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Home My Public Portal About9231 LA ROSA DR_Plumbing__ C WORKERS`COMPENSATION DECLARATION 76A667A I hereby affirm that I have a' certificate of consent to self CE e17 (2-80) APPLICATION FOR. PLUMBING PERMIT. {� insure, or a certificate of Workers'Compensation Insurance,or I J a certified copy thereof(Sec. 3800,Lab.C.) L . COUNTY OF LOS ANGELES BUILDING AND SAFETY , Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING /J ' ADDRESS '/moi Q�/q•' , Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE department. WATER CLOSET LOCALITY Date Applicant NEAREST ' BATH TUB CROSS ST. /`ATVJ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER, cGiT LAVATORYMAIL >_(This section need not be completed if the work. involved ADDRESS a0 by the permit is for one hundred dollars ($100) or less.) SINK CITY -�— e"TEL.NC)—�' U I certify that in the,performance of the,,work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR 0 so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS U Date ApplicantUJI SWIMMING POOL RECEPTOR a NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. to Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. z Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLASS with comply with such' provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PRO SSED BY LICENSED CONTRACTORS DECLARATIONS OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Bust- FINAL VALIDATION ness and Professions Code, and my license is in full force and DATE / effect. FINAL `• License Number Lic.Class BY Contractor Date F1I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code)., TOTAL FEE Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address 2.4`7'6 2,A License Law for the following reason (Section 7031.5, Busi- City Tel.No. # o 0 o o 0 5. ,neesss and Professions Code): IIJQ I, "as owner of the property, am exclusively contracting 2 01-12510 with licensed contractors to construct the project v (Section 7044, Business and Professions Code). •0 0 0 1.2 5 0�H, CONSTRUCTION LENDING AGENCY 0 7s 0 27 8.2. 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 ameLender'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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize repr entatives of this County to enter upon the above-m ti dpr ort or inspection purposes. ' S• nature of FerMittee Date 7SASS7 DBS 17 11-SO APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY �' COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NEI. PLUMBER! Bim„-�,-.�,Q, OR -3 C CEIVED Sly READY FOR DATE ISSUED FIRST INSPECTION — ADORES. BUILDING CITY �L TEL N • ADDRESS �� / Couarr / LICENSE LOCALITY NO. / ® EXPIRES �� ', NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWN MAIL Q f� WATER CLOSET(TOILET) 0.50 s ADDRESS BATH TUB @ 0.50 CITY TEL. SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK Q 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT I POB13EBS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELEB COUNTY LICENSE. OR I AM THE LEGAL OWNER GAS SYSTEM_�OUTLETB 0.50 OF THE RESIDE L P R�IBR,E%D ABO SIGNATURE OFC- WATER F WATER HEATER 0.50 PERMITTEE SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER ® 0.50 DRINKING FOUNTAIN Q 0.50 URINAL @ 0.50 .J Q HOUSE BEWER @ O.SO _Z MIS LANEOU _O O r APPROVALS DATE INSPECTORS NAME .ROUGH PLUMBING �I •OAS PIPING OAS VENT Y CESSPOOL @ 1:00 CESSPOOL SEPTIC TANK: •SEPTIC TANK DRAIN ) PIT ) 1.00 SEWER PERMIT . . . I 1.0o GAS TEST_ UTILITY CO.NOTIFIED A TOTAL FEE s►V FINAL Z WORKERS' I have aSATION te'of R nsen't i20-0026 APPLICATION FOR PLUMBING PERMIT I`,hereby, affirm that have a certificate'of consent to self in- 76A667ADPW 4/87 sure,ora certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified copy thereof (Sec. 3800, Lab. C.) n4�,, COUNTY OF LOS ANGELES DEPT. OF PUB11C WORKS Polic No. fA Company �atiU. `y Certified copy is hereby furnished. (� FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS NUMBER FIXTURE OR ITEM LOCALITY department. �'j' @ FEE C?T A Ilton c WATER CLOSET(TOILET) Date PF ' NEAREST. