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Home My Public Portal About10435 LA ROSA DR_Plumbing__ DEC TION WORKERS't I have a certificate cafe of corse APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76Abb7A insure, or a certificate of Workers" Compensation Insurance, CE 817(REV. 10/81) cy Nti ied co y thereof o c. 3800,' C�) COUNTY OF LOS ANGELES BUILDING AND SAFETY 04P.01.,V 0��75f 9 4i L/ftll ❑ Certified copy is hereby furnished. ��// t! �� FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ©." Certified copy is filed with the county building Tnspec- ADDRESS tion deportment. NUMBER FIXTURE OR ITEM C7rt FEE �y LOCALITY L ^�q a Date 1yApplicant WATER CLOSET 0V NEAREST CERTIFICATE OF EXEMPTI FROM WORKERS' BATH TUB �W OO CROSS ST. COMPENSATC, SU RANCE OWNER (This section need not be com ted if the work involved by SHOWER UMO i97 (/r" the permit is for one hundred dollars ($100)or less.) LAVATORY W MAIL .` ADDRESS A/ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITYn TEL. NO. so as to become subject to the Workers Compensation Laws. DISHWASHER '/ CONTRACTOR Date Applicant CLOTHES WASHER : ADDRESSt N NOTICE TO APPLICANT: If, after making this Certificate of G Exemption, you should become subject to the Workers" SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY "� TEL. NO. LAWN SPRINKLER SYSTEM 464 049A&Z, with comply with such provisions or this permit shall be STATE3 f Q CLA55 deemed revoked. WATER HEATER LICENSE NO. 7 LICENSED CONTRACTORS DECLARATION 1115TRICT NO. PR ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER © } and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL d Co DATE l-- - VALIDATION u License Number w Lic Class G3� K FINf, p Contractor Date �7^O� BY AL S V ❑ W o xempt under Sec w 8Z .8 C. for this reason Date: Plan Check fee ► PLUMBING PERMIT ISSUING FEE$ O Signature TOTAL FEEwa Plan check applicant SINGLE FAMILY '2801 A HOME OWNER-BUILDER DECLARATION Name }`f o o e e e 5 I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, .Business and [ o e'9 b 2 5 Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the - 0 0 916 2 5 structure is not intended or offered for sale (Section 7044, Business and Professions Code). 06 15-83 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 Stole laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- boned pro y f rinspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si tore of Permute Date t COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0106220001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL S PAID BUILDING ADDRESS: TR: 37580 LT: 11 10435 LA ROSA DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803481 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ARDEN 8585-018-052 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY 25 LAVATORIES/SINKS 2.00 FIX 32.40 TENANT: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 ISSUED ON: PROCE SED B : PLAN BY: EXPIRES ON: TOTAL FEES 76.35 06/22/01 JK 12/19/01 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: WONG; SALLY (626) 229-2993- ( 10435 LA ROSA DR 2-0 _Z TEMP 917803481 DESCRIPTION OF WORK PLUMBING FOR CONVERSION APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: - APPROVALS DATE INSP CTOR SIGNATURE SAME AS OWNER LIC. NO UNDER SLAB WORK N 4� ' WATER SERVICE r ' PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: 1 ROUGH PLUMBING '-IT LIC. NO: AS PIPING u GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED - cuv 'e,vic^ - - GRAY WATER SYS REPORT ID: DPR263 ROUTE TO: SS0508