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Home My Public Portal About5827 MUSCATEL AVE_Plumbing__ �7WORKEFI'SCOMPENSATION DECLARATION 2D-0026 APPLICATION FOR PLUMBING PERMIT 11 76A667A I he y af!Irmthatd have a certificate of consent to self Insure, ora tPrt-44:te•nf Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.6) " ' COUNTY OF LOS ANGELES -DEPT.OF PUBLIC WORKS ��DEPT.OF PUBLIC WORKS DIV. Policy hereof 1c9�p4pany e.p� ❑ Certified copy is hereby furnished. 1 'a �}, . •,'•ti ,• • 1' FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 5827 Muscatel UILDING Certified copy Is filed with the county building Inspection department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY' - L e Date 617 6194 Applicant Carl Pink P l h g 3 WATER CLOSET y 3 NEAREST CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 0 ASSESSOR COMPENSATION INSURANCE (This section need not be completed if the work involved by the 2 SHOWER 2 0 0 MAP BOOK PAGE PARCEL permit Is for one hundred dollars($100)or less.) 3 LAVATORY 309 OWNER WeStCO Land, Inc I certify that in the performance of the work for which this permit is issued, I shall not employ any person In an manner so as to MAIL 9088 E Las Tunas Y SINK ADDRESS E. become subject to the Workers'Compensation Laws. 1' DISWASHER 10 0 clTYTemple City TEL.NO. •� Date Applicant 1. CLOTHES WASHER 1 3 0 CONTRACTOR Carl- Fink , �,. P NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL.RECEPTOR provisions of the Labor Code,you must forthwith comply with such I ADDRESS 464 S. Cataract provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY San Dimas TEL.NO.�[/ _�cY1 a 1 hereby affirm that I am licensed under provisions of Chapter 9 1' WATER HEATER 1 ONO =�V (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS L CENSE NO. 4 5 2 0 1 6 CLASS STATE LIC. (n- 4, V Professions Code,and my license is in full force and effect. 1 5 1 0 0 OUTLETS OVER DISTRICT NO. ROCESSED BY 1 5 PER SYSTEM 70 I O fr C License Number 4 5 2 01 6 Lir.Class C-36 �J I' 2' Hosebibbs A260 V FINAL ..Q V LI ATION W Contractor carl Fink Plumking 8/19/95 DATE • U fA ❑ I am exempt under Sec. FINgy AL - Z B.&P.C.for this reason ,.• Date: Plan check fee p i '-'-~•a Signature PLUMBING PERMIT ISSUING FEE$ , ��'+-��) '28. .A21` ❑ TOTAL FEE lim wo `H SINGLE FAMILY Plan check applicant TOTAL_ 211—:17 ® 9 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law €� C'` for the following reason (Section 7031.5, Business and Professions Address CHANGE r, 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 7044, Business , !31300-0,1310,1 ,t/ 1/74 and Professions Code). _ 70.4 31 AM11:15 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 ceve read s application and state that the above , formation is coftect. I re to comply with all County ordinances nd Stat e%laws regula 1 Plumbing, and hereby authorize rep tatives of this C my to enter upon the above-mentioned ,property fo spection oses.` SEE REVERSE FOR EXPLANATORY LANGUAGE 1 /31 /94 Sienatura of Fackrunhia Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby;affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90 76A667A sure,or a certificate of Workers'Compensation Insurance,ora , certified copy thereof(Sec. 3800, Lab. C.) I COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. ,rCom an P Y i Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 2 EJCertified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Ddte Applicant WATER CLOSET(TOILET) NEAREST M lb-y CERTIFICATE OF EXEMPTION FROM WORKERS' I BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER r (This section need not be completed if the work Involved by MAIL the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which th' r- SINK CITY T W�.d Q TEL.NO. 06 363� mit is issued, I shall not employ any per ' any m so as to become subiect to the Workers o nsatio DISHWASHER CONTRACTOR Date., Appi;cant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Cel' icate of Ex- SWIMMING POOL RECEPTOR / emption,you should become subject to the Workers'Compen- CITY v� TEL.NO. 503' 77 I sation provisions of the Labor Code,you must forthwith comp- L4 LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- b o STATE ,`n LLic. �7 ! ed. WATER HEATER LICENSE NO. 5�` �� i LICENSED CONTRACTORS DECLARATION DISTRICT NO. ZZE11 I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS A 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALI ION fect. HOSE BIB DATE $ >. License Number 5`0 313 Lic. Class �� O A FINAL 0 Contractor?A 1 a NLD�1W3 Date J Z�/V BY Q r-11 am exempt under Sec. I� ' t° r V B.BP.C. for this reason d Plan check fee ► rn Date: PLUMBING PERMIT ISSUING FEE$ T 1 EM_, Z Signature ® TOTAL r� 20 TOTAL FEE 9'"��'°" SINGLE FAMILY 813.t:1 Plan check a licant ' '`6 HOME OWNER-BUILDER DECLARATION- P � I hereby affirm that I am exempt from the Contractor's License Name K QZ� Ivi� �3t °i i(: Law for the following reason (Section 7031.5, Business and Professions Code): Address �� G94 f" ❑ I, as owner of the property, will do the work and the City �vG(f Tel. No. 7q7 7,1 c�'"�f structure is not intended or offered for sale(Section 7044, 5- i AM 9%46 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 have read this application and state that the above information is co rect.I agree to comply with all County ► ordinances and State ws regulating Plumbing, and hereby authorize represe tat es of this County to enter upon the abo�enfisied rty for inspection purposes. _ — SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ermittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0601170026 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 ERT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 0000319 LT: 112 5827 MUSCATEL AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91776 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ELM 5387-007-016 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C 47 WATER HHATER(S) 1.00 WTH 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 01/17/06 JK 07/16/06 OWNER: TEL. NO: FIN DATE FINAL BY: CODE: WANG, JOHN (626) 287-1057- Z 5827 N. MUSCATEL SAN GABRIEL CA 91775 DD SCRIPTION OF WORK WATER HEATER CHANGE OUT APPLICANT: TEL. NO: 1 TEKAWA (310) 515-1311- 17111 S. BROADWAY SPECIAL CONDITIONS: GARDENA, CA 90248 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE ACTION CONTRACTORS (310) 515-1311- 17111 SOUTH BROADWAY LIC. NO UNDER SLAB WORK GARDENA, CA 90248 652535BC36 WATER SERVICE PLASTIC YIN METAL YIN ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES � LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508