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Home My Public Portal About9574-9576 LOWER AZUSA RD_Plumbing__ WORKERS COMPENSATION DECLARATION 76A667A I herdby affirnt that I have a certificate of consent to self CIS SO (x 80) APPLICATION FOR PLUMBING PERMIT insure or a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) COUNTY OF LOS AN(i 1L AFETY Policy No Company Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE BUILDING ADDRESS � Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE department LOCALITY p WATER CLOSET Date Applicant NEAREST BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE SHOWER OWNER �'� MAIL (This section need not be completed if the work involved LAVATORY ADDRESS A}. by the permit is fol one hundred dollars ($100) or less) S 1 N K CITY ! 6B EL NO U I certify that in the performance of the work for which this DISHWASHER /f / O permit is issued I shall not employ any person m any manner CONTRACTORaamd (tee' so as to become subject to the Workers Compensation Laws CLOTHES WASHER ADDRESS (~j Date Applicant SWIMMING POOL RECEPTOR ZMEZZ IF. tlJ NOTICE TO APPLICANT If after making this Certificate of CITY Ameawd TEL NO N Exemption you should become subject to the Workers LAWN SPRINKLER SYSTEM STATE LIC ? Compensation provisions of the Labor Code you must forth WATER HEATER LICENSE NO CLASS C^ with comply with such provisions or this permit shall be AWC7�' deemed revoked GAS SYSTEM OUTLE`T'S DISTRICT NO ESSED BY LICENSED CONTRACTORS DECLARATION d OUTLETS OVER V 6� I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Bust FINADATED r AL DATI N ness and Professions Code and my license is in full force and effect r ° License Number,C/�iL�j�t 27r Lic Class In-71C FINAL BY Contractor Date A&11"y I am exempt from the licensing requirements as I am a Plan Check FBC licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ t acting in my professional capacity (Section 7051 Bus mess and Professions Code) TOTAL FEE Lic or Reg No Date Plan check applicant HOME OWNER BUILDER DECLARATION Name :93251 A I hereby affirm that I am exempt from the Contractor a Address License Law for the following reason (Section 7031 5 Busi City Tel No # e e e • • 5 ness and Professions Code) 2 - 127,00 I as owner of the property am exclusively contracting with licensed contractors to construct the project e 1 (Section 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY 1201 -80 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing and hereby authorize representatives of this County to enter upon the above mentioned property for inspection purposes � SlIlliffture of Permittee Date f WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A insure or a certificate of Workers Compensation Insurance CE 817(REV 10/81) n or a certified copy thereof(Sec 3800 Lab C ) COUNTY OF LOS ANGELES 7•` BUILDING AND SAFETY Policy o P�g696—'Mmpony Ce copy is hereby furni hodFOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 9� —p /g�erfified ertified copy is filed with the county building inspec ADDRESS i✓lj 7 tion depart ent NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Appli4ant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE (This section need not be completed If the work involved by SHOWER OWNER MAI the permit is for one hundred dollars($100)or less) LAVATORY ADDRESS q I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner SINK d s` CITY TEL N0 �/3� so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR Date A plicant CLOTHES WASHER ADDRESS d NOTICE TO APPLICANT If after making this Certificate of Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM CITY TEL NO x'31 .� with comply with such provisions or this permit shall be STATE �'( LIC deemed revoked WATER HEATER LICENSE NO v q 7q CLASS /3-,4 LICENSED CONTRACTORS DECLARATION DISTRICT NO NFOCIESSeD BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS s-,0J",— (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER d and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION License Numbera7'"7`' Lic Class 19-1 DATE V ' 09 Contractor Date FINAL O ❑ IV I am exempt under Sec B 8P C for this reason a Plan check fee Date PLUMBING PERMIT ISSUING FEE$ v Sd Signature TOTAL FEE Q d SINGLE FAMILY Plan check applicant HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor s License Low for the following reason (Section 7031 5 Business and Address 4 4 9 q O A Professions Code) I City Tel No # a e e s v 5 ❑ I as owner of the property will do the work and the structure is not intended or offered for sale (Section ► 2 e e 70.50 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY e ° JD"7 O 5 05 I hereby affirm that there is a construction lending agency for i t the performance of the work for which this permit is issued CIS 06 —84 (Sec 3097 Civ C ) Lender s Name Lender s Address 1 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 jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE �a S=q ly* Signature of flermittee Date WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have o certificate'bf consent to self in 7DPW 4/90D sure or a certificate of Workers Compensation Insurance or a • • certiRed copy hereof(Sec 3800 lab C ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Policy No Company Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �^ Certified copy is filed with the county building inspection ADDRESS of department NUMBER FIXTURE OR ITEM FEE LOCALITY Date Applicant WATER CLOSET(TOILET) r NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS sT r { COMPENSATION INSURANCE OWNER SHOWER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or