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HomeMy Public PortalAbout10558 LIVE OAK AVE_Plumbing__ WORKER'S COMPENSATION DECLARATION 78AA66DPW9/89 APPLICATION FOR PLUMBING-PERMIT / I hereby affirm that I have a certificate of consent to self insure, or a eertrficate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab C) ' r, COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT:OF PUBLIC WORKS DIV. Policy No -3641-9 Company State Fund ;l + z - Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING •' , ® ADDRESS 10558 Live Oak Certified copy is fled with the��qq..��A�1t,XX,,bull�i msPechon department L�tSYY 1jN(•;./ NUMBER FIXTURE OR ITEM @ FEE _ LOCALITY Temple Cit Date 3/16/93 Applicant Progressive Plbc(.- WATER CLOSET ST CERTIFICATE OF EXEMPTION FROM WORKERS' � "'Z BATH CCROSS S El. Monte Ave. TUB �� ��j COMPENSATION INSURANCE ASSESSOR' `f9�fl� �j� PARCE� (This section need not be completed if the work involved by the �� SHOWER / %D MAP BOOK Q CJ PAG permit is for one hundred dollars($100)or less) LAVATORY /_ O"� OWNER • Starts International Calif: 'in I certify that in the performance of the work for which this permit Z7 ICLr� is issued, I shall not employ any-person in any mannef so as to SINK MAIL become subject to the Workers' Compensation Laws O ADDRESS 601 S;,'F'1 ueroa St. #4650 DISWASHER CITY IOS'Ancreles TEL NO 962-2428 Date` Applicant CLOTHES WASHER' CONTRACTOR NOTICE TO APPLICANT If, atter making this Certificate of _ Progressive Plumbin Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such_ ADDRESS 4257 'Auction Ave. #F provisions or this permit shall be deemed revoked LAWN SPRINKLER\SYSTEM, - LICENSED CONTRACTORS DECLARATION CITY TEL NO } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER - v Baldwin Park 962-2428 ,t1 (commencing with Section 7000) of Division 3 of the Business and STATE LIC GAS SYSTEM OUTLETS LICENSE NO 478794 CLASS C-36 U Professions Code,and my license is in full force-and effect PROCESSED BY DISTRICT NO OUTLETS OVER _ 5 PER SYSTEM C'© Pi License Number 478794 L,c Class C-36 J 0 �.a U — FINAL DATE _ VALIDATION W ContractorProgressive Plbc:3. Date 3/16/93 r y. ❑ I am exempt under Sec FINgy AL ACCT �. T o Y B&P C for this reason AC .it 1-! • c Plan check fee 3�' � .295.645I Date PLUMBING PERMIT ISSUING FEE$ 6 ® 1' ITE11,75, • f Signature ❑ TOTAL FEE 'TOTAL 295 - 65 Plan"check appllcant CHECK 295.6.., SINGLE FAMILY ( _ � _ ut�w�������ANG _ HOME OWNER-BUILDER DECLARATION Name CHANGE I hereby affirm that I am exempt from the Contractor's License Law,- for the following reason (Section 7031 5, Business and Professions Address .Code)" ❑ City Tel No —I. jt�1 :3f 17/93 I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section-7044, Business 8717 1 'AM 8:51 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 ordinances and State laws regulating Plumbing, and hereby authorize representatives of thi ounty to enter upon the above-mentioned ` property f r in purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 3/.16/93 Signature of ermittee Date J WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 ppp� p �p�� p� ®p/p �I hereby affirm that I have a certificate of consent to self insure, 76A667A " APPLICATION FOR PLUMBING PERMIT or a certificate of Worker's Compensation Insurance, or a certified Y_ copy thereof(Sec 3800 Lab C)- I - - Alpe_-TCOUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. P❑ohcy No �Z7C�lsl Company '� Certified copy is hereby furnishedBUILDING r ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) _ ADDRESS (05 S 9 LI V` OA,4,- ' Certified copy is filed with the county building i ectio -�tdpartme t NUMBER / FIXTURE OR ITEM @ FEE, LOCALITY -Tem GZ \Date 'L pa • 0 Applica WATER CLOSET Y NEAREST- CERTIFICATE OF EXEM TION FROM WORKERS' BATH TUB CROSS ST PAct.