HomeMy Public PortalAbout9237 LOWER AZUSA RD_Plumbing__ 'f YORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
,ffirm that I,have a certificate of consent to self 76A667A
n ee,tifilate of Workers'Compensation Insurance, CE 817(REV. 10/81)
lr or a»Z"r�fied copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. D86237Q pony' Ji!
Certified copy is hereby furnished. BUILDING .`
® FOR APPLICANT TO FILL IN(PRINT OR TYPE)' AzusaADDRESS 9237 bower Azusa
Certified copy is filed with the county building inspec-
tion department. NUMBER FIXTURE OR ITEM @ FEE
LOCALITY TemDle City
Date 12-11-86 Applicant Owen Bros. Plba. WATER.CLOSET
49 NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER Fullmer Construction
(This section need not be completed If the work involved by MAIL
the permit is for one hundred dollars($100)or less.) zz LAVATORY ADDRESS 22632 E. Golden Sprin s#280
I certify that in the performance of the work for which this SINK CITY TELNO
permit is issued, I shall not employ any person in any manner Diamond Bd> . . 681-6633
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR Owen Bros. Plumbincr, Inc.
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR 4265 N. Baldmin
Exemption, you should become subject to the Workers' CITY TEL. NO.
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM El Monte 443-0078
with comply with such provisions or this permit shall be STATE- LIC.
deemed revoked. WATER HEATER LICENSE NO. 231 741 CLASS —20
LICENSED CONTRACTORS DECLARATION DISTRICT NO. -)' CESSED`BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS.SYSTEM OUTLETS y(
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �J
and Professions Code,and my license is in full force and effect. 5 PER SYSTEMFINA L V ATION
DAT 55 a
License Number 211 741 Lic. Class C36-20— FINA C:
Contractor QWen RMS- 21h Date 12-11—865 BY
❑ I am exempt under Sec.
B.BP.C. for this reason Plan check fee ® d
Date: Cr
PLUMBING PERMIT ISSUING FEE$ z
Signature
TOTAL FEE
Plan check applicant
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.
❑ I, as owner of the property, will do the work and the
structure is not intended-or offered for sale (Section ® ;2 6 1'3 4 A
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY # 0 0 0 0.0 5
1 hereby affirm that there is a construction lending agency for 1 0 2 3 8 5 0
the performance of the work for which this permit is issued
Sec. 3097, Civ. C. .
( ) - o 238.505
Lender's Name 1 218-86
Lender's Address
I certify that I have read this application and state that the
above information is correct. I agree tocomply with all County
ordinances and State laws regulating Plumbing, and hereby
uthorize representatives of this County to enter upon the
a ove-m tioned property inspection purposes.
/ , SEE REVERSE FOR EXPLANATORY.LANGUAGE
AV 12-11-86
195bnature of PermittW Date
+ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0912010013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ON FILE I I 9237 LOWER AZUSA RD I
[FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:1 TEMP CA 917803743 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I
18590-029-034 JOW PLANCHECK FEE 0.00 109.40 I THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPEL CITY, Cl
1 101 PERMIT ISSUANCE FEE 27.75 I 1
(TENANT: 153 MED/HIGH GAS 5 OUTL. 1.00 SYS 67.35 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1
IJOE'S AUTO BODY 154 ADDN OUTLETS > 5 1.00 OUT 4.20 +12/01/09 SR 12/01/10 I
1 1 TOTAL FEES 208.70
(OWNER: TEL. NO: I IFINAL DATE FINAL BY: CODE:
(JOE'S AUTO BODY
19237 LOWER AZUSA RD.
ITEMPLE CIYT CA 91780 I IDESCRIPTION OF WORK I
I 1 (INSTALL ONE PRE-FAB SPRAY BOOTH WITH FIRE PROTECTION I
IGAS LINE I
[APPLICANT: TEL. NO: I I I
IMONDRAGON (562) 755-0625- 1 I
114059 GARFIELD AVE. I ISPECIAL CONDITIONS: I
(PARAMOUNT, CA 90723
(CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I
1PERFORMANCE SYSTEMS CO. (562) 790-1762- I 1 1
(14059 GARFIELD AVE LIC. NO 1 (UNDER SLAB WORK I I 1
PARAMOUNT CA 90723 661143 B I I I I 1
[ [ ]WATER SERVICE I [ I
[ I IPLASTIC Y/N METAL Y/N [ [ [
1ARCHITECT OR ENGINEER: TEL. NO: I I [ 1 [
1 - I IROUGH PLUMBING I I 1
LIC. NO: I I I I
(GAS PIPING
[ I IGAS VENT [ 1
] I I ] [ [
I [HOT WATER HEATER I I 1
I I IPLUMBING FIXTURES ] [ 1
[ I ] I I I
ILAWN SPRINKLERS I I 1
I I ] I I I
GAS TEST
1 1UTILITY COMPANY NOTIFIED( [ [
I I I [
I I ICWv I I I
I I IGRAY WATER SYSTEM 1 1 I
IREPORT ID: DPR263 ROUTE TO: BS0508 I ]
I I I I I I