loss) LAVATORY ADDRESS I certify that in the performance of the work for which this per SINK mit is issued I shall not employ any person in any manner so CITY TEL NO as to become subject to the Workers Compensation Laws , DISHWASHER s -CONTRACTOR [/Date 1po Applicant CLOTHES WASHER ADDRESS /y�(,,� tTs✓+l V'c NOTICE O APPLICANT If after making this ertificate of Ex SWIMMING POOL RECEPTOR emption you should become subject to the Workers Compen CITY t TEL NO sation provisions of the Labor Code you must forthwith comp LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok STATE LIC ed WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATIONDISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM 3--'OUTLETS �y y 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER R �j' / and Professions Code and my license is in full force and of HOSE BIB FINAL 9 VALIDATION } fect / DATE License Number 4>'3 Lic Class CIL 6O FINAL + tJ Contractor ?'may Date BY 0a; fC CT e ¢ 1 am exempt un er Sec - — 53W ~ 5�t. t JB 8P C for this reason -3 µ Plan check fee ► 1 j�'EI�:, Date PLUMBING PERMIT ISSUING FEE$ T11TAL It._4 OA Signature TOTAL FEE CHECK 54.ULl SINGLE FAMILY k hecapplicant HOME OWNER BUILDER DECLARATION Plan cPPicant t' GE .1.10 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 WW—Ml -t/28/94 I as owner of the property will do the work and the City Tel No 4920 1 PM 4;437 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 ) Lenders Name ' be�fvr 6,011 Ilk c. 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 above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date �( WQRKERS COMPENSATION DECLARATION 76Aa67A I hereby affirm that I have a certificatq of consent to self C6 sig (:ae) A P P L I C A T I N FOR `PLUMBING PERMIT insure or alcelrtificade of Workers Compensation Insurance or a certified copy th rof(Sec 3800 La JL/Policy Noo G ^ COUNTY OF LOAN LES BUILDING AND SAFETY Company 0 Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Q ADDRESS 7 ._ / �o� Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE J 04i eY u o� \ de`art eek �o ` ��G WATER CLOSET NEAREST Tel-LOCALITY �A C } \Datezjl.2._W Applicant D i ))) BATH TUB CROSS ST e/ Le ei CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE SHOWER OWNER (;RJ1J6Illy LAVATORY MAILII�� / l� (This seebon need not be completed if the work involved ADDRESS 3 Q 1✓e-LujJ DY by the permit is for one hundred dollars ($100) or less.) SINK CITYlc� TEL NO - U aL 0-s uey p I certify that in the performance of the work for which this DISHWASHER O permit is issued I shall not employ y person in any manner CONTRACTOR ��/ so as to become subject to th Compensation Laws CLOTHES WASHER ADDRESStPR Date Applicant SWIMMING POOL RECEPTOR —�NOTICE TO APPLICANT If after making this Certificate of CITY �,/ Le avo CA Exemption you should become subject to the Workers LAWN SPRINKLER SYSTEM STATE r � / Z Compensation provisions of the Labor Code you must forth WATER HEATER LICENSE NO S�7o�o with comply with such provisions or this permit shall bedeemed revoked GAS SYSTEM OUTLETS DIISTRICT NNO EIS SED B LICENSED CONTRACTORS DECLARATION OUTLETS OVER J`Qa I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi FINAL VALIDATION — ness and Professions Code and my license is in full force and V ¢�, DATE effect <Lic`ense Number ��Gd Lic Class— 3 BY A i Contractor b � /I#L C. Date 10 —g �13 Plan check fee I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ 334-0 acting in my professional capacity (Section 7051 Bus loess and Professions Code) TOTAL FEE 6 Lic or Reg No Date Plan check applicant HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractors Address License Law for the following reason (Section 7031 5 Busi ICIty Tel No ness and Professions Code) ;22757A I as owner of the property am exclusively contracting with licensed contractors to construct the project �I�'- r�V4+2.1 J # • • • • •5 (Section 7044 Business and Professions Code) 2 000 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency • • • 1 Q 0 Q 2i for the performance of the work for which this permit is issued(Sec 3097 Civ C) f 023-8o 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing and hereby authorize repr atives of this County to enter upon the a e tion perty for inspection purposes 3 - Signature o erm tree Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0902260001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT i LEGAL ID FEES PAIDI BUILDING ADDRESS ITR 12998 LT 20 BL 001 I 9576 LOWER AZUSA RD FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917804224 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET TEMPLE_ CITY 18592 001 061 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID A5 , LOCALITY TEMPLE CITY C) 125 LAVATORIES/SINKS 1 00 FIX 16 20 TENANT 47 WATER HEATER(S) 1 00 WTH 16 20 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON TOTAL FEES 60 15 02/26/09 SR 08/25/09 (OWNER TEL NO FINAL DATE FINAL-BY CODE TANG JIAN JUN (626) 375 1060 9576 LOWER AZUSA RD TEMPLE CITY CA 91780 I D SCRIPTION OF WORK MISC PLUMBING FIXTURES WATER HEATER AND SINK APPLICANT TEL NO D T K CONTRUCTION INC (323) 261-1388- 855 MONTEREY PASS RD SPECIAL CONDITIONS (MONTEREY PARK 91755 CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE D T K CONSTRUCTION INC (323) 261-1388 855 MONTEREY PASS ROAD LIC NO UNDER SLAB WORK MONTEREY PARK CA 91754 637017 B WATER SERVICE PLASTIC YIN METAL YIN IIi ARCHITECT OR ENGINEER TEL NO ROUGH PLUMBING LIC NO GAS PIPING OTVENT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST li UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM I I I� _ REPORT ID DPR263 ROUTE TO BS0508 I '