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Home My Public Portal About9061 LONGDEN AVE_Plumbing__ WORKERS' COMPENSATION DECLARATION n PP- C n MN FOR PLUMBING n n flMBING PERMF r hereby,`affirm that,I have d ceriificate of consent to self in- 20-0026 DPW 4/87 / 1 l� /�� (f II CJ ISL U u�+ n " 76A667A• _ Iul ` sure,or a certifiSote of Workers'Compensation Insurance,ora_' CE 817�(REV 8/86) - _ certified copy thereof (Sec 3800, Lab C ). ,,-, Policy`No ` ' Company COUNTY OF,LOS ANGELES DEPT. OF PUBLIC WORKS' Fj -Certified copy is hereby.furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the countybuilding mspection ADDRESS department NUMBER FIXTURE OR ITEM Lal FEE LOCALITY p f Date" ' Applicant- . WATER CLOSET(TOILET) JL'v l— v. PP NEAREST /' BATH TUB' CROSS,ST' CERTIFICATE OF`EXEMPTION,FROM WORKERS' - COMPENSATION INSURANCE 4 v- OWNER Q I a.. i SHOWER; (This section need not be completed if the worVinvolved'by MAIL the permit is for,=one hundred dollar`s (5100)or less.) LAVATORY: '"v ADDRESS D I certify that in the^performance of the work for which this per' a mit to become subject is issued;I shall not employany person in any"manner so SINK ;'b., ` CITY e.ryl_ /eC TEL NO 3, as ect to the Workefs' Compensation Laws DISHWASHER t , �- CONTRACTOR, r ,y DateApplicant, CLOTHES WASHER " ADDRESS' • NOTICE TO APPLICANT If„after making this Cer'tifi'cate of Ex- SWIMMING POOL RECEPTOR emption,you should become subje'ct•to the Workers'Com' pen- CITY VV TEL NO sation piovision's•,of the Labor Cod ,y e' ou must forthwith comp- - LAWN,SPMNKLER`SYSTEM 'ly,vvrth such'provisions-oc this permit shall be deemed revok- STATE ed- WATER HEATER LICENSE'NO L 5 a LICENSED CONTRACTORS DECLARATION- DIST IC P S D I hereby affirm%that,l am licensed under,provisior a of ChdGAS SYSTEM„ OUTLETS a � pter �, tJ{` 9 (comm enung'with Section 7000)of Division 3 of the Business OUTLETS,OVER ' and Professions Code, and my license is'in full force and ef- 5 PER SYSTEM F I N A 3� ALIDATION feet �” �` DATE • . l�� License•Number - Lic Class V r: A. FINAL GC Contracto-r` r Dote' )BY O I am exempt under Sec W B&P C' for this reason a • • • - Plan check fee Date _PLUMBING PERMIT-ISSUING FEE$ / s Signature— TOTAL t TOTAL FEE ` SINGLE FAMILY Plan check a hcant HOME OWNER-BUILDER DECLARATION PP I hereby affirm That I am.exempt from the Contractor's License Name Law for the following reason (Section 7031 5, Business and - -5 Professions Code) Address I, as owner`'-ofrthe property, will do the work and the Gty Tel-No structure isnot intended or offered for sale(Section 7044, =X17 ="1 it r \' Business and'Professions Code) :> ITEMS {; CONSTRUCTION LENDING AGENCY jTOTAL 43 00-_ I•hereby affirm that there is a construction-lending agency,for the:performance-19f the work for`which rthis,permit is'issued '' aCHECK, (Sec 3097, Civ 6 ) Lender's'Name -. Lender's Address I certify that,I have read flits application and,state that the D '79731 'AM 8o�r�'- above information is,correct•I agree to comply with all County ordinances•and Siate lows regulating Plumbing,;and hereby authorize representatives of this County.to enter upon the Y, abov -_menti ned0pr 'erty for msp'ectio purpo es �-3 SEE.REVERSE FOR-EXPLANATORY LANGUAGE Signature o PeriniTee• ` Date ` -76A607•-.CE017 10-60 APPLICATION FOR .PLUMEING PERMIT � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUJOHNIDINA G AE SAFETY DIVISOUNTY ION BUMDING ER DRESS WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEARSCROSS ST NUMBER FIXTURE OR ITEM OWNER , tw WATER CLOSET MAIL BATH TUB ADDRESS CITY - TEL. NO. � SHOWER CONTRACTOR LAVATORY SINS ADDRESS DISHWASHER CITY CONTRACTOR'S STATE LAUNDRY TUB REGISTRATION NO. COUNTY CLOTHES WASHER DISTRICT NO. GRO P Z E P SSED BY WATER HEATER GAS SYSTEM INDUSTRIAL - WASTE APPROVAL. } INSPECTION REg6oInd O - h e a $1.00 PER ITEM OR FIXTITRE $ APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 QQ UNDER SLAB WORK < TOTAL FEE ROUGH PLUMBING GAS PIPING IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. - - HOT WATER HEATER 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNS :OF TH OVE GAS TEST DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE - FINAL 7(7 ALIDATION ROBERT A. WOOD M.0. CASH SUPERVISING MECHANICAL ENG'R U,,CO 5 2 3 4 % NOV 17 5 D 3.0 0 WORKERS' COMPENSATION DECLA14ATION /,� ��n �� /� y��®fin �O� n�p n��pn� PONT _ 20-0026 DPW 4/87 A L6 A Il II C7 (� U I(� g I hereby affirm that I-have