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Home My Public Portal About9856 LA ROSA DR_Plumbing__ _ WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT �7 I hereby affirm that 1 have a certificate of consent to self 20-0026 DPW 6/87 I insure, or a certificate of Workers'Compensation Insurance, 76A667A IILJII 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. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING - 44- Certified copy is filed with the county building inspec- ADDRESS O� tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Dote Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS', BATH TUB CROSS ST. ' COMPENSATION INSURANCE SHOWER OWNER O V (This section need not be completed If the work involved by MAID ,L the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 7 V' (i�`1' 1 certify that in the performance of the work for which this /�� permit is issued, t shall not employ any person in any manner SINK - CITY �'� LCA TEL. NO. so as to become subject to the Workers Compensation Laws. DISHWASHER 'Jl w CONTRACTOR o W Date Applicant CLOTHES WASHER ll NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should becomesubject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the Lobar Code, you must forth- - CITY TEL. NO, with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLA55 LICENSED CONTRACTORS DECLARATION DISTRICT NO. CE ED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS l Q „ (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM p } FINAL a y3� /L VALIDATION O DATE E License Number Lic. Class 0 FINAL - Contractor Date BY ❑ C(lam exempt under Sec. �` s'' `� W B:BP.C. for this reason =":7 Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature �3 �Eii=1 a ---I TOTAL FEE Plan check.applicant CHECK T3.S-5 SINGLE FAMILY • HOME OWNER-BUILDER DECLARATION Name 1. r1iYv- °t�11 I hereby affirm that I am exempt from the Contractor's License Address Low for the following reason (Section 7031.5, Business and pProfessions Code): City Tel. No. ill i_I[i-[(_t_16 _, LLA I, as owner of the property, will do the work and the - "`jtC, j •jib 7;,5` structure is not intended or offered for sale (Section ® - 7044, Business and Professions Code). 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 tocomply 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 6 �� / Date 'T d`" TOAO67 -CE48I7 9/63 T.P . APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING G G JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY r. FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 51.25 2-< IL BATH TUB 1,25 ADDRESS SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR SINK 1.25 ADDRESS DISHWASHER 1.25 CITY TEL. NO hoc/� LAUNDRY TUB 1.25 CONTRACTOR'S 3`ve/(�I STATE [0]REGISTRATION NO. Vv U COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE P CESSED BY WATER HEATER 1.50 ! 7-'/ o.. GAS SYSTEM OUTLETS 1'50 INDUSTRIAL a WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD V z 0 F- V w a N Z APPROVALS DATE LII INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK �fX�..,��_.';r� ROUGH PLUMBING u "4 ,wk TOTAL FEE GAS PIPING I I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER ✓��-�� -�. PLUMBING. ^�I 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANOIOR PLUMBING FIXTURES A121 A4 .��'n��/ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST I CALIFORNIA OR THAT I A TME LEGAL OWNER OF.AND INTEND TO RESIDE IN,THE ABOVE aLTIAL P OPERTY UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE - FINAL LIDATION ROBERT A. WOOD CASH SUPERVISING MECHANICAL ENG'R �,03998� SEP 5 p 5.75IN - WORKERS'COMPENSATION have ATIONcateDECLARATION corse APPLICATION FOR PLUMBING PERMIT 7-L I Hereby G certificate thafica haver certificate Comp of consent to self -76A666 DPW 6/87 C ' insure, or a certificate of Workers' Compensation insurance, 76A667AIILJII or a certified copy thereof (Sec. 3800, Lob. C. