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Home My Public Portal About10330 KEY WEST ST_Plumbing__ WORKERS',COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT Ihereby affirm that I have a certificate of consent to self 76A667A iwsure, or q certificate of Workers' Compensation Insurance, CE 817 (REV. 10/81) or a a j/c)errtti�fijed copy thereof (Sec. 3800, Lab. C.)', COUNTY OF LOS ANGELES BUILDING AND SAFETY Po cy I�o'r'� �i�'—Coni onY �D LVI�IL �uAL `L! Certified copy is hereby furnished. FOR APPLICANT 70 FILL IN(PRINT OR TYPE) BUILDING IYWI Certified copy is filed with the county building inspec- ADDRESS' -i ,,r tion department. NUMBER FIXTURE OR ITEM @ FEE') LOCALITY i, Date — .`D Applicant WATER CLOSET 00 NEAREST S C CERTIFICATE OF EXEMPTIOfSRANCE WORKERS' BATH TUB tl CROSS ST. COMPENSATION SHOWER OWNER, �' (This section need not be completed if The work involved by I the permit is for one hundred dollars $100 or less. Mna AIL P ( ) ) LAVATORY � ADDRESS `Ig&5�1 I certify that in the performance of the work for which this a permit is issued, I shall not employ any person in any manner SINK v CITY SAA(! L. NO. %1�_q(�; ` so as to become subject to the Workers'Compensation Laws. DISHWASHER DrTN >O � CONTRACTOR Date Applicant CLOTHES WASHER O ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of L . Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR p Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM 77 a CITY /°' VL q0 TEL. NO. ) V0 with comply with such provisions or this permit shall be STATELIC. deemed revoked. WATER HEATERAl 6 LICENSE NO. 8 g M CLASS & LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS66 /6 y (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER VV IJIZA and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL LIDATION /0 y G DATE License Number Lic. Class � FINA Contractor Date BY ❑ M I ammpt under Sec. B. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE -5'6 22 2 7 1.5 A SINGLE FAMILY Plan check applicant o o o o o 55 HOME OWNER-BUILDER DECLARATION Name I o - 7650 1 hereby affirm that I am exempt from the Contractor's License Address Low for the following reason (Section 7031.5, Business and o 0 - 76505 Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the Q 8 1 4-8 5 structureis 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 enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 00 y Signatur of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1011240013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1 ITR: 36735 LT: 10 I 1 10330 KEY WEST ST 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803476 1 (ASSESSOR INFORMATION NUMBER: I INEAREST CROSS STREET: HALIFAX 18585-018-074 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl 107 BATHTUBS/SHOWERS 2.00 FIX 32.50 1 1 (TENANT: 113 DISHWASHERS) 1.00 FIX 16.30 (ISSUED ON: PROCESSED BY: PLAN BY: 1 1 125 LAVATORIES/SINKS 4.00 FIX 65.10 111/24/10 SR 1 I 145 WATER CLOSET/URINAL 2.00 FIX 32.50 1 I (OWNER: TEL. NO: 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.30 IFINAL DATE FINAL BY: CODE: 1 1TRAN, WILLIAM (626) 862-1778- 1 TOTAL FEES 190.50 \��t 10330 KEY WEST ST ®L� ITEMP 917803476 1 IDESCRIPTION OF WORK 1 IPLUMBING FOR KITCHEN AND TWO BATHROOMS REMODEL I (APPLICANT: TEL. NO: 1 1 IWENDT, RON (626) 497-6320- 1 1 I I I (SPECIAL CONDITIONS: 1 I I I 1 I (CONTRACTOR: TEL. NO: 1 JAPPROVALS DATE INSPECTOR SIGNATURE IWENDT AND SONS CONSTRUCTION (626) 497-6320- I 1 16149 LOMA AVENUE LIC. NO 1 (UNDER SLAB WORK I 1 1 ITEMPLE CITY, CA 91780 432646 1 1 I I IWATER SERVICE 1 IPLASTIC Y/N METAL Y/N 1 1 (ARCHITECT OR ENGINEER: TEL. NO: I 1 1 IROUGH PLUMBING 1 LIC. NO: I I I IGAS PIPING I I I I IGAS VENT 1 I I I 1 IHOT WATER HEATER 1 I I I 1 1PLUMBING FIXTURES I I I I I 1 ILAWN SPRINKLERS I I I 1 IGAS TEST 1 I I I I I (UTILITY COMPANY NOTIFIEDI I I 1CWV I I I I I IGRAY WATER SYSTEM I I I 1 1 1 i I I I I I ~ I I I I I I I I I I I I I I IREPORT ID: DPR263 ROUTE TO: BS0508 I 1 I I 1 I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1207130002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID 1 BUILDING ADDRESS: 1 ITR: 36735 LT: 5 10300 KEY WEST ST I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 917803476 I (ASSESSOR INFORMATION NUMBER: I NEAREST;-CROSS STREET: I 18585-018-069 101 PERMIT ISSUANCE FEE 27.80 1 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY CAI 149 WATER TREATING EQUIP 1.00 SYS 16.20 (TENANT: 164 WATER PIPNG - 1 1/2 1.00 LIN 16.20 IISSUED ON: PROCESSED BY: PLAN BY: 1 193 NO PERMIT OTHER OCCP 342.20 DOL 342.20 107/1.3/12 SR 1 I TOTAL FEES 402.40 1 (OWNER: TEL. NO: I (FINAL DATE FINAL BY: CODE: 1 IQUAN SHIRLEY G;QUAN CHARLENE J 1 I I _ 110300 KEY WEST ST ITEMP 917803476 I IDESCP. TION OF WORK 1 (INSTALL WATER CONDITIONER I (APPLICANT: TEL. NO: ISAME AS OWNER - I I I (SPECIAL CONDITIONS: 1 I I I I CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE (SAME AS OWNER I1 I LIC. NO 1UNDER SLAB WORK I I I I I I IWATER SERVICE I IPLASTIC Y/N METAL Y/N I I I (ARCHITECT OR ENGINEER: TEL. NO: - I IROUGH PLUMBING LIC. N0: I I I IGAS PIPING I I I IGAS VENT 1 I IHOT WATER HEATER I I I IPLUM3ING FIXTURES I I I I I ILAWN SPRINKLERS I I I I IGAS TEST I I I I _- 1 (UTILITY COMPANY NOTIFIEDI I I ICWV, 1 f I I I I I I IGRAY 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 II I I I f I I I I 1 IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I I I