HomeMy Public PortalAbout10455 LA ROSA DR_Plumbing__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0612050011
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 37579 LT: 10 - 10455 LA ROSA DR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803481
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: KEY WEST
8585-018-031 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, C
47 WATER HEATER(S) 1.00 WTH 16.20
TENANT: - TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
12/05/06 JK 06/03/07
OWNER: TEL. NO: - PI AL DATE FINAL BY: CODE:
CARLOB G;SOCORRO R (626 442-3489-
10455 L �-
10455 LA ROSH DR ///��� t/OY�
TEMP 917803481 DESCRIPTION OF WORK
WATER HEATER CHANGE OUT
APPLICANT: TEL. NO:
TEKAWA (310) 515-1311-
17111 S. BROADWAY SPECIAL CONDITIONS:
GARDANA, CA 90248
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
ACTION CONTRACTORS, INC. (310) 515-1311-
17111 S BROADWAY LIC. NO UNDER SLAB WORK
GARDENA CA 91775 652535C36
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
- ROUGHPLUMBING
LIC. NO:
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
CWV
GRAY WATER SYSTEM
W,
REPORT ID: DPR263 ROUTE TO: BS050B
WORKERShat I have a certificate of
CE
APPLICATION FOR PLUMBING PERMIT
1 hereby affirm that 1 have a' certificate of consent to sett ce srr (z-eol
insure, or a certificate of Workers'Compensation Insurance,or
a certifiedco Y thereof(Sec. 3800, Lab.C.) �• C/
70/Z —0w 0Sisf9 COUNTY OF LOS ANGELES BUILDING S TV
-Ptolol�icy No. Company
I/N Certified copy is hereby,furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
ADDRESS
I hV Certified copy is filed with the count burl in a ion NUMBER FIXTURE OR ITEM • FEE
LOCALITY
department. '�••r
Date.�.� Applicant WATER CLOSET GV NEAREST /-
BATHTUB J 00 CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER S-p OWNER .
MAIL
LAVATORY /
(This section need not be completed if the work involved ADDRESS T
by the permit is for one hundred dollars (SIBB) or less.) SINK3
G'O CITY ELN 1
O
I certify that in the performance of the work for which this DISHWASHER - U
permit is issued, 1 shall not employ any person in any manner CONTRACTOR Ai<
so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ?yV�� 2
ADDRESS Q !'' I O
Date Applicant SWIMMING POOL RECEPTOR (~j
NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NCS_ .7 W
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE , LIC. N
Compensation provisions of the Labor Code, you must forth- LICENSE NO.37S70-0 CLASS C Z
with comply with such provisions or this permit shall be WATER HEATER P•(,
deemed revoked. GAS SYSTEM OUTLETS DISTRICT
(/NO. PRO �'
SSED B
LICENSED CONTRACTORS DECLARATION OUTLETS OVER �rda
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL // y VALIDATION
ness and Professions Code, and my license is in full force and DATE ( � ^ZL—�(
effect.
FINAL
License Number Lic.Class _ BY
- •�
Contractor Date !f=/5-
D
f/5-❑ 1 am exempt f in the licensing requirements as I am a Plan Check fee r /�
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ &0
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE Q v
Lie.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION' Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section.7031.5, Busi- City Tel.No. .rj O Q O A
ness and Professions Code):
1, as owner of the property, am exclusively_contracting # o o a e 05
with licensed contractors to construct the project
(Section 7044, Business and Professions Code). 2 0 - 4 (100
CONSTRUCTION LENDING AGENCY
0 0 - 40,005
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is 04,28-81
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
au rice Fpresen[atives of County to enter upon the
ov -me ho operty i pectin purposes.
/5
Signature of Permittee Date