- AA-69t— COMPENSATION INSURANCE 1ASSESSOR p S Q PAGE 7.- PARCEL, (This section need not be completed If the work involved by the SHOWER MAP BOOK D O permit is for one hundred dollars($100)or less.) LAVATORY 4 OWNER S-T�U-[S t F4 CL_ QC.\/ I certify that in the performance of the work for which this permit Ili- is issued, I shall not employ any person in any manner so as to SINK ADDRESS Q �sS LOM ZO�L become subject•to the Workers'Compensation Laws ( - DISWASHER CITYP.05IF TEL NO q1S t Date Applicant CLOTHES WASHER �`T �� 1 NOTICE TO APPLICANT If, after making this Certificate of CONTRACTOR TirX'roN G01-VS-I Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR s�� provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY<,AN �j�s$y�-l�L, TEL NO a I hereby affirm that l am licensed under provisions of Chapter 9 WATER HEATER LIC (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM / OUTLETS LICENSE NO 7STATE Oq CLASS V Professions Code, and my license is in full force and effect OUTLETS OVER DISTRICT NO PROCESSED BY O 5 PER SYSTEM License Number S�0 Lic Class 02' U 1 FINAL DATE ��17 VALIDATION a 'f�FYCCO+ti Cmr�� 'T Z Contractor^ Date C/3 ❑ I am exempt under Sec BY AL j B&P C for this reason - Date Plan check fee ` � PLUMBING PERMIT ISSUING FEE$ Y - Signature ❑ [ TOTAL FEE ( Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name � •t °y _ I hereby affirm that I am exempt from the Contractor's License Law, i -� for the following reason (Section 7,031 5„Business and Professions. Address) a S A N J =�) = 141.'5, Code) � ` 0City G A► Tel No 1 I T EM'1 I,as owner of the property,will do the work and the structure S5 is not intended or offered for sale (Section 7044, Business TOTAL 4 1 _ _a and Professions Code) UG4If® 7 HE ° , CONSTRUCTION LENDING AGENCY, '_'iA4+IGE - 2 Ill-, I hereby affirm that there is'a construction lending agency for the n 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 ap roation and state that the above information is correct gree t omply all County ordinances and State laws r u ting umbin d hereby authorize representatives o Cou o ente u n the above-mentioned prop for ms i n u s SEE REVERSE FOR EXPLANATORY LANGUAGE 'L - natu a of Permittee Date i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0910280023 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID FEES PAID BUILDING ADDRESS ITR 49392 LT 5 - 1 10558 LIVE OAK AV E IFEE DESCRIPTION QUANTITY UOM AMOUNT ARCD CA 910078564 1 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 1 18586-012-035 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID D3 LOCALITY TEMPLE CITY, Cl I 147 WATER HEATER(S) 1 00 WTH 16 20 I 1 ITENANT I TOTAL FEES 43 95 (ISSUED ON PROCESSED BY: PLAN BY- EXPIRES ON 1 1 1 110/28/09 SR 10/28/10 I (OWNER TEL NO I IFINAL DATE FINAL BY CODE 1 1CHENG, JERRY (626) 864-6373- 1 1 1 110558 LIVE OAK AV I I 1ARCD 910078564 1 IDESCRIPTION OF WORK 1 I (REMOVE/REPLACE GAS WATER HEATER 50 GALLONS ENERGY FACTOR 1 I I 1APPLICANT TEL NO II 1 IFAST WATER HEATER COMPANY (425) 636-7084- 1 112601 132ND AVE I ISPECIAL CONDITIONS IKIRKLAND, WA 98034 1 I 1 I I I I CONTRACTOR TEL NO 1APPROVALS DATE INSPECTOR SIGNATURE IFAST WATER HEATER CO (800) 454-8955- 1 1 112601 132 AVE NE LIC NO 1 1UNDER SLAB WORK 1 I 1 KIRKLAND WA 98034 877489 C36 I I 1 (WATER SERVICE 1 I IPLASTIC Y/N METAL Y/N 1 1ARCHITECT OR ENGINEER TEL NO I I1 1 I IROUGH PLUMBING I I i LIC NO (GAS`PIPING I I IGAS,VENT I I I IHOT WATER HEATER I I I 1PLUMBING FIXTURES 1 I ILAWN SPRINKLERS I 1 EXIa I 1GAS TEST 1 1 1 � � I I I I 1 1 1UTILITY COMPANY NOTIFIED( 1 1 ICWV I 1 1 1GRA) WATER SYSTEM I I I I I I I I I I I I I I I I I I 1 IREPORT ID DPR263 ROUTE TO BS0508 i I I I I I