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Home My Public Portal About9638-9640 LONGDEN AVE_Plumbing__ ' APPLICATION FOR PLUMBING PERMI ORKERS!COMPENSATI N DECLARATION `f(rin'that I have a certificate of consent to self 76A667A a�ertlicate of Workers'Compensation Insurance, 'CE 817(REV. 10/81), �J erfifiecKVIPy thereof(Sec.13800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY icy Na.'98-9449 Company Republic Indemnity Certified copy is hereby furnished. BUILDING ` a FOR APPLICANT TO FILL IN(PRINT OR TYPE) 9 6 3'8 Lo nqd e n Aver, Certified copy is filed with the county b 'ng inspec- ADDRESS. tion de artment. NUMBER FIXTURE OR ITEM @ FEE // LOCALITY Temple City Date Applican WATER CLOSET U NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB Q� CROSS ST. COMPENSATION INSURANCE 3 SHOWER D OWNER Z-1. Bi Weber Development (This section need not be completed if the work Involved by ' MAIL the permit is for one hundred dollars($100)or less.) LAVATORY dd ADDRESS P O• Box 588 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK O CITY Lake Arrowhead TEL. N0.2 82-86 74 ' so a3 to become subject to the Workers'Compensation Laws. DISHWASHER Od CONTRACTOR Frank Marrone and Sons Date Applicant CLOTHES-WASHER Gd ADDRESS 9860 Lower Azusa Rd. NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR N Exemption, you should become subject to the Workers' CITY El Monte TEL. No•444-2548 Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER (J 6Q LICENSE NO. 3 9 7 8 8 4 CLASS C/36 LICENSED CONTRACTORS DECLARATION O DISTRICT NO. PROCESSED BY I hereby affirm that I'am licensed under provisions of Chapter 9 GAS SYSTEM 5 OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �J Q and Professions Code,and my license Is in full.force and effect. 5 PER SYSTEM. FINALVA A -ION / DATE License Number 397884 Lic. Class C 3 6 Marrone 7/9/87 F1 c Contractor Date r � C ❑ I am exempt under Sec. F C BAP.C. for this reason u Plan check fee ` p Date: a PLUMBING PERMIT ISSUING FEE$ d � L SignatureTOTAL FEE iv _4,7 4 a 0 A # o c o a o 5' Plan check applicant Io20850 SINGLE FAMILY n o 0 2 0 8,5 0 0 x HOME OWNER-BUILDER DECLARATION Name 1 hereby affirm that I am exempt from the Contract'or's License Address U 7, 16-8.7 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 representatives of this County to enter upon the a ve-m property for inspection pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Permittee Date _ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT yffirm that,l have a certificate of consent to self 76A667A �}� F-$r gydnfJifieate'of Workers'Compensation Insurance, CE 817(REV. 10/81) �J .'` '�S�a certifiedc'opy thereof(See! 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY �cy iva.' 98.9449 Company Republic Indemnity Certified copy,(s hereby furnished. al Ila FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ._ ® Certified copy is filed with a count_,; ing inspec- ADDRESS LOnn d.eri A e NUMBER FIXTURE OR ITEM do d artme t. � FEE LOCALITY Date �� Applican WATER CLOSET DO . NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUBCROSS ST. COMPENSATION INSURANCE SHOWER OWNER ,J,I .B4 Weber- Development (This section need not be completed if the work Involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY d ADDRESS P .O. BOX 588 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner , SINK G CITY Lake ArrowheA.NO.282-8674 so as to become subject to the Workers'Compensation Laws. 69• DISHWASHER OD CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS 9.8.60 Lower ftz'usa Rd NOTICE TO APPLICANT: If, after making this Certificate'of Exemption, you 'should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM cliY El Monte TEL. NO- 444-254 with comply with such provisions or this ,permit shall be STATE LIC. deemed revoked. . WATER HEATER pv LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT N�QQ E55 BY GAS SYSTEM OUTLETS jr—`U� I hereby affirm that I am licensed under provisions of Chapter 9 U �JJ V (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALI TION License Number- 3 9 7 R R d Lic. Classes 3 6 DATE FINAL C' Contractor Ma rron n Date 7 J g J R 7 BY ❑ I am exempt under Sec. C i B.BP.C. for this reason ► G -Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ v 2 Signature TOTAL FEE (� V SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name Ihereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and Address A 7 4 7.9 A Professions Code): City Tel. No. # o 0 0 0.05 El I, as owner of the property, will do the work and the o,14250 structure is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LEND.ING.AGENCY I hereby affirm that there is a construction.lending agency for , the performance of the work for which this permit is issued o o 14 2 5 Q C51' (Sec. 3097, Civ. C.). • 0.1 6d87 • Lenders Name--- Lender's ame 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 , abve-ment' rt�d�roperty for inspection purposes.. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature.of P69rmittee Date . f b COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0306240020 �( BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: EGA PAID BUILDIVG-ADDR5SS: TR: 31144 LT: 1 UN: 5 9640 LONGDEN AV B ,FEE DESCRIPTION: QUANTITY: LION: AMOUNT: TEMP CA 917801400 5 SSOR INFORMATION NUMBER: NEAREST CROSS STREET: TEMPLE CITY BLVD 5385-016-054 !01 PERMIT ISSUANCE FEE 27.75 ITH014AS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY '47 WATER HEATERS) 1.00 WTH 16.20 1 TOTAL FEES 43.95 ISS : PROCESSED BY: PLAN BY: EXPIRES ON: 06/24%03 JK 12/21/03 OWNER: TEL. N0: FINALDATEFI MAL Y: CODE: DI BARI JOHN JR;MARIAN (626) 286-3618- I / 9640 LONGDEN AV l TEMP 917801400 DESCRIPTION OF WURK C/O WATER HEATER APPLICANT: L. 0: ACTION CONTRACTORS (310) 515-1311- 17111 S BROADWAY SPECIAL CONDITIONS: GARDENA 90248 CONTRACTOR: TEL. 0: APPROVALS DATE INSPECTOR SIGNATURE ACTION CONTRACTORS (310) 515-1311- 17111 SOUTH BROADWAY LIC. NO DER SL R GARDENA CA 90248 B/L 27953 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECTOR ENGINEER: L. 0: - ROUGH LIC. NO: iGAS PIPING GAS E T WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY C P NY 0 CwV G TER SSE I i * ADDITIONAL DATA ON FILE REPORT ID: DPR263 ROUTE TO: BS0508