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Home My Public Portal About8640 LONGDEN AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION APP UCAT� ON FOR PLUMBING PERMIT 1 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 Policy No Company Certified copy is hereby furnished J ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS ? >� : ( L(,t Certified copy is filed with the county building inspec- tion department NUMBER FIXTURE OR ITEM @ FEE / _ LOCALITY Date Applicant WATER CLOSET NEARESTl CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST �n.�� COMPENSATION INSURANCE. OWNER ku (This section need not be completed If the work Involved by MAIL SHOWER the permit permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS ) - A1_ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK ' CITY Ly TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER ,l ,.•, �• I �.•' CONTRACTO Da-teb ._ Applicant � A 'r` CLOTHES WASHER ADDRESS ' {V NOTICETO APPLICANT If, after-m-aking this C lrtificote of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR !� � Compensation provisions of the Labor Code, you must forth- y o LAWN SPRINKLER SYSTEM CITY TEL NO with comply with such, provisions or this permit shall be STATE u /� LIC deemed revoked WATER HEATER LICENSE NO 7 1–! (" CLASS LICENSED CONTRACTORS DECLARATION ' DISTRI T NO /t PgOC SSED BY. I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ✓/1 l/�D (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER y. and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL / ' r V IDATIOPV 9L MC L i C DATE/ / �� O a V License Number I ` - l ,Lic Class 4 FINAL ; V ,/ ,'. 0 Controcto (r ate BY ❑ V I am exempt under Sec B&P C for this reason �!li 6 `'i`L-� Plan check fee 3 4 5 9 A Date PLUMBING PERMIT ISSUING FEE$ Signature # 0 0 0 0 0 5 TOTAL FEE Plan check applicant . Iaa2250 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name o o 0 2 2 5 0 5 I hereby affirm that I am exempt from the Contractor's License Address I �, 3_8 5 Law for the following reason (Section 7031 5, Business and Professions Code) City Tel No ❑ I, 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 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 represe totiveI f this County to enter upon the a ve-mentio rg pr rty for inspection purposes ' 1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature f Permitte)9 Date—� I T j14G;2kERS' C6AVENSATION DECLARATION AP L0CA MN FOR P LMpEN G PERMIT 1�hereby Affirm that I have a certificate of consent to self 76A667A insure, qr 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 Policy No Company Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS t � •° Certified copy is filed with the county building inspec- tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY P Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER _ (This section need not be completed if the work Involved by MAIL (� the permit Is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any nner SINK CITY TEL NO so as to become subject to the W r rs'Compe sail Laws DISHWASHER CONTRACTOR V Date t " pphcan CLOTHES WASHER ADDRESSt o NOTICE TO APPLICANT If; after make is Certif ate <of . ��' Exemption, you should become subject to the • orkers' SWIMMING POOL RECEPTOR CITY TEL NO Compensation provisions of The Labor Code, you must forth- LAWN SPRINKLER SYSTEM _ with comply with such provisions or this permit shall be STATE [� LIC + deemed revoked WATER HEATER LICENSE NO [ CLASS LICENSED CONTRACTORS DECLARATION Q DISTRICT Np v XSSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �" �e (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER J t i and Professions Code,and m license is in full force and effect - 5 PER SYSTEMFINAL/' / 1 y FINAL VALI