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Home My Public Portal About9363 LOWER AZUSA RD_Plumbing__ r WORh'tha charvea eriON DECLARATION J APPLICATION FOR PLUMBING PERMIT I hereby, affirrh that I'ha've a certificate of consenj,to self irf-ti 26A66 DPW 4/87 76A667A sure,.or o certificate'bf-Workerrs'-Cd'mpefisationdnsurancg,oraCE 817(REV.8/86) certified copy thereof(Sec. 3800, Lab.,C.) I ' Policy No.WP6273789Q�,pony`PACIFIC•COMP:: j COUNTY OF LOS ANGELES DEPT.-OF PUBLIC WORKS Certified copy'is hereby furnished. 4I � Is filed with the count buildin p I FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 'Certified co Py. y g ins ection' -ADDRESS 93 LOWER .AZUSA RD. department. NUMBER FIXTURE OR ITEM @ FEE ; I LOCALITY TEMPLE CITY CA. Date •3-12-90 A licont OTs1M PT.HC,_ i WATER CLOSET(TOILET) PP NEAREST ; BATH'TUB ' CERTIFICATE OF EXEMPTION FROM.WORKERS' - I' � CROSS ST.. COMPENSATION INSURANCE • I OWNER SHOWER E I• (This section need not be completed If the work involved.by MAIL "• the permit is for one hundred dollars(4160)or less.) 5 LAVATORY 37.50 ADDRESS X1.642 EARLNlONT AVE:. ' I certify that in t'he.performance of-the work for which this.per; ;v ; mit is.issued, I shall not employ any person in.any.,manner so. SINK' r CJO. CITY ` �EL:',NO. f•; LA CANADA CA.9107:1' •790,=86:62 as to become subject to the Workers'Compensation Laws. DISHWASHER �- CONTRACTOR-OWEN '•PLUMBING CO. Date Applicant• CLOTHES WASHER' 7.50 I, NOTICE TO APPLICANT: If-,'after making this Certificate of ADDRESS Ex- i TA AVE. 1'emotion,you should become subject to the Woikers'Compen-. SWIMMING POOL RECEPTOR • CITY 'sation provision's of the Labor Code,'you must forthwith comp- •;•I LAWN SPRINKLER SYSTEM � • S. EL•MONTE,CA.91733TEL. N0443-3384 •., ly with'such provisions or this permit shall be deemed revo_k- STATE - CIC. n ed. �,: ; WATER HEATER LICENSE NO. 451933 CLASS C-36. 5 ' LICENSED.CONTRACTOR$,DECLARZ. 0.ATION � - DI T.RICT NO: i \PROUSSED BY ' I Hereby''affirm that I am licensed under provisions of Chapter i GAS.SYSTEM OUTLETS i 9(commencing-with Section 7000)of Divisiori 3 of the Business 'OUTLETS OVER .and Professions Code, and my license is in full force and ef- ; SPER SYSTEM FINAL . } VAL ATION. DATE. License Number451933• Lic. Class C-36 Oti11EDT' .PLBG. :" -FINAL Contractor Date 3-1?-9O a BY 'l am exempt under Sec. i _- - W B.&P.C.,for this reason . PIOrIICheCk fee AC .oa y' -Date155 PLUMBING PERMIT ISSUING,FEE$13. Q 1 '.00 " 3307 '50 Signature _. . 1 ITEMS - . i TOTAL FEE 15• •.50 ... SINGLE M MILY - HOME OWNER-BUILDER DECLARATION Plan';heck applicant' -. TOTAL .. - -155.50 I hereby affirm that I am exempt from the Contractor's•License Name 1�,e}• � Law for,the following reason (Section 7031.5, Business and �� n0 Professions.Code): Address: '• I as owner of the property, will do the work and the City Tel. No, ' 0000-0001 '3/29!90 - structure.is not intended or ffered for sale(Section 7044;.� .' . Business and Professions Code). _ --, 9785 1 • AhliiS3CI CONSTRUCTION LENDINGAGENCY 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.). ` It _ + Lender's Name Lender's.Address I certify that I have read this application and-state that the above••infofmatiori is correct.I agree to complywilfi aII County ordinances dnd State. laws regulating Plumbing, grid Hereby f i authorize representat'iv of this County to.enter upon the above- enti ned r ert .for inspection purposes: /9 �ISEE NEVERSE FOR EXPLANATORY LANGUAGE eD, Signaa of Permittee Dafe i ' ' '{ i •� 11'II 20-0026 0 WORKER'S thralICOMPENSATIONate of cLARATI to l7SM68DPW9/89 APPLICATION FOR PLUMBING PERMIT I�herebpya�fiim 1Mi) I have a certificate of consent to self insure, i 78A857A or certificate of Worker's Compensation Insurance,or a certified cop theieof(Sec.3800 Lab..C.)" COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company Certified copy Is hereby tumished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING q'2 1 `�,�Li-2 �Q� ❑ Certified copy is filed with the county building inspection ADDRESS x'7767 (/V {� !/9 10 department. NUMBER FIXTURE OR ITEM ® FEE i LOCALITY 7221ZOLe Date APpli�t WATER CLOSET ��GG///J NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. COMPENSATION INSURANCE BATH TUB ASSESSOR (This section need not be completed If the work Involved by the SHOWER MAP BOOK PAGGEE� PARCEL permit is for one hundred dollars($100)or less.) 1 LAVATORY OWNER t`R l TiOItl 1i{T I certify that in the performance of the work for which this permit' is Issued, I shall not employ any person in any manner so as to SINK MAIL ADDRESS become subject to the Workers'Compensation Laws. j' ZA l®� DISWASHER CITY ,FS�y,�pG �� TEL.NC+X u _f* 50i 1 Date Applicant i CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this. Certificate of i Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code,you must forthwith comply.with such . provisions or this permit shall be deemed revoked. I LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. > " I.hereby affirm that I em licensed under provisions of Chapter 9 WATER HEATER , ,(commencing with.Section 7000)of Division 3 of the Business and STATE ,LIC. V Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. CLASS I DISTRICT NO. PROC SSED BY OUTLETS OVER Q I 5 PERSYSTEM 1 License Number. Lic,Class H � FINAL � W '; ; ;VALIDATION ' D DATE - d Contractor .Date- , (J) ❑ I am exempt under Sec. r FINgy�L ,til ► z B.&P.C.for this reason Date: i Plan check feepolw ' Signature PLUMBING PERMIT ISSUING FEE$ I ElTOTAL FEE i Plan check applicant 5 � SINGLE FAMILY �•. HOMEOWNER-BUILDER DECLARATION " Name I��Q W�� AfCg Te I hereby affirm that'I am exempt.from the Contractor's License Law n� 1 for the following reason(Section 7037.6, Business and Professions Address I W 1,M 2;kg* fzn 3307 20.511 Code): City TC- L C ( Tel.No.2 g 1 ITEMS I,as owner of the property,will do the work and the structure , I is not Intended or offered for sale(Section,7044, Business ; I TOTAL 20 e 50 and Professions Code). CASH ((�� r}i �! `.•ASH 20 s 513 CONSTRUCTION LENDING AGENCY '� � I � I 1 hereby affirm that there is a construction lending agency for the CHANGE e[0 Performance of the work for which this permit is issued(Sec.3097, 1 Civ,C.) i I Lender's Name 0030-13001 10/11/90 .� 3264 1 AM Ill-27 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 I J representatives of this County to enter upon the above-mentioned ' property forpacti n purposes. q I SEE REVERSE FOR EXPLANATORY LANGUAGE to a-V,P- N99VT =ea Tet?IE I A19)12i L G-1f Z4