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Home My Public Portal About10550 LIVE OAK AVE_Plumbing__ WORKER'S COMPENSATION DECLARATION ' DPW 9/89 76A667A APP TION FOR PLUMBING P ERRq� I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified r copy thereof(Sec 3800 Lab C) �ZZ3t3L� Com ST,o.-tE kua COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No Company \ ❑ Certified copy is hereby furnished - FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING I V v� �� Certified copy is filed with the county budding inspection ADDRESS ) department . NUMBER FIXTURE OR ITEM, @ FEE Z� LOCALITY -('E� (�'� Date �/ Applicant Te`$ CO .► C.o N4PT WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST PQq_ COMPENSATION INSURANCE BATH TUB ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK gS��O PAGE LZ" PARCEL permit is for one hundred dollars($100)or less.) LAVATORY _ OWNER I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as tcMAIL SINK ADDRESS ggiO$ y }j�N n�f become subject to the Workers' Compensation Laws n DISWASHER CITY rz Mo a� TEL NO Qc55 Date Applicant CLOTHES WASHER CONTRACTOR f v 7 NOTICE TO APPLICANT If, after making this Certificate of �C'*i, Q GQN ' Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 11 C7- 7 S SA44 provisionsor this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY �N G�� TEL No Zf�(p(,O� } I hereby affirm that I am licensed under provisions,of Chapter 9 WATER HEATER d (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO S1�91� CLASS STATE LIC0 Professions Code,and my license is in full force and effect OUTLETS OVER DISTRICT NO PROCESSED BY )r 5 PER SYSTEM j Q License Number 51CR—M Lic Class GGGG��GG U FINAL VALIDATION W DATE IZ Contractor 'Te)CTar4 f OW;-T Date,'1 Z �7� 6 / [ U) ❑ _ I am,exempt under Sec FINAL ZBY B&P C for this reason Plan check fee Date PLUMBING PERMIT ISSUING FEE$ / Q Signature •� TOTAL FEE - Ela=F Plan check applicant - SINGLE FAMILY a HOME OWNER-BUILDER DECLARATION Name-Te%f�TO tA coe4sT• (ri'•�•f 4 I hereby affirm that I am exempt from the Contractor's License Law �n',� for the following reason (Section 7031 5, Business and Professions Address 1101j S Lii�.SADd.! ''`'0''r Code) � � City CA Tel No 10 0 O ITEM-� I,as owner of the property, ro ertwill do the work and the structure r ` ❑ is not intended orof offered for sale (Section 7044, Business I TOTAL IL "� and Professions Code) l ® CHECK .}1,,__i CONSTRUCTION-LENDING AGENCY CHANGE eti;E I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097, 0 Civ C) 1t — I_0—i ii_llj1 Lender's Name _ 1071 1 AN ?:[I_ Lender's Address I certify that I have read this application and state that the above information is correct I agree to comply ith all County ordinances end State laws r ul i Plumbi g, and hereby authorize represent s is to en er pon the above-mentioned prop for i ti pu SEE REVERSE FOR EXPLANATORY LANGUAGE Zii� "I 2 ure of Permittee i date WORkEFI'S COMPENSATION DECLARATION 240026 DPW 9/89 p ,/� ®® p gip g�� ® ®pp I hereb�ffirm that I have a certificate of consent to self insure, 76A667A APPLICATI®N FOR PLUMBING ILEO" MIT (J or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec 3800 Lab C) Policy No 3641-93 Company State Fund COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) ABUILDING DDRESS 10550`Live Oak Certified copy is filed with the cQl{q(t 1lt?q(fis jcticn department �Hjt�ij� 1111VV(� / NUMBER FIXTURE OR ITEM @ FEE LOCALITY Temple Cit Dale Applicant WATER CLOSET 3/16/93 Progressive Plbg. BZJ NEAREST CRoss sT El Monte Ave. iCERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE