIPING I I IGAS VENT I I I I I - .IHOT WATER HEATER I I I I I 1 - - (PLUMBING FIXTURES I I 1 I I I I I ILAWN SPRINKLERS 1 GAS TEST I I (UTILITY COMPANY NOTIFIEDI I I (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 I I I I I I I I I I I I I I I I I I I I I (REPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I