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Home My Public Portal About9650 LA ROSA DR_Plumbing__ WORKERS' °MPE"3qT'°" DECLARATION APPLICATION FOR PLUMBING PERMIT {� ,I her^'affirm that I have a certificate of consent to self 76A667A u insure, or o certificate of Workers' Compensation Insurance, CE 817 (REV. 10/8)) or a certified copy thereof (Sec. 3800, Lob. C. \ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N 6 37 Compon /0/0 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING cea 9—Certified copy is filed with the county building inspec- ADDRESS / Iron deportment NUMBER FIXTURE OR ITEM Q FEE _ LOCALITY Date.Applicant WATER CLOSET NEAREST •—�' n CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. COMPENSATION INSURANCE El—SHOWER OWNER (This.sectiori need not be completed if the work Involved by MAIL the permit is for one hundred dollars ($100)or lees.) LAVATORY ADDRESS I certify that in the performance of the work for which this )) permit is issued, I shall riot employ any person in any manner SINK CIT TEL. NO. so as to bec a ubject to the Workers'Compensation Laws, DISHWASHER CONTRACTOR T>✓ ,�•d.n. Date D Applicant CLOTHES WASHER ADDRESS 77 NOTICE TO APP (CANT: If, after making this Certificate of d Ue Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR y, CITYTEL .-'��j.d Compensation provisions of the Labor Code, you must forth- v . NOl. ZI with comply with Such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE �^s LIC. Q deemed revoked. WATER HEATER LICENSE NO. 74B CLASS 4 d� LICENSED CONTRACTORS DECLARATION DISTRICT NO.— PROCESSED BY I hereby affirm thot I am licensed under provisions of Chapter 9 / GAS SYSTEM OUTLETS O (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER c and Professions Code,and myyl�license is in full force and effect. 5 PER SYSTEM FINAI _ VALIDATION }' License Number dOV Lic. Class `��U DAT F�J 0 1% J r FI U. Contractor�i LDate W Elam exempt under Sec. OF B.BP.C. for this reason ► W Plan check fee ELI Date:— En PLUMBING PERMIT ISSUING FEE$ Z Signature TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address Professions Code) City Tel. No. 1'S. 5l ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section __ 7044, Business and Professions Code). , 116 m 50 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 A" ae'i,<-, 1 certify that I have read this application and state that the above information is correct. 1 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 Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY N 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0511090039 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91980 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 14467 LT: 76 9650 LA ROSA DR FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917803860 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: TEMPLE CITY 6589-017-024 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: 13 DISHWASHER(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 21 HOSE BIBB(S) 2.00 FIX 32.40 11/10/05 JK 05/09/06 25 LAVATORIES/SINKS 2.00 FIX 32.40 OWNER: - TEL. NO: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 FINAL DATE FINAL BY: CODE: HEASLIP SCOT W;OLACHEA-HEASLIP ROSE )626) 286-3922- 47 WATER HEATER(S) 1.00 WTH 16.209650 TEMP LA ROSA DR 51 LOW PRS GAS 5 OUTLET 1.00 TOTAL FEES SYS 16.20 173.55 DESCRIPTION OF WORK PLUMBING FOR ADDITION AND REMODEL APPLICANT: TEL. NO: HEASLIP (626) 286-3922- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE TOM O•LEARY CONSTRUCTION (626) 287-0927- 5823 AGNES AVENUE LIC. NO UNDER SLAB WORK TEMPLE CITY, CA 91780 489354 B-1 WATER SERVICE ' PLASTIC YIN METAL YIN ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED Cw GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BSOSOB w COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0105090028 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILDING ADDRESS: TR: 14467 LT: 76 9650 LA ROSA DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803860 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: TEMPLE CITY 8589-017.024 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY 47 WATER HEATER(S) 1.00 WTH 16.20 TENANT: TOTAL FEES 43-95 ISSUED ON: PROCESSED : PLAN Y: EXPIRES ON: 05/09/01 UT 11/05/01 OWNER: TEL. NO: FINAL D(�T F CODE: HEASLIP SCOT W;OLACHEA-HEASLIP ROSE (626) 286-3922- Sf4 0 I SI 9650 LA ROSA DR TEMP 917803860 DESCRI TION OF WORK INSTALL A NEW WATER HEATER APPLICANT: L. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: SAME AS OWNER APPROVALS DATE INSPECTOR SI GNATU E - LIC- NO UNDER SLAB WORK / 5 WATER SERVICE ARCHITECT OR ENGINEER: TEL. N0: / PLASTIC Y/N METAL Y/N ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS -' - GAS TEST UTILITY COMPANY NOTIFIED CW ` - GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0104300005 BUILDING AND CAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEG ID: FEES PAID BUILDING ADDRESS: TR: 14467 LT: 76 9650 LA ROSA DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803860 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: TEMPLE CITY 8589-017-024 OW PLANCHECK FEE 0.00 109.35 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY 63 WATER PIPING BR/FIX 7.00 FIX 47.25 T NANT: 64 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 172.80 05/01/01 UT 10/28/01 OWNER: TEL. N0: FINAL DATE I CODE: HEASLIP SCOT W;OLACHEA-HEASLIP ROSE (626) 286-3922- �IIO}O 9650 LA ROSA DR I 1 TEMP 917803860 DE SCRIP ON OF WO COPPER RE-PIPING APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: - APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO UNDER SLAB WORK WATER SERVICE ARCHITECT OR ENGINEER: TEL. N0: PLASTIC Y/N METAL Y/N ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT " 65 HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NO IFIED - c-WV-GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE T0: BS0508