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Home My Public Portal About9945 LOWER AZUSA RD_Plumbing__ •_ ,��,�%PRKERS'COMPENSATIgN DECLARATION APPLICATION FOR PLUMBING PERMIT i he that I have a certificate o{consent to self 20-0026 DPW 6/87 s insi.i4ror a certificate of Workers'Compensation Insurance, 76A667A f or a certified copy thereof(Sec 3800. Lab C ) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No 10-04896Compony CNA Ins- Co- Certified copy is hereby furnished (''�� FOR APPLICANT TO FILL IN PRINT OR TYPE BUILDING 01 Certified copy is filed with the county building inspec- ( 1 ADDRESS 9945 Lower Azusa, T. C. tion department NUMBER FIXTURE OR ITEM FEE LOCALITY Date 9-19—RR Appligant Chien Rr0Q PlbB. WATER CLOSET — NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST COMPENSATION INSURANCE OWNER (This section need not be completed if the work Involved by MAIL SHOWER the permit Is for one hundred dollars(=100)or loss) LAVATORY RESS 9170 E. Las Tunas Dr. 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 CITY Temple City TEL NO 286-0855 so as to become subject to the Workers'Compensation Laws DISHWASHER c°NrRACTOR Owen Bros. MR. Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR - Exemption, you should become subject to the Workers' SWIMMING E1 Monte TEL No 443-0078 Compensation provisions of the labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE 231 741 LIC 36-20 deemed revoked WATER HEATER LICENSE NO LICENSED CONTRACTORS DECLARATION DISTRICT NO SSED BY 1 hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS C� (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER CJQ yy.. and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION O: License Number 231 74 1 Lic Class C 36-20 DATE p FINAL C: Contractor Owen Bros. Date 9-12-88 1BY o ❑ 1 am exempt under Sec U Lrl B&P C for this reason n' Plan check fee Z Z Date PLUMBING PERMIT ISSUING FEE 3 0 f6 Signature TOTAL FEE Q 0 9 9.8 A Plan check applicant SINGLE FAMILY # • • • • • Jr HOME OWNER-BUILDER DECLARATION Nome • * 4(150 1 hereby affirm that I am exempt from the Contractor's License Address • • • 4(15.0 Law for the following reason (Section 7031 5, Business and Professions Code) City Tel No 1 Q26-88 ❑ 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 hove 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 reprelentatrves of this County to enter upon the -r.Jntioned props or inspection purposes � SEE REVERSE FOR EXPLANATORY LANGUAGE 6" 'l02 T-gnature of PerriVee Date WORKER'S COMPENSATION DECLARATION 76AO5ADPw9,89 APPLICATION FOR PLUMBING PERMIT 1 hereby aiflrm�tet I have a certificate of consent to self insure, or a certificate of Worker's Corflpensation Insurance,or a certified copy thereof(Sec 3860 Lab C) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORDS DEPT.OF PUBLIC WORKS DIV. Policy No Company - ' ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING A� �y 11 p ElCertified copy is filed with the county building inspection � � 'D y�.F- department NUMBER FO(TURE OR ITEM FEE LOCALITY Date Applicant WATER CLOSET/ NEAREST C' CERTIFICATE OF EXEMPTION FROM WORKERS' BATH CROSS ST COMPENSATION INSURANCE TUB ASSESSOR (This section need not be completed If the work involved by the SHOWER MAP BOOK PAGE ' L.P�ARCEL permit Is for one hundred dollars($100)or lose) 2 LAVATORY OWNER �L) T LJ C-1 L I certify that in the performance of the work for which this permit is issued, I shall not