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB. 4 CROSS ST. COMPENSATION INSURANCE SHOWER OWNER C1RV (This section need not be completed if the work involved by MAIL the permit is for one.hundred,dollars (;100) or less.) I LAVATORY ADDRESS 'Z I certify that in the performance of the work'for which this per- SINK ' CITY TEL. NO. mit is issued, I'sholl not employ any person in any manner so as to become subject to the Workompens-fiLcrws. t DISHWASHER Q CONTRACTOR r Datey^ -�v Applicants—A CLOTHES WASHER C ADDRESS 'SLA.t.J NOTICE.TO APPLICANT: If, after making this Certificate of Ex- � SWIMMING POOL RECEPTOR emptian; you should become subject.to the Workers'Compen.- CITYC TEL. NO4ktZ'L'Z/.4 sation provisions of the Labor Code, you must forthwith comp LAWN SPRINKLER SYSTEM ly,with such provisions.oi this permit shall be deemed revok- STATE ` UC. ed. t WATER HEATER LICENSE NO. q3\ O4�( CLASS' LICENSED CONTRACTORS DECLARATION, DISTRICT NO. CESSED BY I hereby affirm that I am Licensed under provisions of Chapter GAS SYSTEM OUTLETS t 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in'full force-and ef- 5 PER SYSTEM FINAL VALIDATION ?' fect. 2 DATE License Number 7�®� Lic. Classt O �p �1 FINAL Q Contractor ��—S�1�T�ate v BY O �. 1 am exempt under Sec. LLI B.&P'C. forthis reason , Plan check fee � D PLUMBING PERMIT ISSUING FEE$ Signature L'�• TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION PP I hereby affirm that I am exempt from,the Contractor's License Name Law for the following reason (Section 7031.51 Business and Professions Code): Address ❑ h as owner of the property, will do'the work' and the City Tel. No. structure is not intended or offered for sale(Section 7044, ;2 0'4 4 8 A . Business and Professions-Code): o ®'o o'o CONSTRUCTION LENDING AGENCY ► ° °,� 5.'� I hereby affirm that there is a construction lending agency for ! o a0 3 5 0 0 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). 0 8. 1 8-8 Lender's Name Lender's Address I certify that 1.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 , -mentioned p opertr for inspection purposes. � �- -`"1 ��'j SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur aee of Permittee Date -� COU$TY OF LQS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT PEPA5 RTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 050060014 ' BUILDING AND'SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) ,285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ' TR: 16475 LT: 104 9231 LA ROSA DR FEE DESCRIPTION: QUANTITY:- UOM: AMOUNT: TEMP CA 917803732 ASSESSOR INFORMATION NUMBER: - NEAREST CROSS STREET: FRATUS 8590-010-004 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: JS LOCALITY: TEMPLE CITY 13 DISHWASHER(S) 1.00 FIX 16.20 TENANT:. - j' 25 LAVATORIES/SINKS 2.00 FIX 32.40 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 60 DWV REPAIR OR ALTER 2.00 SYS 32.40 05/06/05 JK 11/02/05 _ TOTAL FEES 108.75 OWNER. TEL. NO: FINAL DATE FINAL BY: CODE: MAGALLANES, ALBERT (626) 285-9345- 9231 LA ROSA DR TEMP 917803732 DESCRIPTION OF WORK PLUMBING FOR KITCHEN REMODEL APPLICANT: TEL. NO: - - - SAME AS OWNER - - -• SPECIAL CONDITIONS: CONTRACTOR: TEL.'NO: APPROVALSDATE INSPECTOR SIGNATURE SAME AS OWNER LIC: NO UNDER SLAB WORK WATER SERVICE PLASTIC YIN METAL YIN ARCHITECT OR ENGINEER: TEL. NO: - BREIG ARCHI-TELT (626) 257-8537- ROUGH PLUMBING � 431 CHERRY DR. LIC. NO: _ - PASADENA CA 91105 - - NONE .4 GAS PIPING GAS VENT .r HOT WATER HEATER y PLUMBING FIXTURES n LAWN SPRINKLERS GAS 'TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE T0: BS0508 COUNTY OF LDS ANGELES - TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0506240016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 16475 LT: 104 9231 LA ROSA DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803732 ASSESSOR INFORMATION NUMBER. NEAREST CROSS STREET: FRATUS 8590-010-004 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY. PLAN BY. EXPIRES ON: 06/24/05 JK 12/21/05 OWNER: TEL. NO: FINAL DATE FINA BY: CODE: MAGALLANES, ALBERT/LORI (626) 285-9345- p'� l(/ 9231 LA ROSA DR TEMP 917803732 DESCRIPTION OF WORK GAS LINE FOR AIR CONDITIONING AND HEATING SYSTEM APPLICANT: TEL. NO: SAME AS OWNER - - , SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER _ - LIC. NO UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: BREIG ARCHITECT (626) 257-8537- ROUGH PLUMBING 431 CHERRY DR. LIC. NO: PASADENA CA 91105 NONE GAS PIPING GAS VENT HOT WATER HEATER, PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508