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HomeMy Public PortalAbout9501-9503-9505 LONGDEN AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION 78^867^ ;• hereby affirm that I have a• certificate of consent to self PC 617(7-60) APPLICATION F O RSPLUMBING PERMIT insure,or a certificate of Workers'Compensation Insurance,or a certified copy therof(Sec.3800,Lab.C.) W 479107 Wes- h¢&< :res Ga _COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ,t ADDRESS (,� OG.ei1I e Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE •� department. LOCALITY hate Applicant WATER CLOSET NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' r9 9 L` COMPENSATION INSURANCE SHOWER OWNER(/ f, (This section need not be completed if the work involved LAVATORY MAIL ADDRESS'S K.Jr,,' ® O Ur C. by the permit is for one hundred dollars ($100) or less.) SINK O CITY' TEL. O. U e C'd Y" "4( I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR,&I..�.4 f ,6�,2s A O so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER s-, /� = ~ .Date Applicant ADDRESS / ea eg1_;Z��,e V;,9 sr V OW. NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR CITY TEL.NO.ea to Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. �I Z Compensation provisions of the Labor Code,you must forth- ® LICENSE NO'. .� CLASS 4 with comply with such provisions or this permit shall be WATER HEATER deemed revoked. DISTRICT NO. PR CESSECLBY GAS SYSTEM _1 OUTLETS f/ LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm.that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL ness VALIDATION ness and Professions Code, and my license is in full force and DATE �r•1� effect. •. License Number o/f��y® Lic.Class BY FINAL BY I Contractor a ke I— Data � F+ 42— ElI am exempt from the licensing requirements as I am a Plan Check fee licensed architect or a registered professional,engineer PLUMBING'PERMIT ISSUING FEE$ O 7i Lj acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE so Lic.or Reg,No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION • Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section.7031.5, Busi- City Tel.No. ness and Professions Code): I, as owner of the property, am exclusively contracting 2-3 4 0,7 A with licensed contractors to construct , the project ° (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY 2 ° 56,50 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is O ­ 56,5060 issued(Sec.3097,Civ.C.). I1 3 2'6—8 2 Lender's Name t 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize, representatives of this County to enter upon the abov I ntio ed prop e�rtyyff r inspection purposes. Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76AG67A I hereby affirm that I have a' certificate of consent to self CE e17(2-60) APPLICATION FOR PLUMBING PERMIT insure,or a certificate of Workers'Compensation Insurance,or ac rt' ied copy thereof(Sec.38 0,Lab.C.) T ��r � �� N f �. COUNTY OF LOS ANGELES ' BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING �+��� Q �3 yw ❑ NUMBER R FIXTURE OR ITEM © FEE ADDRESS J 7 Certified copy is filed with the county building inspection department. r LOCALITY^� Date Applicant 7 WATER CLOSET NEgREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. .�. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved LAVATORY MAIL ADDRESS�� � �b7 tE Ga• A.SOerL�� } by the permit is for one hundred dollars ($100) or less.) q ,{s SINK CITY '— TEL.NO �. 1� O I certify that in the performance of the work for.which this DISHWASHER U permit is issued, I shall not employ any person in any manner CONTRACTOR �® �f� � 7 �, so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ��) ADDRESS �f �� ����� S^ U Date Applicant SWIMMING POOL RECEPTOR NOTICE TO APPLICANT: If, after making this Certificate of CITY `� TEL.NO. � „� , W Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE fe.�^ LIC. /' r°/] Compensation provisions of the Labor Code,you must forth- WATER HEATER LICENSE NO. /✓.i CLASS 311 z .with comply with such provisions or this permit shall be deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PR CESSED B LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that.I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL 7e �/ �� VALIDATION ness and Professions Code, and my license is in full force and DATE (j effect. E/ P FINAL License Number ° Lic.Class a BY Contractor tJgh1' r Date L� 4 I am exempt from the licensing requirements as I am a Pian Check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ tr acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE. D Lio.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I .hereby affirm that I am exempt from the Contractor'sAddress License Law for the following reason (Section.7031..5, Busi- I'City Tel.No. ness and Professions Code): 0 I, as owner of the property, am exclusively contracting z 3 4 0.8 A with licensed contractors to construct the project (Section 7044,Business and Professions Code). $� 0 0 0 0 o 5 '88 - .50 • CONSTRUCTION LENDING AGENCY � 2 0 • I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 0-0 0 8 7 C 5 issued(Sec.3097,Civ.C,). Lender's Name 0 3 26 —8 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- ntioned roperty for inspection purposes. Signature of Permittee Date +il •� COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1309030039 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID 1 BIIILDING ADDRESS: 1 ON FILE I 1 9505 LONGDEN 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 91780 1 (ASSESSOR INFORMATION NUMBER: I INEAREST CROSS STREET: 1 15382-020-067 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY 1 147 WATER HEATER(S) 1.00 WTH 16.20 1� ITENANT: I TOTAL FEES 44.00 ISSUED ON: PROCESSED BY: PLAN BY: 1 1 I 109/03/13 SR (OWNER: TEL. NO: 1 1FINAL DATE FINb4 BY: CODE: 1 IJULIE, WU (626) 241-4621- I 1 1 19505 LONGDEN AVE 1 1 • ?) I ITEMPLE CITY,CA 91780 DEISCRIPTIOR OF WORK 1 WATFR HEATER REPLACEMENT (APPLICANT: TEL. NO: I I 1 ILUBA BATIOFF (714) 381-7974- 1 I I 115103 BARNWALL ST I ISPECIAL CONDITIONS: ILA MIRADA, CA 90638 v I ICONTRACTOR: TEL. NO: - I IAPPRCTVALS DATE INSPECTOR SIGNATURE 1 IFAST WATER HEARTERS I_ I 111715 NORTH CREEK PKWY LIC. NO 1 1UNDER SLAB WORK I I I IS. C-106 NONE 1 I I I I IBOTHELL, WA 98011 I ]WATER SERVICE I I (PLASTIC YIN METAL YIN I I I (ARCHITECT OR ENGINEER: TEL. NO: 1 I I I I I - IROUGH PLUMBING 1 LIC. NO: II I 1 IGAS PIPI.NG I I IGAS VENT I I I IHOT WATER HEATER I I I I IPLUMBING FIXTURES I I I 1 1 ILAWN SPRINKLERS I I I I I I 1 I IGAS TEST 1 1 I I I ]UTILITY COMPANY NOTIFIED( I 1 I�- 1-1- I 1GiAY WATER SYSTEM 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 IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I