p �ertficote'of consent to self m- 76A667A r sure, or a'certificote of Workers'Compensation Insurance, or a CE 817(REV 8/86) Iertified^copy thereof (Sec 3800,-Lab •C )' Policy No' Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS '� , , - - _ - Certified copy is hereby furnished ' FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING 0 Certified copy i"s filed with the county building inspection ADDRESS (� a ` department: NUMBER FIXTURE OR ITEM' @ FEE LOCALITY / WATER CLOSET(TOILET) Date Applicant' NEAREST Q i 7t T _ c�J (/�1 ��/L� . CERTIFICATE OF EXEMPTION FROM WORKERS' '— Y BATH TUB CROSS ST, i - COMPENSATION INSURANCE - r' f, SHOWER' OWNER •r (This sectlomneed'not be-completed•If the work involved by' " MAIL the,permit is for,one hundred dollars(5100)or less.), LAVATORY ADDRESS CIO�p LQ I'certify that in the performance of the work for which this-per- TEL NO SINK � mit is issued,'l'shall not employ any person,in any manner so 1 � e lvU J as to become•su6lect to the,Woikers' Compensation LawsCITY: DISHWASHER' CONTRACTOR Date Applicant = CLOTHES WASHER ' ADDRESS NOTICE,TO APPLICANT',lf,,;,`after making„this,Certifcate of Ex- — SWIMMING POOL RECEPTOR w. , emphon,youu should become sublect to the Workers'Compen- e CITY ' satiomprovisions of=the'Labor Code°you must forthwith comp- jAWWSPRINKLER SYSTEM t TEL NO ly.with•such proJisioris,or this permit shall be deemed revok-• STATE LIC „ed ' ,_ LICENSE NO CLASS .WATER HEATER ~ `,LICENSED CONTRACTORS DECLARATION- DIS T ICT,pi ROCESSED BY” I•hereby dffirm'that I'am licensed under proyisidns of•Chapter GAS SYSTEM' OUTLETS _ vJ 9'(commenang with Section 7000)'of Division 3 of the'Busmess^ OUTLETS OVER t L and Professions Code, and my license ir5 PER SYSTEM'in.full force and ef- n FINAL / 7 Lic U DATION >a- fect DATE License Number' W U e O FINAL Contractor Date BY p Tam exempt under Sec W B BP C• f60his reason} T D i W Plan check fee "• Date PLUMBING PERMIT ISSUING FEE$ Signature' , • - . 4 ., TOTAL FEE CU SINGLE FAMILY. ' HOME OWNER-BUILDER DECLARATION Plan-check applicant c f hereby affiim that I am exempt from the Contractor's License Name ry Law,for the following reason+(Sect iori':7031,5, Business and 'ACCT. Professions Code) Address' n - 7 ell - r i.. 1, as owrier-of the'property; will';do'the work and the City ! - Tel No IT �.. ' EM struct6rre is not intended or offered for;sale(Section 7044, ' Businessand Professions Code) TOTALi m 50 CONSTRUCTION LENDING,AGENCY'` ' D CHECK n 22.50 hereby:'affir I m•that there is a construction lending agency for CHANGE �� { the perfo'rman'ce of the work forTwhich this permit is issued (Sec'3 CIV C ) : ., ,s r •. :, a' .- - ...- _ - _ �--,�gnni - - -. ,• Lend'er's Name Offlo-15001 12f ,.Lender si Address j 737 1 A 9:01 I,certify that I have read this,application•and state that the ti above information is correct I agree to comply with all County ordinances and State laws regulating Plumbing, and her " authorize trepresentatives of'this.County to,:enter upon the „ above-mentiorted_pro erty for pechon purposes' SEE REVERSE FOR EXPLANATORY LANGUAGE- Sign -r f'Pe'rmittee 'Date ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0310210012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: BUILDINGLEGAL ID: FEES PAID TR: 12048 LT: 1 9061 LONGDEN AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801512 ASSESSOR IO N NEAREST CROSS STREET: SULTANA 5382-021-027 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 4.00 FIX 64.80 13 DISHWASHER(S) 1.00 FIX 16.20 ISSUED 0 PROCESSED S 25 LAVATORIES/SINKS 6.00 FIX 97.20 10/21/03 JK 04/18/04 45 WATER CLOSET/URINAL 5.00 FIX 81.00 OW EL. 0: 47 WATER HEATER(S) ' 1.00 WTH 16.20 FIN4 DATE �/ BY: CODE: NAKAMURA TOSHIYUKI;TOMOMI (626) 285-7134- 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 _ Z`� 9061 LONGDEN AV TOTAL FEES 319.35 TEMP 917801512 DESCRIPTION OF WORK PLUMBING FOR ADDITION/REMODEL APPLICANT: TET INTERNATIONAL (626) 285-2562- 145 N EARLE ST SPECIAL CONDITIONS: SAN GABRIEL 91775 CONTRACTOR: 0: �Oy� APPROVALS DATE INSPECTOR SIGNATURE RICHARD WU (626) 285-2562- 145 N EARLE ST LIC. NO UNDER SLAB WORK SAN GABRIEL, CA 91775 540918 B/ PLASTE TICY/N SERVICE Y/N ARCHITECTT ROUGH PLUMBING LIC. N0 I X1111111 1 AS VENT Cal �t]L1 RK. OT T R H ATE--LhPLUMBING FIXTURES I" !16 LAWN SPRINKL R 12 0 1, 1_ � '7 t D ❑ � S TEST T rF UTILITY COMPANY NOTIFIED u ®� CwV SGthpvOCe-Th WATERGRAY SYS TEM REPORT ID: DPR263 ROUTE TO: BS0508