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Home My Public Portal About6263 IVAR AVE_Plumbing__ WORKER'S COMPENSATION DECLARATION 76A667ADPW 9f89 QPIf'L��CA��®N FOR PLUMpBNG PERMT I hereby affirm that I•have a certificate of consent to self`insure, �I PLUMBNG u�u or a certificate of Worker's.Compensation Insurance, or a certified copy ther.00f(Sec.3800 Lab..C.) -- COUNTY:OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV.' Policy No. Company ❑ Certified copy is hereby furnished.- BUILDING ( FOR APPLICANT TO FILL IN(PRINT.OR TYPE) ADDRESS RU�. ❑ Certified copy is filed with the county building inspection ' department. _ NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant , WATER CLOSET' NEAREST j O CROSS ST. L CERTIFICATE OF,EXEMPTION FROM WORKERS' f BATH TUB COMPENSATION INSURANCE I ASSESSOR (This section.need not,be completed if the work involved by the / SHOWER MAP BOOK PAGE 9/0 PARCEL permit is for one hundred,dollars hollars($100)or less.) 1 LAVATORY OWNER A/D I certify that in the performance of the work for which this permit � J � is issued, I shall not employ any person in any manner so as to SINK MAIL ADDRESS become subject to the Workers' Compensation Laws. _' DISWASHER CITY -,fit c- TEL.NO.-44-1((A 4 s1 J /r 3 Date Applicant ' CLOTHES WASHER I crr O v 1� NOTICE TO APPLICANT:"If; after making tFiis Certificate of CONTRACTOR Exemption,you should become subject to the Workers'.Compensation SWIMMING POOL RECEPTOR I �v provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall.be deemed revoked. _ LAWN SPRINKLER SYSTEM I LICENSED CONTRACTORS DECLARATION. CITY TEL.NO. >' I hereby affirm that I am licensed under provisions of Chapter 9 i WATER HEATER O (commencing with Section 7000 of Division 3 of the Business and STATE LIC. i ( 9 ) I LICENSE NO. CLASS '-Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS V OUTLETS OVER DISTRICT NO. ROCESSED BY 5 PER SYSTEM i Of O FINAL 0 I- License Number Lic.Classas�e { DATE �Z VALIDATION Wd Contractor Date fA T1 am exempt under Sec. By Z B.&P.C.for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ - =- Signature k , - ❑ TOTAL FEE Plan check applicant1=U!AL SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name '�;h ,..C." I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address - :,�;•.tt;=�µ Code City Tel.No. 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). CONSTRUCTION LENDING AGENCY I 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.) 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 representatives of this County to nter upon the a ove-m ntioned propert ,inspect' n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 1/ Ignatur of Permi a Dat 1. r� COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0303120014 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 29 UN: .002 6263 IVAR AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801526 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5386-010-029 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY 47 WATER HEATER(S) 1.00 WTH 16.20 1 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 03/12/03 JK 09/08/03 OWNER: