HomeMy Public PortalAbout9213 LEMON AVE_Plumbing__ 'f WORKERS'COMPENSATION.DECLARATION;�,' C
Irheieb iaf�iim iHat 1 have.`a certificate of consent t'-self in-' � 26�PW.4i87 "� APPL�ICATIOI�J' f,OR •PLUMBING PERMIT '
f sur "'r a certificate- f Workers'Com 6 A' . x
e•a pensation Ins'ura'nce,,".or a' CE 817;(REV 8/86)
certified- y.;tfiereof (Sec '3800,Lab. ) ' -"°
o" . : CompanyCOUNTY-OF LOS tiANGEIEs. DEPT. OF PUBLIC,W.ORKS ;•
.FIicy, No
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. -� i ,y 3:. 'y. - _ ,r .. .•e+. ,';� =ate
_Certified-copy is here byrfurnished!
' `F,OR APPLICANT TO'F,ILL IN(PRINTOR•TYPE) BUILDING '
Certified copy is.filed;w,ith'the,c6 my building inspection " ADDRESS."
�•r "' 'depdrimenY a� NUMBER �4 FIXTURE OR ITEM: FEE'
p LOCALITY.
Date _-� A I cant• / - /�,�y(�,�} � WATER GLOSET(TOILET)' �r ''r
-�• ." pp r• .. , NEAREST'.
CERTIFICATE OF EXEMPTION F.ROM'WORKERS' S' BATH TUB_T'• - ° ;CROSS Si
COMPENSATION'INSURANCE.• < SHOWER' OWNER" i;�• a. �.
(This.s&&i6ri'need'riot'be completed if tKe.work involved`by S V i
fhe permit`is'•fonone;hundred.dollc�s'(5100)or-.fess:) - L4VATORY MAIL
s_. ADDRESS Z^� ° N s7 _
I'certiN thow'withe•performance of the.wor`k,for viFich this'per- r 1 , .
mrt'is'issued;'I shall "iot employ any person in,any manner so`• SINK- CITY •'?Y�y„r i��Lj! TEL.NOtC�11/"
'Ss,to become sublect;to-the.Workers'Coinpensation-Laws DISHWA !.7�d
�• SHER. r•:. ,
_
,_ n - ca „• - CO_NTRACTOR./�}y G•
Date• v gPP.licant CLOTHES"WASHER
ADDRESS.
NOTICE,TO /(lj�O
:AP'PLICANT: If;:after m'okingrihis Certificate of Ex-, (< SWIMMING POOL RECEPTOR
emption*you should become sublectato th'e_Workers'Compen- _ = CITY. r TEL NO -��,�
°saTion provisions of"the L'abgrGodel you must forthwith comp- >` _ - - ••/)'1dn!/t�vf.4--' iI-�•e' 3•S •.r
LAWN'SPRINKLER SYSTEM '
!ly with such provisions'br this,permitrsha'll-be deemed'revok- STATE �7p� -LIC-'^
:r r. ' WATER HEATER_• LICENSE NO. � ZZ O. CLASS �_��SO�' ..
,L; •,�, LICENSED CONTRACTORS DECLARATION DISTRICT NO , - CE SED BY ;' x
I•h&eby affiim that I am�licensed under provisions of,Chapter,,, "GAS SYSTEM OUTLETS (�
9:(comrrier cmg with Section=7000)of;Division 3:of,t 0 Business. _ OUTLETS OVER
and`Profes"sions'Code, and my�license is rn f II '5 PER SYSTEM' - .- : ` _ -
u force and ef- - FINAL -
feet:• 3•: r :,* ,x ryA I ATION' _
DATE �'
L cense~Number�•Z,, {� �Z�Lc.-ClassFINy
' ;�Y nn—{!Crf� l/�li, ,Date L G'�I:: / " ? * BY AL F.. 0
Contractor /S
Ixam exempt under Sec. {(�
'
a
B.&P C for this.reason
', Plan check;fee ,+ = _• m
_ Date: PLUMBIN PERMIT;I $ ►
. r•: f G ISSUING FEE
Signature'
�. TOTAL•FEE• 1 �
SINGLE FAMILY,• a
HOME.'"OWNER-BUILDER DECLARATION ' -PlanLcheck applcant•:`r v
I hereby affirm that)I-aPn exempt=from the Co'ntractor's License+ Name'•-
Law•for,the'following`reason (Section:7031'S, Business-and -' ?' '• r" s '• _
'Professions Code)., a Address, °s r t--
y, •?. •! Y- r - ',•?—i•-•z
aM I, as`',owner,of,the,propehy,,,"will do, the work;and the C tY ' fel•No.
structure'is not;mtended or offered for sale(Secfion,7,044, _ r T• 14,� 'y.
'Business'and;Professions Code). y
t1I_
CONSTRUCTION-LEND ING.AGENCj :HEY
I°hereby affirm that there ls a construction'lendin9Y'a enc 4for
per
. ;• x L-'t
. 9 v c Y v y
the formance,of th'e work'for' c
whh P this ermit is issued
s(Seep 3097,,Gvt C:)., ;' r -' �,a v. _ q. '. r " ti•HA �� .F sy ° i ..
, i ,r- i;,bt"iIy _oi''L•Ff _' +-r► 7,f;lLe'nder's Name JGf
Lender's Address .3
`
'l•,"
I#certify'that;l'have-read this applcatior and st6te't}hat the
above mformotion is correct"I agree to comply with all?County a a
ordinances and State`laws`regulating Plumbing,-and hereby
autho'
representa Ives of 1 is"CourSty to entei upon the
abov ;me boned pr,o erty.for.mspection purposes°; "
' :,
77 ;SEE REV.ERSE•FOR>EXPLANATORY`LANGUAGE
,�-
SignatureKof-Permittee: ' Date., .i p
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0209050008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
L ADDRESS:
ON FILE 9213 LEMON AV-
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801327
AS NFO NUMBER: NEAREST CROSS STREET: OAK
5382-015-029 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596" GRID: J1 LOCALITY:- TEMPLE CITY
07 BATHTUBS/SHOWERS 2.00 FIX 32.40
T 21 HOSE BIBB(S) 2.00 FIX 32.40 ISSUED N: PROCESSED BY: PLAN .
25 LAVATORIES/SINKS 2.00 FIX 32.40 09/05/02 JK 03/04/03
45 WATER CLOSET/URINAL 2.00 FIX 32.40
OWNER:, TEL. N0: 47 WATER HEATER(S) c ,. 1.00 STH 16.20 FINAL DATE NALB� COD
WONG - 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20
3749 COGSWELL RD TOTAL FEES 189.75
EL MONTE 91732 DESCRIPT ONTO WORK
PLUMBING FOR ADDITION/REMODEL
APPLICANT:
SUNG-LAM CHAN (626) 926-9840-
120 W CAMINO REAL AV SPECIAL COND IONS:
ARCADIA 91007 '_
L E
CONTRACTOR: TEL. \�
INF BUILDERS (626) 574-0138 A RO A S DATE INSPECTORS TRE
120 W CAMINO REAL LIC. NO -64AB WOR
ARCADIA CA 91007 490547BHIC / d 6-y
WATER SERVICE z
/l/ I _ PLASTIC Y/N METAL Y/N
ARCHITECT OR N L. N0: ROUGH PLUMBING
LIC. No,./
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GAS VENT
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— -- -- -- - ---- -- -- -- - PLUMBING FIXTURES
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GRAY WATER SYgnW–
REPORT ID: DPR263 ROUTE TO: BS0508