TION O �/ DAT ,r / ) i7 U License Num er r Lic Class _ FINA / O ContractorDate BY u� W ❑ I am exempt under Secr f 40 02 A N B &P C for this reason Plan check fee "\�u, t / # o o o o o 5 � �� Date 1 0 - 2Z50 PLUMBING PERMIT ISSUING FEE$ Signature 4 0 0 0 225060 TOTAL FEE Plan check applicant Q 2 0 7—8 6 ,I SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 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 Tel No ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section D 7044, Business 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 applicatiori and state that the above information is correct I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby aut nz represent❑ Ives o hi y to enter upon the, ov 4 entioned pe , i sp on purposes 7 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of8ernfiftee F Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0806200003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS 1TR. 5903 LT 32 8640 LONGDEN AV I IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 91775 ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET BURTON 15386-006-018 101 PERMIT ISSUANCE FEE -27 75 THOMAS PAGE 596 GRID G2 LOCALITY: TEMPLE CITY, Cl 151 LOW PRS GAS 5 OUTLET 1 00 SYS 16 20 1 TENANT I TOTAL FEES 43 95 JISSUED ON PROCESSED BY PLAN BY: EXPIRES ON i 1 106/20/08 SR 12/17/08 OWNER TEL. NO IFINAL DATE FINAL BY CODE ISCIURBA, MARTHA (626) 799-1210- 1 1 1 18640 E LONGDEN AVE I I 1 ISAN GABRIEL, CA 9177 I ID14SCRIPTION OF WORK 1 I I IGAS LINE FOR THE HVAC SYSTEM 1 1APPLICANT TEL NO I 1 1 IBRYANT HEATING & A/C (626) 286-1141- 11350 E LAS TUNAS DR I ISPECIAL CONDITIONS I ISAN GABRIEL CA 91776 I I I I I I I I (CONTRACTOR TEL NO- 1 (APPROVALS DATE INSPECTOR SIGNATURE I IBRYANT HEATING AND A, C (626) 286-1141- 1 1 11350 E LAST TUNAS DR LIC NO I (UNDER SLAB WORK ISAN GABRIEL, CA 91776 221751C20H 1 I IWATER SERVICE 1 (PLASTIC Y/N METAL Y/N (ARCHITECT OR ENGINEER -TEL NO I I I I - I IROUGH PLUMBING 1 LIC NO I I I 1 IGAS PIPING I 1 1 (GAS VENT I I I IHOT WATER HEATER 1 1 IPLUMBING FIXTURES 1 I I I 1 1 ILAWN SPRINKLERS I I I 1 1 IGAS TEST I I I I I I (UTILITY COMPANY NOTIFIEDI I I� I I I IGRAY 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 IREPORT ID DPR263 ROUTE TO BS0508 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF.PUBLIC WORKS 9701 LAS TUNAS PL 0508 0808280021 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID I FEES PAID I BUILDING ADDRESS I ITR 5903 LT 32 I 1 8640 LONGDEN AV 1 I IFEE DESCRIPTION QUANTITY UOM AMOUNT I TEMP CA 91775 1 (ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET _ 15386-006-018 101 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 596 GRID G2 LOCALITY TEMPLE CITY, Cl I 147 WATER HEATER(S) 1 00 WTH 16 20 1 ITENANT I TOTAL FEES 43 95 (ISSUED ON PROCESSED BY PLAN BY EXPIRES ON 1 108/28/08 SR 02/24/09 I I I I (OWNER TEL NO I IFINAL DATE FINAL CODE. 1 ISCIURBA, MARTHA (626) 286-4471- 1 1 �I 18640 LONGDEN AVE 1 ` ISAN GABRIEL CA 91775 I IDE CRIPTION OF WORK 1 I I IWATER HEATER REPLACEMENT 1 (APPLICANT TEL NO I 1 1 (DAVID PEDROZA (626) 355-3496- 1 1 1140 E MONTECITO AVE 1 ISPECIAL CONDITIONS 1 ISIERRA MADRE I I 1 (CONTRACTOR- TEL NO 1 (APPROVALS DATE INSPECTOR SIGNATURE 1 IGEM PLUMBING INC (626) 355-3496- 1 1 1 1140 E MONTECITO AVENUE LIC NO 1 1UNDER SLAB WORK 1 1 1 ISIERRA MADRE, CA 91024 111308/C36 1 I 1 1 1 1 1 IWATER SERVICE 1 1 1 1 1 1PLASTIC Y/N METAL Y/N 1 1 (ARCHITECT OR ENGINEER TEL NO _ I - IROUGH PLUMBING I I 1 LIC NO I 1 11 I I IGAS PIPING I 1 IGAS VENT 1 1 I I 1 IHOT WATER HEATER I I I I 1 IPLUMBING FIXTURES 1 1 I 1 ILAWN SPRINKLERS I I 1 GAS TEST I I 1 11 1 1 (UTILITY COMPANY NOTIFIEDI I 1 I I ICWV 1 I 1GRAY WATER SYSTEM 1 1 1 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 1 1 I 1 I I I I I I