HomeMy Public PortalAbout5414 A & B MCCULLOCH AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION 76A667A 1
I,h'efeby- affirm that 1 have g certificate of.consents to self ,-:. .CE,6,;1R-6o);. •A P P:L K A T I O N FOR P L U M]I N G. P:E R M I T
insure,:ora certif'cate of Workers'Compensation Insurance,or
a certified copy,thereof(Sec.3800;Lab.C.)
'WCg4f1'��7 Aetna In4Lr_ Co. COUNTY OF LOS ANGELES 'BUILDING AND SAFETY
Policy No . ,Company
O Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE ADDRESS 54'14 A&B N. McCulloch Ave.
'department. LOCALITY Te. le Cit
Date 8=6-30 Applicant.OWPn Rrna_ Plilmhing I WATER CLOSET Q O Y
NEAREST
BATH TUB CROSS ST. Daes• Dr. . •.
CERTIFICATE OF EXEMPTION FROM WORKERS' m-
COMPENSATION INSURANCE SHOWER OWNER Sharon .0. Lee
LAVATORY MAIL
(This section need not be completed if the work involved ADDRESS 4:265 N. Baldwin Ave: 0
by the permit is for one hundred dollars ($100) or less.) SINK
CITY E1 Monte TEL.NO. 443-00 78 C)
I certify that in the performance'of the work for which this DISHWASHERIE
permit is issued, I shall not employ any person in any manner A 00 CONTRACTOR ,Owen Brod. PlumLing, -Inc-] p
so as to become subject to the Workers'Compensation Laws. CLOTHES WASHERto I
Date Applicant ADDRESS4269 N. Baldwin Ave'
SWIMMING POOL RECEPTORC
NOTICE'TO APPLICANT: If, after making this'Certificate of CITY El Monte TEL.NO. 443-00'7.8
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM
STATE LIC.
Compensation provisions of the Labor Code,you must forth- WATER HEATER LICENSE NO. 231741 CLASS C36-20
with comply with -such provisions or this permit shall be
deemed revoked. GAS SYSTEM OUTLETS /_ DISTRICT NO. PR ESS_ED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER L[� 1^^01
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM J .
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATEr �
effect.
' FINAL
License Number. 231.741 Lic.Cis' C36-20 BY .—
ContractorOWAn Rrria Pl•h je Tnc
I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
mass and Professions Code). i TOTAL'•FEE
Lie..or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
� � .• .
I hereby affirm that I am exempt from the Contractor's Address F 1.6 5 5 nK
License Law for the following reason (Section 7031.5, Busi- City Tel.No. o a C.0 e
ness and,Professions Code):
ElI, as owner of the property, am exclusively contractingt, 2 ° ° 91,00
with licensed contractors to construct the project - ,i
(Section 7044,Business and'Professions Code): o a v 9 n( u
CONSTRUCTION LENDING AGENCY F 1 1 —3 0
I hereby, affirm that there is a construction lending agency
for the performance of the work for which this permit is
issued(Sec.30.97,Civ.C.).
Lender's Name r'
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 r esentatives of this County to enter upon the i
(01 - n 'on property foM' tion purposes.
-80 '
SignaMr of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1401290012
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS:
ITR: 35757 UN: 3 I 1 5414 MCCULLOCH AV B
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917803561 ]
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET:
I I
8573-014-057 01 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY CAI
47 WATER HEATER(S) 1.00 WTH 16.20 I I
ITENANT: TOTAL FEES 44.00 ISSUED ON: PROCESSED BY: PLAN BY:
101/29/14 SR
OWNER: TEL. N0: I (FINAL DATE FINAL CODE: 1
ITACHIBANA TANEAKI;GRACE M (626) 448-6354- I I I
15414 MCCULLOCH AV 1 3/3 //-/
ITEMP 917803561 1 IDESCRIP ION OF WORK
I (WATER HEATER CHANGE OUT 40 GAL
1APPLICANT: TEL. NO: ] I I
(BLOCK, KEN (951) 345-4083-
130300 PUERTA VALLART 1SPECIAL CONDITIONS: I
IMANIFEE CA 92584 I 1
I I
]CONTRACTOR: TEL. NO: i (APPROVALS DATE INSPECTOR SIGNATURE ]
1ALL STAR WATER HEATER, INC. (951) 301-0067- 1
130300 PUERTA VALLARTA WAY LIC. NO (UNDER SLAB WORK ] I I
IMENIFEE CA 92584 812894 1 I I I
I IWATER SERVICE
I [PLASTIC Y/N METAL Y/N
(ARCHITECT OR ENGINEER: TEL. NO: ] I I
[ - I IROUGH PLUMBING [ ] I
1 LIC. NO: I I I I
[ I IGAS PIPING
I I IGAS VENT
[ iiHOT WATER HEATER
I IPLUMBING FIXTURES (/
I
[ I ILAWN SPRINKLERS I I
I � I
I IGAS TEST
I I
1 (UTILITY COMPANY NOTIFIED( 1
I I IC ] I
IGRAY WATER SYSTEM
[ IREPORT ID: DPR263 ROUTE TO: BS0508 ] I I I
I I I I I I
I t
1
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ((PP MBING PERMIL
DEPARTMENT OF PUBLIC WORKS 1 9701 LAS TUNAS pq2 08 0001190010
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BU3 DING ADDRESS:
TR: 35757 UN: 3 54CULLOCH�V B
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: a-CAS 1280356
ASSESSOR INFORMATIO NUMBER: INEAR EST'-CROSS--STREET:
8573-014-057 .01 PERMIT ISSUANCE FEE 27.75 �TH&AS-P-AGE-597 GRID: D3 LOCALITY: TEMPLE CITY
47 WATER HEATER(S) 1.00 WTH 16.20
TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLA BY: EXPIRES ON:
01/1900T 07/17/00
OWNER: TEL. NO: FINAL'DA rr��- FINAL BY: CODE:
TACHIBANA TANEAKI;GRACE M (626) 448-6354- li✓7 Q,
5414 MCCULLOCH AV vCJ
TEMP 917803561 DESCRY0 _OF-WORK
jnA OU7�F WA•T-ER-H
APPLICANT: TEL. NO:
A L A P ASSOCIATES (818) 407-1247-
7229 VARNA ST. SPECIAL CONDITIONS:
N. HOLLYWOOD, CA :71_ _
0 c
CONTRACTOR: TEL. NO: !` �j 4 10 APPROVALS DATE INSPECTOR SIGNATURE
A L A P ASSOCIATES (818) 407-1247- id fP
7229 VARNA ST LIC. NO \ NDER'SLAB WORK
NORTH HOLLYWOOD CA 771905 C36
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO: - I
ROUGH PLUMBING
LIC. N0: f
F L — � �I GAS PIPING
GAS VENT
�I II r1( n,�f��1i + HOT WATER HEATER
--_L-� `�•' LJ IJ �J' PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
TILITY COMPANY NOTIFIED
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS05O8
I
•I
i