TEL. NO: F NAL. E FIN BY: CODE: SU;LI SHAN (626) 286-2544- 6263 I VAR AVE TEMPLE CITY 91780 DESCRIPTION OF WORK C/O WATER HEATER APPLICANT: TEL. NO: MARAVILLA FOUNDATION (213) 721-8883- 5729 E UNION PACIFIC SPECIAL CONDITIONS: COMMERCE 90022 CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE MARAVILLA FOUNDATION (323) 721-8883- 5729 UNION PACIFIC LIC. NO UNDER SLAB WORK COMMERCE, CA 90022 622969 C20 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: - ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT i HOT WATER HEATER t PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED I CWV GRAY WATER SYSTEM REPORT ID: OPR263 ROUTE TO: BS0508 • COUT77Y OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1310280028 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID BUILDING ADDRESS: I ITR: 5904 LT: 29 UN: .002r'4 I 6263 IVAR AV 1 _IEEE DESCRIP.;TION4 —' ? QUANTITY: UOM:• AMOUNT: ( TEMP CA 917801526 (ASSESSOR INFORMATION NUMBER: x ' '".-J-1 NEAREST CROSS STREET: LONGDEN 15386-010-029 101 PERMIT ISSUPNCE`FEE:�a -,27•.8,0 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI I 107 BATHTUBS/SHOWERS l,tl t a 1.00 FIX 16.20' TENANT: 125 LAVATORIES ISINKS,,tt�'"A 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: 145 WATER CLOSET/URINFi"•'-,i. 1.00 FIX 16.20 110/28/13 SR 151 LOW PRS GAS 5 OUTLET.__ ��' 1.00 SYS 16.20 1 OWNER: TEL. NO: I t TOTAL FEES 92.60 IFINAL DP-7 FIN BY: CODE: ISU ANDREW W;LI SHAN L TRS (626) 286-2544- 1 .1 16263 IVAR AVENUE I TEMP 917800525 1 IDESCRIPT ON OF WORK I (1) TUB, (1) WATER CLOSET, (1) LAVATORIE AND GAS LINE I (APPLICANT: TEL. NO: I I I ICORREA, MANNY (626) 786-2347- I 1 12509 EUCLID CREST E I ISPECIAL CONDITIONS: I (UPLAND CA 91784 I I 1 I I I I (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I IB X D CONSTRUCTION (626) 786-2347- I I 1 12509 EUCLID CRES E LIC. NO I FUNDER SLAB WORK (UPLAND CA 91784 627142 1 1 I 1 I IWATER SERVICE 1 IPLASTIC YIN METAL YIN I 1 (ARCHITECT OR ENGINEER: TEL. NO: i I I I IROUGH PLUMBING I 1 LIC. NO: IGAS PIPING I I 1 I I I _I IGAS VENT I I I I I I I IHOT WATER HEATER I I I I I IPLUMBING FIXTURES i I I ILAWN SPRINKLERS I I I ' IGAS TEST I_' I (UTILITY COMPANY NOTIFIEDI I I 1CWV I I t• 1GRAY WATER SYSTEM I I I I I I I I I I I I I I t (REPORT ID: DPR263 ROUTE TO: BS0508 1 i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMI 'DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL-0508-0003020 012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING-ADDRESS: TR: 5904 LT: 29 UN: .002 6263 IVAR AV .) FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: T-EMP-CA7917801526 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5386-010-029 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: 13 DISHWASHER(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 25 LAVATORIES/SINKS 3.00 FIX 48.60 03/02/00 UT 08/29/00 45 WATER CLOSET/URINAL 1.00 FIX 16.20 OWNER: TEL. NO: 47 WATER HEATER(S) 1.00 WTH 16.20 FINAL DATE FINAL BY: SU ANDREW W;LI SHAN L TRS (626) 286-2544- 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 �p,�� _ 6263 IVAR TOTAL FEES 157.35 V TEMP 917800525 DESCRIPTION OF WORK PLUMBING FOR ADDITION