employ any person any manna o SINK ADDRESS become subject to the Workers'Com tlo Law DISWASHER CITY TEL NO Date Applicant CLOTHES WASHER CONTRACTOR5f'>C� NOTICE TO APPLICANT If, of ng this Certificate of c>� Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ;1 S( 3QlA�K�{V� provisions of the Labor Code,you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY ,c)` TEL NO 531-403 7, �- I hereby affirm that 1 am licensed under provisions of Chapter 9 WATER HEATER a L�. E LIC (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LLIICENSE NO 6140 W1 CLASS J71 8 Professions Code,and my license is in full force and effect OUTLETS OVER DISTRICT NO PROCESSED BY � �,'^ 5 PER SYSTEM �D� Q License Numb— 640.10 Lic Class FINAL ATE VALIDATION W D Contractor le� �S.Jl J� Date DATE co FI ❑ I am exempt under Sec BYNAL ACCT a 14 Z B a,P c for this rasa«, 3303 74.10 Date Plan check fee PLUMBING PERMIT ISSUING FEE$ 410 ► 1 ITEMS SignatureTOTAL 74 . 10 ❑ TOTAL FEE D GHEC K 74.10 SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name (HAME °0a I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031 5, Business and Professions Address Code) 0000—MOl 5/22/95 • ❑ I,as owner of the property,will do the work and the structure City Tel No is not intended or offered for sale(Section 7044, Business 0526 AM �20 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 Pol.information is correct I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize rep--Gnnn'&ativeMty to enter upon the above-mentioned operty i apeclion purposes SEE REVERSE FOR EXPLANATORY LANGUAGE StW2� ature of Permittee Date • c COUNTY OF LOS ANGELES TEMPLE CITY 0 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0108140021 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL 10: FEES PAID BUILDING u BK: 17 PG: 52 PC: 1 9945 LOWER AZUSA:RD ' FEE DESCRIPTION: QUANTITY: LION: AMOUNT: TEMP CA 917804041 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: BALDWIN 8589-025-045 01 PERMIT ISSUANCE FEE, 27.75 THOMAS PAGE: 597 GRID: B5 LOCALITY: TEMPLE CITY 05 BACKFLOW DEVICES) 1.00 DEV 16.20 TENANT: 15 DRINKING FOUNTAIN(S) 1.00 FIX 16.20 . TEMPLE CITY ARTIFICAL KIDNEY CENTER 17 FLOOR DRAIN(S) 4.00 FIX 64.80 03/21/02 JK 09/17/02 . 19 FLOOR SINK(S) 9.00 FIX 145.80 OWNER: TEL. NO: 25 LAVATORIES/SINKS 15.00 FIX 243.00 . AMMAD, BASHIR - 27 PRESS REG DEVICE(S) 1.00 DEV 16.20 717 W. FOOTHILL BLV 41 TRAP PRIMER(S) 2.00 SYS 32.40 MONROVIA CA 91016 45 WATER CLOSET/URIMAL 4.00 FIX 64.80 low Of WUR 47 WATER HEATER(S) 1.00 NTH 16.20 T. ., NEY SINKS, TOILET, WASTE, WATER VENT SYSTEM, BOILER 49 WATER TREATING EQUIP 1.00 SYS 16.20 R/0 LOOP APPLICANT: TEL. NO: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 --' GOLDEN CONTRUCTION (714) 549-9309- 55 GAS METER (PRIVATE) 1.00 MET 16.20 P.O. BOX 1872 56 GAS REGULATOR 1.00 REG 16.20 SPECIAL CONDITIONS: CAOSTA MESA CA 92628 60 OW REPAIR SYS 16.20 50.55 9 L P E LE S C 437.40 CONTRACTOR: TEL. MO: APPROVALS DATE INSPECTOR SIGNATURr- GOLDEN CONSTRUCTION (714) 549-9309- TOTAL T� 1,212.30 P. 0. BOX 1872 LIC. NO .AL COSTA MESA, CA 603827 B WATER SERVICE ARCHITECT OR ENGINEER: TEL. NO: - PLASTIC Y/N METAL Y/N KINCANNON ARCHITECH (714) 730-5995ROUGH PLUMBING - 13691 REDHILL AVENUE _ LIC. NO: 111111 TUSTIN CA 92680 _ C10523 GAS PIPING GAS VENT PUBLIC WORKS] HOT WATER HLAIM UMUMMERSGAS TEST UTILITY COMMyr-RUrUlIff Z - - - -- - - ` Service 7hat� tCWV 5 GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: OS0508