V ASSESSOR MAP BOOK GE ��Cv// PAPARCF�a SHOWER Q�� (This section need not be completed if the work involved by the Q � permit is for one hundred dollars($100)or less.) OWNER Starts International Calif. Inc. I certify that in the performance of the work for which this permit LAVATORY O �� is issued, I shall not employ any person in any manner so as to SINKMAIL become subject to the Workers'Compensation Laws ADDRESS601 S. Figueroa St. #4650 DISWASHER CITY Los Angeles TEL NO Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of 14 CONTRACTOR Progressive Pl i Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 4257 Auction Ave. #F- provisions provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION WATER HEATER CITY Baldwin Park TEL NO 962-2428 CL >_I hereby affirm that I am licensed under provisions of Chapter 9 b � STATE LIC 0 (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS Da LICENSE NO 478794 CLASS C-36 U Professions Code,and my license is in full force and effect OUTLETS OVER DISTRICT NO ROCESSED BY a: 5 PER SYSTEM J Q License Number 478794 Lic Class C-36 FINAL VALIDATION LU DATE- _ Contractor Progressive P1bq.Date 3/16/93 c ACCT.TAT I W El221/5.65 FINAL — C Z I am exempt under Sec BY 3107 1/5.65 i B&P C for this reason ) Plan check fee 1 ��r ` Date - ' Signature PLUMBING PERMIT ISSUING FEE$1 TOTAL 295 - 65 ❑ TOTAL FEE 5 CHECK, 295.65 SINGLE FAMILY Plan check applicant CHANGE .00 - 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 Professions Address ( 117— i 3/17/?3 Code) ❑ City Tel No 8714 i. AM 8:* I,as owner of the property,will do the work•and the structure is not intended or offered for salet(Section 7044, Business and Professions Code) ' CONSTRUCTION LENDING AGENCY j 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 ordinances and State laws regulating Plumbing, and hereby authorize representatives of t s County to enter upon the above-mentioned property for inspe n purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 3/16/93 Sign lure of Ittee Date• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0911230018 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE- (626) 285-0488 EXT (LEGAL ID- FEES PAID BUILDING ADDRESS ITR 49392 LT 6 10550 LIVE OAK AV E I )FEE DESCRIPTION QUANTITY UOM AMOUNT ARCD CA 910078564 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 18566-012-036 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID D3 LOCALITY TEMPLE CITY, Cl 1 163 WATER PIPING BR/FIX 13 00 FIX 87 75 I TENANT. I TOTAL FEES 115 50 JISSUED ON PROCESSED BY PLAN BY EXPIRES ON I 111/23/09 SR 11/23/10 1 (OWNER TEL NO IFI L AT FINAL 13Y CODE KHAN, LUI (626) 821-0911- /%i }C 10550 LIVE OAK AV ARCD 910078564 IDESCRIPTI N OF WORK COPPER REPIPE 13 FIXTURES I I I ( I (APPLICANT TEL NO JOHN NELSON PLUMBING CO (818) 218-4422- 12534 FOOTHILL BLVD ISPECIAL CONDITIONS ILA CRESCENTA 91214 I I i I I I I (CONTRACTOR TEL NO: I (APPROVALS DATE INSPECTOR SIGNATURE I (JOHN NELSON PLUMBING COMPANY INC (818) 248-4422- I 1 12534 FOOTHILL BLVD LIC. NO (UNDER SLAB WORK ILA CRESCENTA CA 91214 518842036 I I I I I (WATER SERVICE I IPLASTIC Y/N METAL Y/N 1 I (ARCHITECT OR ENGINEER TEL NO I 1 - I (ROUGH PLUMBING I I I LIC NO i 1-1 I 1 I IGAS PIPING IGAS VENT I I } I 'I IHOT WATER HEATER I I I I I I I IPLUMBING FIXTURES I I I I I I (LAWN SPRINKLERS I I I I I I IGAS TEST I I I I I I (UTILITY COMPANY NOTIFIEDI I I I I I I I Icwv. I I I I I I (GRAY WATER SYSTEM I I I I I I I I I I I i I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID- DPR263 ROUTE TO. BS0508 I I I 1 I