AND REMODELING APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: � ELQ1 C® CONTRACTOR: TEL. NO: � �� APPROVALS DATE INSP TOR SIGNA SAME AOWNER TU LIC. NO UNDER SLAB WORK pS WATER SERVICE ((JJ PLASTIC Y/N METAL Y/N � ARCHITECT OR ENGINEER: TEL. N0: \ ROUGH PLUMBING LIC. N0: _ 1771111 GAS PIPING VENT u � 1 I \1!!111/ � i��11�3HOT WATER HEATER L�LLLIII V V l PLUMBING FIXTURES Iyy,iPn, LAWN SPRINKLERS O 0 ?; r� ' 1�;�� GAS TEST nu �'�U ✓ E� UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508 o. 0. 17 . a*a APPLICATION FOR PERMIT DEPART11ENT OF BUILDING AND SAFETY PLUMB y�,4� M1;' COUNTY OF IAS ANGELES 1!� WM. J. FOX CHIEF ENGINEER NATURE,OF INSTALLATION / DISTRICT NO.. GROUP ZONE PERMIT No. +. ROUGH / FIXTURESCOMPL6TR 7 YLUMBIN6 READY FOR RECEIVED BY OATQ 168UED HEATER CESSPOOL SEPTIC TANK FIRST INGPECTION GAB —7 MISCELLANEOUS Jr� 3 APPJ.ICANT FILL IN HEAVILY OUTLI ED OR ON ONLY Joe r 1� NAM �✓ l ADORQIIQ n '� LOCALITY R Aa'ui.SbS V T y ^' r I+CAR G" TL I , l� CROSS ST. [ COUNTY REG. N YV EXPIRESIt NAM[V U �`'� \ LOCATION OF SEPTIC TANK, OR CESSPOOL ; MAILS NORTH O ADDRES CITY TEL No. - CORRECTIONS 4 w , ni la < z LA i I 0 ` IIOUTH DESCRIPTION OF YORK .TM Tun FURNACE T no ..._ __DIIIHWASHER. APPROVALS j LAVATORY REFRIGERATOR DATA INO cTOR n AAWQ KITCHEm SINK WATER SOFTENER ROUGH PLUM BINO LOOR SINK QANO TRAP .. �ULt•'..r�' ? GA8 PIPINm� '-s V'r�^r'• �� _—SLOP"Sim —FLOOR DRAIN GAII-VENT' WASH TRAY URINAL CESSPOOL (' " WATER CLOSET DRINKING FOUNTAIN SEPYIC TANK WATER NEATER DENTAL: LAVATORY . SEWER ' IETtR-16 GAB SODA FOUNTAINOUrL UTILITY CO. NOTIFIED FINAL A 1 AM THE LIZOAL OWNER OP H� L 1ANOML D COUNTY, RQOIIITRATION.NVM8 TOTAL NUMBER OF FIXTURE r QPTIC TANK .GPSSPOOL 1 AM THB LKOAL OWNER OP Q PROPMRY'1dDR'IItA166D Aeova :> t a, kw o. 8. 17 4.30 :!M APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY � TA 141 !1`� cr�YA T� :�. COUNTY OF LOS ANGELES PL11.1 WM. J. FOX CHIEF CNGINEER NATURE OF INSTALLATION DISTRICT NO, GROUP ZONE PERMIT NO. ROUG11 TPG ( PLUMBING FIXTt1RE9 COMPLETE READY FOR RECEIVED BY ATQ ISSUED HEATER CE86POOL I 1_75EPTIC TANK FIROT INSPECTION •F �' GAB MISCELLANEOUS COC p �`� O APPLICANT FILL IN HEAVILY.OUTLINED PORTION ONLY ADORE /1f �iX�►r NAME r - �. BS ' C ADURE69 1� Ga LOCALITY 1,4 NEAREST CITY O/� /J TEL NO. CROSS ST. 6- COUNTY REG. NOw EXPIRES y NAME LOCATION OF SEPTIC TANK; OR CESSPOOL ; MAIL E69 N.^.RTH 13 CITY 'f�__.•� TEl No. l CORRECTIONS I . �F9 J z SOUTH — - DESCRIPTION OF WORK SATN Tun FURNACE MOWER DISHWASHER APPROVALS - _ LAVATORY REFRIGERATOR DATE_ mopecroa•n tANQ KITCHEN SINK WATER SOFTENER ROUGH PLUMBING _FLOOR OINK SAND TRAP_ GAS PIPIN01 " SLOP OINK FLOOR DRAIN "' • - GAS VENT WASH TRAY _ URINAL C289POOL WATER CLOSET —DRINKING FGU:7AIN 'SEPTIC TANK V, - WATER HEATER DENTAL LAVATORY I SQW2R " METER GAS 5ODA'FOUNTA:N OUTL UTILtTYGO. NOTIFIED f' _ M FINAL . ,I+ysII 1 AM THE LEGAL OWNER OF THE Ab LOO ANGELES COUNTY REGI BTR T 018•'P/UM6EIj. TOTAL NUMBER OF FIXTURES �� SEPTIC TANK �y��7'�-tea.=.i.tp•'•' ..IMd•rA7H•ro' ..t `.' - � / PLUNGER _, J •; 1 AM THE LEGAL OWNEiF•OP THQ PROPERTY DEOCRIDED ' ABOVE.„ �S TOTAL' FEE ?..: .. i oMM¢R