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Home My Public Portal About9903 LA ROSA DR_Plumbing__ 7 WO affirm t C I have ATION DECLARATION 1E 817 APPLICATION FOR PLUMBING PERMIT I hereby affirm that 1 have a' certificate of consent to self ce air Iz-eol insure, or a certificate of Worker's'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab.C.) COUNTY OF LOS ANGELES / BUILDING AND SAFETY Policy No. Company L� s/O Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING El Certified co NUMBER FIXTURE OR ITEM • FEE ADDRESS py R filed with the county building inspection department. WATER CLOSET LOCALITY Dale Applicant NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' p COMPENSATION INSURANCE SHOWER OWNER low LAVATORY MAIL (This section need not be completed if the work involved ADDRESS 7T VV L•NL by the permit is for one hundred dollars ($100) or less.) SINK G� 4 /3� �� _-7 cL CITY l Ott TEL. NO. !v O 1 certify that in the performance of the work for which this DISHWASHERU permit is issued, 1 shall not employ any person in any manner CONTR TOR so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER lZ ADDRESS O Date Applicant U SWIMMING POOL RECEPTOR NOTICE TO APPLICANT: If, after making this Certificate of CITY t TEL. NO. 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. CLASS to with comply with such provisions or this permit shall be WATER HEATER ' - deemed revoked. DISTRICT NO. P :�SSEDJ3Y GASSYSTEM OUTLETS (� LICENSED CONTRACTORS DECLARATION OUTLETS OVER � 14-11 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 VALIDATI N ness and Professions Code, and my license is in full force and DATE effect. FINAL License Numher Lia Class BY Contractor Date I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer . / PLUM ING PERMTT'ISSUING FEES acting in my professional capacity (Section 7051, Busil - iness and Professions Code). TOTAL FEE Lie.or Reg.No. Date rNa�a heck applicant HOME OWNER-BUILDER DECLARATION r3479A I hereby affirm that I am exempt from the Contractor's ssLicense Law for the following reason (Section7031.5, Busi- T.I.No. 2 ° ° 1650 pe31s and Professions Code): _ y� I, as owner of the property, am exclusively contracting `T with licensed contractors to construct the project O 6 02-82 Z_8 2 (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 to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize represen Lives of this County to enter upon the above{men n erty for inspect io ur '(H1f� 2N, . e,+-1 Signature of Permittee Date 7 WO affirm t C I have ATION DECLARATION 1E 817 APPLICATION FOR PLUMBING PERMIT I hereby affirm that 1 have a' certificate of consent to self ce air Iz-eol insure, or a certificate of Worker's'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab.C.) COUNTY OF LOS ANGELES / BUILDING AND SAFETY Policy No. Company L� s/O Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING El Certified co NUMBER FIXTURE OR ITEM • FEE ADDRESS py R filed with the county building inspection department. WATER CLOSET LOCALITY Dale Applicant NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' p COMPENSATION INSURANCE SHOWER OWNER low LAVATORY MAIL (This section need not be completed if the work involved ADDRESS 7T VV L•NL by the permit is for one hundred dollars ($100) or less.) SINK G� 4 /3� �� _-7 cL CITY l Ott TEL. NO. !v O 1 certify that in the performance of the work for which this DISHWASHERU permit is issued, 1 shall not employ any person in any manner CONTR TOR so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER lZ ADDRESS O Date Applicant U SWIMMING POOL RECEPTOR NOTICE TO APPLICANT: If, after making this Certificate of CITY t TEL. NO. 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. CLASS to with comply with such provisions or this permit shall be WATER HEATER ' - deemed revoked. DISTRICT NO. P :�SSEDJ3Y GASSYSTEM OUTLETS (� LICENSED CONTRACTORS DECLARATION OUTLETS OVER � 14-11 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 VALIDATI N ness and Professions Code, and my license is in full force and DATE effect. FINAL License Numher Lia Class BY Contractor Date I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer . / PLUM ING PERMTT'ISSUING FEES acting in my professional capacity (Section 7051, Busil - iness and Professions Code). TOTAL FEE Lie.or Reg.No. Date rNa�a heck applicant HOME OWNER-BUILDER DECLARATION r3479A I hereby affirm that I am exempt from the Contractor's ssLicense Law for the