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY Date Applicant WATER CLOSET 50 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB Z 50 CROSS ST 2/ COMPENSATION INSURANCE OWNER (This section need not be completed If the work Involved by SHOWER O the permit Is for one hundred dollars($I00)or leu.) LAVATORY MAIL I certify that in the performance of the work for which.this ADDRESS permit is issued, I shall not employ any person in any manner SINK 5 00 CITY L so as to become subject to the Workers'Compensation Laws. DISHWASHER n CONTRACTOR ti DatnApplican z CLOTHES WASHER V NOTICE TO APPLICANT: If, after making is Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CIT ELN „r L� with comply with such provisions or this permit shall be LA WN SPRINKLER SYSTEM 5 .LIC. deemed revoked. WATER HEATER 7 50LICENSE NO. C SS LICENSED CONTRACTORS DECLARATION - DI ICT NO. P CE55 0 I hereby off irm that I am licensed under provisions of Chapter 9 GAS SYSTEM a OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM' y FINAL VALIDA ON DATE a YJ/ J Q License Class FINAL U. Contract ate BY 0 ❑ I am exempt under Sec. - O W B.RP.C. for this reason Plan check fee U) Date: loopZ PLUMBING PERMIT ISSUING FEE$ Signature ' TOTAL FEE Plan check applicant r SINGLE FAMILY J HOME OWNER-BUILDER DECLARATION Name - .a._1-.T I hereby affirm that I am exempt from the Contractor's License gddress Law for the following reason (Section 7031.5, Business and 33017 7.5 eLRf Professions Code): City Tel. No. ❑ 1, as owner of the property, will do the work and the I ITEMS structure is not intended or offered for sale (Section , TOTAL 73 - 00 7044, Business and Professions Code)., i CONSTRUCTION LENDING AGENCY �11'�' /3.00 1 hereby affirm that there is a construction lending agency for CHANGEI(j COUNTY OF LOS ANGELES TEMPLE CITY N 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0901060017 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS ITR: 9481 IT: 80 BL: .001 9856 LA ROSA DR (FEE DESCRIPTION: QUANTITY: 00M: AMOUNT: ( TEMP CA 917803920 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS 'STREET: 18589-022-017 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4' LOCALITY: TEMPLE CITY, Cl 4] WATER HEATER(S) 1.00 WTH 16.20 1 I TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 01/05/09 SR 07/05/09 10WNER: - TEL. N0: iFINAL DATE `, R gggp�Y. CODE: 1 PRADO ROBERT D;LANKA M X - PI � 19856 LA AOSA DR 'n1 U TEMP 917803920 DESCRIPTION OF WORK - 1 1REMOVE/REPLACE GAS WATER HEATER (APPLICANT: TEL NO: IHOME DEPOT (800) 454-8955- 112601 132 ND. AVE NE (SPECIAL CONDITIONS: 1 KIRKLAND, WA 98034 I I 1 CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE 1HOME DEPOT (800) 454-8995- 12601 132ND AVE NE LIC. NO 1UNDER SLAB WORK KIRKLAND WA 98034 602331 1 WATER SERVICE PLASTIC YIN METAL YIN ARCHITECT OR ENGINEER: TEL. NO: 1 IROUGH-PLUMBING LIC. NO: (GAS PIPING IGAS VENT HOT WATER HEATER 1 PLUMB ING FIXTURES I (LAWN SPRINKLERS I I 1 1 GAS TEST I I 1 1UTILITY COMPANY NOTIFIED( CWV 1 GRAY WATER SYSTEM I I I I 1 II II 11 I I I I I I I I 1 II I I 1 1 I I I I IREPORT I0: DPR263 ROUTE TO: 060508 I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0411240023 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID- BUILDING ADDRESS: TR: 9481 LT: 80 BL: .001 9856 LA ROSA DR FEE DESCRIPTION: QUANTITY: .UOM: ._AMOUNT: TEMP CA 917803920 ASSESSOR INFORMATION NUMBER: - .NEAREST CROSS STREET: AGNES 8589-022-017 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 2.00 FIX 32.40 TE 25 LAVATORIES/SINKS - 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PL EXPIRES ON: 45 WATER CLOSET/URINAL. 1.00 FIX ' 16.20 11/24/04 JK 05/23/05 TOTAL FEES - 92.55 OWNER: TEL. NO: PRADO ROBERT D;LAURA M ,� FI NgL_6 DATE FINAL BY: CODE: - ' _/ 9856 LA ROSA DR i" 6 4 TEMP 917803920 DESCRIPTION OF WORK PLUMBING FOR NEW BATHROOM. TE . NO- O'LEARY (626) 287-0927- 5823 AGNES AVE SPECIAL CONDITIONS: TEMPLE CITY CA 91780 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 Y/N METAL Y/N ARCHITECT OR ENG ER: TEL.-NO- ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED C V GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508