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Home My Public Portal About6214 LOMA AVE_Plumbing__ WORKERS' COMPENSATION DECLARATION APPUCAYpO ] FOR PL UMBPNG PERMIT `I hereby.offirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or a certified copy th reof(ta 38 Lab C ) c4 �Y '-l' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N V Cn ' ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESSIR-I tion department F BER FIXTURE OR ITEM @ FEE CLOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE OWNER C (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL / ADDRESS •/ LO ep` I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY Zt;rle �i/� TEL NO so as to become subject to the Workers'Compensation Laws / ✓�r DISHWASHER CONTRACTOR L7 / Date Applicant CLOTHES WASHER ADDRESS ,�,7 NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ,LAWN SPRINKLER SYSTEM CITY Epi TEL NO_ . with comply with such provisions or this permit shall be STATE �-�f 7 LIC deemed revoked WATER HEATERLICENSE NO CLASS �' S LICENSED CONTRACTORS DECLARATION �- DISTRICT NO r PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 ki "go GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER ID and Professions Code, and my license is in full force and effect 5 PER SYSTEM FINAL Q DATE �� VALIDATION V License Number q5)v 3 ? ,* Lic Class ) IX FINAL ' /!�/ Contractor Date BY y//` V ❑ W I am exempt under Sec tL N B&P C for this reason Plan check fee Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name el?vl I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031 5, Business and Professions Code) City Cy- w2- Tel NoS�7 ,0'r/ ❑ j, 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) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 3 0 6..7 A the performance of the work for which this permit is issued (Sec 3097, Civ C ) ° 0,0 ° ° 5 . Lender's Name 2,.°'° 2250, Lender's Address iO-o i° 2 2 5 0 U I certify that I have read this application and state that the above information is correct I agree to comply with all County > 0 x7 3 0—,84 ordinances and State jaws regulating Plumbing, and hereby authorize representativep of this County to enter upon the above-me ned prop ty for inspection purposes i _ SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Perl Date f s WORKERS'COMPENSATION DECLARATION �p ��L�D�fi�1�DOl1V ®� p�� 8� I hereby'affirm that I have a certificate of consent to'self 76A667A `� insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) ( or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY U` Policy No Company Certified copy is hereby furnished BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 9---Certified copy is filed with the county building inspec- tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCEOWNER SHOWER rJ p O (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) 7� LAVATORY ADDRESS 60 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY `l A TEL NO so as to become subject to the Workers Compensation Laws DISHWASHER01 CONTRACTOR , Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of ADDRESS��df G Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY �,,�� TEL NO�'�S/g®� LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE l! LIC deemed revoked WATER HEATER LICENSE NO ys�/3 CLASS/5"6e2 3(A LICENSED CONTRACTORS DECLARATION DISTRICT NOP OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER O and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL J VALIDATION License Number 3 -// Lic Class DATE 2z� V • �T�CCr�4'f�, r� BY AL G Contractor Date O ❑ I am exempt under Sec d B 8P C for this reason ® Z Plan check fee Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY /7 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License ss Law for the following reason (Section 7031 