following reason (Section7031.5, Busi- T.I.No. 2 ° ° 1650 pe31s and Professions Code): _ y� I, as owner of the property, am exclusively contracting `T with licensed contractors to construct the project O 6 02-82 Z_8 2 (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 to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize represen Lives of this County to enter upon the above{men n erty for inspect io ur '(H1f� 2N, . e,+-1 Signature of Permittee Date WORKERS'at I have a ION DEC of cealr ' 'APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a' certificate of consent to self ce en (z-ea) insure, or a certificate of Workers'Compensation Insurance,or /l a certified copy thereof(Sec. 3800,Lab. C.) aaircn-�f��yq �. ./� COUNTY OF LOS ANGELES BUILDING AND SAF�T,Y Policy No. Company —(/ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING •` ADDRESS Certified 1 ^ Certified copy E filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE `f'• LOCALITY Daleyd p�ar� n�{ lL/ /y/J� WATER CLOSET NEAREST Applicant t�l/� 6L/Yl/1�/�� BATH TUB 3 CROSS ST. /�� CERTIFICATE EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER � LAVATORY MAIL p1 / (This section need not be completed if the work involved ADDRESS by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL. NO. O I certify that in the performance of the work for which this DISHWASHERU permit is issued, I shall not employ any person in any manner CONTRACTOR so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS Date Applicant SWIMMING POOL RECEPTOR ~ NOTICE TO APPLICANT: If, after making this Certificate of CITY EL.NO ��f Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATq LIC. ;7N Compensation provisions of the Labor Code, you must forth- WATER HEATER 1 LICENSE NO. J / e41 CLASS C/ (00' Z with comply with such provisions or this permit shall be deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROXESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER lS ADO I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL �I ' � VALIDATION ness and Professions Code, and my license is in full force and DATE G�— (� effect. r7 NAL r f License Numbe /� Lie.Class Contractor Date 2 _//7 FINAL , ,x'11 I am exempt from the licensing requirements as 1 am a Plan Check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lie.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that [ am exempt from the Contractor's Address License Law for the following reason (Section 7031.5. Busi- City Tel.No. ness and Professions Code): I, as owner of the property, am exclusively contracting 9 4 0 b 6 A with licensed contractors to construct the project (Section 7044, Business and Professions Code). # u 0 0 0 0 5 CONSTRUCTION LENDING AGENCY 2,0 0 37.00 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is - 37.005 issued (Sec. 3097,Civ.C.). Lender's Name 02. 17-81 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 SEE REVERSE FOR EXPLANATORY LANGUAGE � . ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the ab(+y£aten ned prop erty�y�spection purposes. Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0805120020 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: IBX: 147 652 PG: PC: 1 - 9903 LA ROSA DR I IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: 1 TEMP CA 91780 ASSESSOR INFORMATION NUMBER: ] I NEAREST CROSS STREET: 8589-007-027 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl I ]13 DISHWASHER(S) 1.00 FIX 16.20 1 TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.20 11SSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 105/12/08 SR 11/08/08 I TOTAL FEES 76.35 1 OWNER: TEL NO I IFINAL DATE FINAL BY: CODE: 1ELLIS, ARTHUR (626) 285-9028- 1 19903 LA ROSA DR. ]TEMPLE CITY, CA (DESCRIPTION OF WORK ]PLUMBING FOR KITCHEN REMODEL 1APPLICANT: TEL. NO: TIMNA POLGAR (818) 266-8978- 113564 RYE ST. k6 SPECIAL CONDITIONS: SHERMAN OAKS 91423 I I I I CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE IREMODELING CALIFORNIA, INC. (310) 733-4232- ] 1 1 13611 MOTOR AVE 4100 LIC. NO I (UNDER SLAB WORK ] ]LOS ANGELES, CA 90034 881905 B 1 1 1 1 I IWATER SERVICE I 1 1 I 1PLASTIC YIN METAL YIN 1ARCHITECT OR ENGINEER: TEL. NO: I - I IROUGH PLUMBING I LIC. NO: I I IGAS PIPING I I I ] GAS VENT I I ]HOT WATER HEATER I I I PLUMBING FIXTURES ] I I ]LAWN SPRINKLERS 1 I I IGAS TEST I I I (UTILITY COMPANY NOTIFIEDI I I I Gw ] (GRAY WATER SYSTEM ] I I I EXPIRE® 0 I I I I I I I I I I I I ] REPORT ID: DPR263 ROUTE TO: BSO50H I I I I I I