HomeMy Public PortalAbout9451 1/2 LAS TUNAS DR_Plumbing__ WORKERS'COMPENSATION DECLARATION,' AP'P.LICATION FOR PLUMBING PERMIT'
I hereby, affirm that I have a certificate of'consent to self in- 76A667A PW 4/87. '
sure;or a certificate'of Workers'Compensation'Insurance,or a CE 817(REV:8/86)
certified,•copy thereof (Sec .3800, Lab. C.)
COUNTY OF LOS ANGELES ' DEPT. OF PUBLICVORKS
Policy,No. Company J':�I/� i✓.ri.iJ
Certified co is hereby furnished..--
pY
FOR APPLICANT TO FILL IN(PRINT OR.TYPE) BUILDING ��/ . / -
j Certified.copy'is filed'with the county build g inspection ` ADDRESS �% j„ LA wiyfJ
e artment. NUMBER FIXTURE OR ITEM �a FEE
G
LOCALITY
Date•'"s ApplicantE4WATER CLOSET(TOILET) NEAREST - f` r
CERTIFICATE OF EXEMPTION FROM/E�
RKERS' BATH TUB CROSS.Si,
COMPENSATION INSURAN OWNER 644--s-7 +
SHOWER L�'/ /1J,�C WSJ-
(This section need:not be completed if'the work involved*by MAIC
the permit is for-'onehundred dollars ($100)or less.) LAVATORY ADDRESS !�/• S �FQIQ %
I certify that in the performance of the work•for which this per-
SINK
mitis issued, I shall not employ any person in any manner so C CITYXe
y7Tf N0. /i
as to become subject to the.Workers:Compensation Laws. DISHWASHER _ 9N
CONTRACTOR l/� 1 4
�lpU/ z (1 -' �C�iC J'J �E
Date « Applicant CLOTHES WASHER'
NOTICE TO APPANT If;.after making this Certificate of Ex= ADDRESS
LIC
emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR (�
CITY TEL. NO.
sation provisions of the Labor Code, you'must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit.sholl be deemed revok- STATE LIC. r
ed. WATER HEATER //7/J LICENSE NO, 4..._. CLASS
LICENSEDCONTRACTORS DECLARATION, RICT N PROCESSED BY
I hereby affirm that 6.6m licensed under provisions of Chapter GAS SYSTEM OUTLETS T /
9,(commencing.with'Section 7000)of Division 3 of.the Business . J OUTLETS OVER Q
and Professions Code, and my license is in-full force and ef- 5 PER SYSTEM FINALVALIDATION. a"
fect.
AT
a
License Number—541 Lic. Class �-
U
FINA
Contractor `, : Date '� BY 't p
❑ t-
I am exempt under Sec. W
5' W
B.BP.C..for this reason 33017 •} I Vaj
Plan check fee _
PLUMBING PERMIT ISSUING FEE$ _#' �{ �_
Signatu� TOTAL FEE r <IJCJ e z. -_s`
S GLE-FAMILY tt __.;
�. Plan check applicant ; ''tC :'a_,
HOME OWNER-BUILDER DECLARATION PP E
-. 1 i'J. a I-F:
I hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and
Professions Code): Address _ _
{H !t t 6 StL(t .E s ' '
0 I, as' owner of the property, will do the work'and the . City Tel. No. .r ,
structure is not intended or offered for.sale(Section 7044, S1A-3. i H i 9,-
Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a cdnstruction,lending,agency for .
the performance of the'work for which this permit is issued "
(Ser.'3097, Civ.:C.).
Lender's,Name
Lender's Address
I certify that:1 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-me oned pr r for in purposes.
SEE.REVERSE FOR EXPLANATORY LANGUAGE
I�LSignature Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1201170012
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 8526 LT: 1 BL: .001 1 9451 1/2 LAS TUNAS DR
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917802100 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
18587-008-018 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl
1 125 LAVATORIES/SINKS 5.00 FIX 81.30 I 1
(TENANT: I TOTAL FEES 109.10 (ISSUED ON: PROCESSED BY: PLAN BY: J
JUS FINE ART 1 101/17/12 SR
I I I I
DOWNER: TEL. NO: 1 1FINAI, DATE FINAL BY: CODE: J
JZHAO, JIAN XIN (626) 673-6368- I I" 1
19451 1/2 LAS TUNAS I 3�j�:�L
ITEMPLE CITY CA 91780 1 JDESCRIPTION OF WORK 1
ITENANT IMPROVEMENT PLUMBING 5 LAVATORIES i
JAPPLICANT: TEL. NO: I J I
IGEORGE ZHANG (626) 945-8612-
1448 W. CAMINO REAL 1 ISPECIAL CONDITIONS: J
JARCADIA, CA 91007 I 1
(CONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE J
JUNI-GLORY DEVELOPMENT INC. (626) 945-8612- D I J
1448 W CAMINO REAL AVE LIC. NO I JUNDER SLAB WORK I I I
JARCADIA, CA 91007 383572B I I I I I
(WATER. SERVICE J 1
I IPLASTIC YIN METAL YIN I 1
JARCHITECT OR ENGINEER: TEL. NO:
IMAD IT (626) 945-8612- I IROUGH PLUMBING
1448 W. CAMININO REAL AVE. LIC. NO: J I I I I
1ARCADIA, CA 91007 NONE J IGAS PIPING
I i I I I I
J GAS'VENT
I i I I I
I 1 IHOT WATER HEATER I I
I I I I
IPLUMBING FIXTURES
1 I I I
1 ILAWN SPRINKLERS I I I
IGAS TEST I
I I
I 1 11
JUTILITY COMPANY NOTIFIED( I
I ICWV I
JGRAY WATER SYSTEM
I I I
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 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 k PL 05OR 920610046
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BULLJ)_LNG-ADDRESS"
TR: 8526 LT: 1 BL: .001
f-'94'51 1/2.LAS TUN-M
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: mp-CP 91-78021DG-
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: OAK AVE.
8587-008-018 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY
25 LAVATORIES/SINKS 1.00 FIX 16.20
TENANT: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
U.S. ARTS EDUCATION CENTER TOTAL FEES 60.15 06/10/99 UT 12/07/99
OWNER: TEL. NO: FINAL DATE FINAL CODE:
GEWERTZ, HARRY R (310) 393-0848-
533 14TH ST 4r 19�q
SANTA MONICA 90402 DES CRIPTION_01-WORK -
TEN N - _=-LT-LONAL_SATHROOM
APPLICANT: TEL. NO:
ZHAO (626) 287-7961
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: �� APPROVALS DATE INSPECTOR SIGNATURE
A J L DEVELOPMENT, INC. (909) 860-8530-
21481 COLD SPRING LANE LIC. NO / ,� �r^� '� UNDER SLAB WORK
DIAMOND BAR CA 91765 762775 B •r
WATER SERVICE
'H ✓jr PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO: \
ZHANG, GEORGE (626) 945-8511/ ) 1 ROUGH PLUMBING
21481 COLD SPRING LANE LIC. NOI / / -� J 1111;11 t
DIAMOND BAR, CA NONE 1 JII I l GAS PIPING
-- --- - GAS VENT
J� ^ D HOT WATER HEATER
f'Y 00 a
--- ---- PLUMBING FIXTURES
-0- A LAWN SPRINKLERS
GAS TEST
��'�❑
� UTILITY COMPANY NOTIFIED
,c ❑ ®�' CWV
v c GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508