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Home My Public Portal About5925 LOMA AVE_Plumbing__ tiNORKER'SCOMPENSATION DECLARATION 6DPW 9/89 76A667A APPLICATION FOR PLUMBING PERMIT 76A66 I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec. 3800 Lab. C.) ��'�Company Sir ��-ltl COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. y ❑ tified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS [?/7�/r9 Certified copy is filed with the county ilding inspection department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date " Applicant WATER CLOSET � � NEAREST '7 CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. • COMPENSATION INSURANCE 1ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit MAIL LAVATORY Q �/•7 .. /t1 is issued, I shall not employ any person in any manner so as to SINK ADDRESS became subject to the Workers' Compensation Laws. DISWASHER CITY VTE�PC� /7/l/ Te NO.�.j Date Applicant CLOTHES WASHER `7 CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of O .1ki f Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS Q� {� c+Q A n� provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM J LICENSED CONTRACTORS DECLARATION CITY TEL.NO. 9L�_�Q . x I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER / (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. O STATE LIC j � CLASS Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY `/� C� *^ 5 PER SYSTEM -7 License Number ` too Q T, J Lic.Class C o LLsG� FINAL 2- VALIDATION _ Qp Contractor i L�i9+�-1/g DATE Date "/t3 CO) ❑ I am exempt under Sec. FFIINAL - B.&P.C.for this reason f' Date: Plan check fee ' - Signature PLUMBING PERMIT ISSUING FEE$ L� 7> , ___. -ted- ❑ TOTAL FEE Plan check applicant I Ji-IT i- '-t q = SINGLE FAMILY 71 F tLx s1 HOME OWNER-BUILDER DECLARATION Name - •••• �-- hereby affirm that I am exempt from the Contractor's License Law --- for the following reason (Section 7031.5, Business and Professions Address M= Code): ❑ City Tel.No. 1,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business ° and Professions Code). , =1 y i Y 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 repre tives of this County to enter upon the above-mentioned grope y f r inspiection pfrrposes. SEE REVERSE FOR,EXPLANATORY LANGUAGE Signature of Permitte Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL-0508-9807090022 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 355 05925-L"OMA AV _s FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP-CA-9-1-7801924 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5384-014-029 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 2.00 FIX 32.40 TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 07/09/98 UT 07/09/99 TOTAL FEES 92.55 A ' OWNER: TEL. N0: FINAL DATE FINAL BY; T CODE: SELTMAN BOBBY W;MARLENE F TRUS (818) 285-8542- r O� 5925 LOMA AV l TEMP 917801924 DESCRIPTION OF WORK C PLUMBING FOR AND-BATH _ APPLICANT: TEL. NO: PHINEAS CONSTRUCTION (626) 797-8703- 2063 PEPPER DR. SPECIAL CONDITIONS: ALTADENA, CA 91001 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE PHINEAS CONSTRUCTION (626) 797-8703- 2063 PEPPER DR. LIC. NO UNDER SLAB WORK ALTADENA, CA 91001 741350 B WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: LIC. NO: ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508