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Home My Public Portal About10305 LA ROSA DR_Plumbing__ WORKERS' that, COMPENSATION DECLARATION dose APPLICATION FOR PLUMBING PERMIT I hereby affirm that,I hove a certif icote•of consent to,self 20-0026 DPW 6/67 iosure,lcr .-certificate of Aorkers' Compensation Insurance, 76A667A IT .or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. F-1Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS /0305 LA ROSA V9OGE C/TY GA tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST ' CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed i1 the work involved by MAIL - the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. . so as to become subject to the Workers'Compensation Laws, DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT,NO. PROCESS I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS G'� (commencing with Section 7000) of Division 3 of the Business n OUTLETS OVER . and Professions Code, and my license is in full farce and effecT. 5 PER SYSTEM FINAL ALIDATION 0: DATE Q License Number Lic. Class U. FINAL Contractor Date BY �Q�--; ❑ I am exempt under Sec. WQ 8.8P.C. for this reason Plan check fee co► to Z Date: PLUMBING PERMIT ISSUING FEE$ 50 Signature TOTAL FEE SINGLE FAMILY Plan check applicant 3307 16.50 _ HOME OWNER-BUILDER DECLARATION Name 1 ITEMS I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address TOTAL i.6 xx 10 P fe ons Code): City Tel. No. as owner of the property, will do the work and the CHECK 1175._c_l d structure is not intended or offered for sole (Section , CHANGE .OEI 7044;Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is o construction lending agency for I13OW-0001 1229/39 the performance of'the work for which this permit is issued (Sec. 3097, Ci, C.). 7881 1 AM 11:`3 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. ��7SEE REVERSE FOR EXPLANATORY LANGUAGE 12-ze -89 Signatu a of Permi ee Date WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81)' r o ce tified coy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY tC -oc-c o. �Sf 99�i Ltl CRS 1 �cy Company Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspec- ADDRESS tion deP artment. NUMBER FIXTURE OR ITEM C FEE LOCALITY G Date logy- Applicant WATER CLOSET �(J NEAREST CERTIFICATE OF EXEMPTIO OM WORKERS' BATH TUB 00 CROSS ST. RQ COMPENSATION I RANCE OWNER (This section need not be comple d if the work involved by SHOWER O the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS MAIL � (( 1(J I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK D CONTRACTOR CITY ` TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Q / Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL. NO. _ Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM )ILvd2tax with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. JReCLASS LICENSED CONTRACTORS DECLARATION 00 DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 / GAS SYSTEM OUTLETS O i (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER Y and Professions Code, and my license is in full force and effect, 1 5 PER SYSTEM FINAL DATE C��3D VALIDATION u License Number Li, Class ®.7 09 FINAL I„ O Contractor Date By V W ❑ d I a xempt under Sec. w B. C. for this reason Plan check fee ► Z Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY r HOME OWNER-BUILDER DECLARATION Name G 7 9, 1 A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address c o 0 0 o rj Professions Code): City Tel. No. o 0 9(5 2 S ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section , - 96255 7044, Business and Professions Cade). () 15-83 Jr_ 3 CONSTRUCTION LENDING AGENCY 1 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 propert for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE AS J_ (oily-�3 Sig ure of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS " PL 0508 0203050015 _ BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 - PHONE: (626) 285-0488 EXT: - - LEGAL D:. - _ S PAIADDRESS: - TR: 37580 LT: 1 - 10305 LA ROSA DR FEE DESCRIPTION: QUANTITY: LION: AMOUNT: TEMP CA 917803402 - ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ARDEN 8585-018-041 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY 47 WATER HEATER(S) 1.00 WIN 16.20 T TOTAL FEES 43.95 ISSUEDPROCESSED N BY: EXPIRES ON: 03/05/02 JK 09/01/02 X1�,/ OWNER: TEL. NO: . FINAL DATE E /^I ED: CODE: - - MIKE WANG (626) 279-6789- 1 10305 LA ROSA DR " TEMP 917803402 -DE-sc-FITTROV OF WORK C/O WATER HEATER APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: P�1GELES CO CONTRACTOR: TEL. NO: OS U�T APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - V Y LIC. NO UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: - - ROUGH PLUMBING LIC. NO: lull ll GAS PIPING i ELM _ _ _OR) R K 3 GAS VENT HOT AER HEATER PLUMBING FIXTURES S ! LAWN SPRINKLERS O 0 GAS TEST UTILITY C P I IED cwv Service Tha GRAY WATER SYSTEM - REPORT ID: DPR263 ROUTE T0: 13S0508 " COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0504070012 BUILDING AND SAFETY / LAND DEVELOPMENT TETMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: Fz;g jD FEES PAID BUILDING TR: 37580 LT: 1 10305 LA ROSA DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803402 ASTE SOR 1M509A710N NLTM NEAREST CROSS STREET: ARDEN 8505-018-041 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: 34 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 _ TERM 25 LAVATORIES/SINKS 2.00 FIX 32.40 ISSUE ON: PROCESSED BY: PLAN BEXPIRES . TOTAL FEES 76.35 04/07/05 JK 10/04/05 OWNER: TEL. N0: FINAL DATE FINAL BY: CODE: NOYES, JOSEPH (626) 443-4023- i� Jam- ' 10305 LA ROSA DR C7� /� TEMP 917803402 DESCR �YiT -bF�WORK PLUMBING FOR BATHROOM REMODEL APPLICANT: TEL. NO: BUCCOLA (626) 287-1131- 8812 LAS TUNAS DR SPECIAL CONDITIONS: SAN GABRIEL CA 91776 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE L & W KITCHEN & BATHS (626) 287-1131- _ 8812 LAS TUNAS DR. LIC. NO UNDER SLAB WORK SAN GABRIEL, CA 91776 2053448 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENG NEER: TEL. NO: 907PLUMBING LIC. N0: S _ GAS VENT HOT TER HEATER PLUMBING f X - LAWN S NK S GAS E UTILITY NY NOTIFfTD CWV GRAY E SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508