5, Business and Addre ��es S Professions Code) City ��,y�rn_ Tel 1\155 fy_9fJ"Fdc 2 0 9.5 A ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section j 0 0 0 0 o'5 7044, Business and Professions Code) 2 e o 34.50 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for o 0 o 34, 5 0 6 the performance of the work for which this permit is'issued 7 (Sec 3097, Civ C ) 06 19-84 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 this County to enter upon the above-men apned pr perty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P i ee talre } COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1108100015, BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID I FEES PAID I BUILDING ADDRESS I ITR 5904 LT 267 1 6214 LOMA AV IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917801634 I (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 1 15384-012-013 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID H2 LOCALITY: TEMPLE CITY, CI 1 107 BATHTUBS/SHOWERS 1 00 FIX 16 30 1 1 (TENANT I11 CLOTHESWASHER(S) - 1 00 FIX 16 30 (ISSUED ON PROCESSED BY PLAN BY I 1 125 LAVATORIES/SINKS 1 00 FIX 16 30 108/10/11 SR 1 1 145 WATER CLOSET/URINAL 1 00 FIX 16 30 1 (OWNER TEL NO 101 PERMIT ISSUANCE FEE 27 80 IFINAL DATE FINAL AY. CODE IWONG, ALAN - 107 BATHTUBS/SHOWERS 1 00 FIX 16 30 1 16214 LOMA AV I11 CLOTHESWASHER(S) 1.00 FIX 16 30 1 (TEMP 917801634 125 LAVATORIES/SINKS 1 00 FIX _ 16 30 1DESCRIPTION OF WORK 1 I 145 WATER CLOSET/URINAL 1 00 FIX 16 30 1ADD MASTER BEDROOM, BATHROOM, LAUNDRY ROOM, AND PATIO 1 I TOTAL FEES 186 00 1 1APPLICANT TEL NO 1 I IKWOK, TERENCE (323) 697-2120- 1760 E GARVEY AVE I (SPECIAL CONDITIONS 1 (MONTEREY PARK 91755 I 1 I I I (CONTRACTOR TEL NO 1 (APPROVALS DATE INSPECTOR SIGNATURE 1 IBEN KWOK CONSTRUCTION CO (626) 922-6181- 1 _ 1 1 1720 HILL PLACE #3 LIC NO 1UNDER SLAB WORK J 1 1 ILOS ANGELES, CA 90012 591589 B I I I (WATER SERVICE I 1 I (PLASTIC YIN METAL YIN 1 1 I 1ARCHITECT OR ENGINEER TEL NO I I I IKWOK, TERENCE (323) 697-2120- I (ROUGH PLUMBING 1 1 1260 E GARVEY AVE LIC NO 1 1 (MONTEREY PARK, CA 91755 C24796 IGAS PIPING I GAS 'vENT I I I )• IHOT WATER HEATER I I 1 (PLUMBING FIXTURES 1 I 1 I ILAWN SPRINKLERS I 1 1 1 1 IGAS TEST I 1 1 I 1 (UTILITY COMPANY NOTIFIEDI I 1 I I ICWV 6 I 1 IGRAY WATER SYSTEM 1 I I I I I I I I I I I I I I I I I I I (REPORT ID DPR263 ROUTE TO BS0508 I _ I I I I I I B , COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1108120004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS ITR 5904 LT 267 6214 LOMA AV 1 1FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917801634 ASSESSOR INFORMATION NUMBER 1 NEAREST CROSS STREET 15384-012-013 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY, Cl 163 WATER PIPING BR/FIX 3 00 FIX 20 20 1 1TENANT 1 TOTAL FEES 48 00 11SSUED ON PROCESSED BY PLAN BY 1 1 1 108/12/11 SR 1OWNER TEL NO 1 1FINAL DATE FINAL BY CODE 1 WONG, ALAN 16214 LOMA AV 1TEMP 917801634 1 1DtSCRI15TIONIOF WORK 1 1 1RELPLACE GANVILNIZED PIPE TO COPPER PIPE (APPLICANT TEL NO 1 1 I IKWOK, TERENCE (323) 697-2120- 1 1 1760 E GARVEY AVE ISPECIAL CONDITIONS 1 IMONTEREY PARK 91755 1 1 I I I CONTRACTOR TEL NO 1 1APPROVALS DATE INSPECTOR SIGNATURE IBEN KWOK CONSTRUCTION CO (626) 922-6181- 1 1 1720 HILL PLACE #3 LIC NO 1 1UNDER SLAB WORK 1 1 ILOS ANGELES, CA 90012 591589 B I I 1 (WATER SERVICE 1 1 1 1 IPLASTIC YIN METAL YIN 1 1ARCHITECT OR ENGINEER TEL NO I1 1KWOK, TERENCE (323) 697-2120- 1 1ROUGH PLUMBING 1260 E GARVEY AVE LIC NO 1 1 1 (nl{1J- 1 1MONTEREY PARK, CA 91755 C24796 1 1GAS PIPING 1 1 1 1GAS VENT 1 1 1 1 1HOT WATER HEATER 1 1 1 1 1 1PLUMBING FIXTURES 1 1 1 1LAWN SPRINKLERS 1 1 1 1 1GAS TEST 1 1 1 1 1 1UTILITY COMPANY NOTIFIED( I 1 I I 1cWV I 1 1 1GRAY 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 1 1REPORT ID DPR263 ROUTE TO 9S0508 1 I I I I I I