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Home My Public Portal About6031-6035 MUSCATEL AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION4/87 APPLICATION FOR PLUMBING PERMIT hereby,,affirm that I have a certificate of consent to self in- 76A66jA/ � sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV.8/86) ,ILMI certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company ❑ Certified copy is hereby furnished. Certified co is filed with the count building p FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING D Ave.copy� y gins inspection ADDRESS C department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY p Date y�Applicant WATER CLOSET(TOILET) NEAREST Y i, , m eL CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST e COMPENSATION INSURANCE SHOWER OWNER A V& (This section need not be completed If the work involved by MAIL the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL. NV mit is issued, I shall not employ any person in any manner so as to become ubject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date ApplicantLOACLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after maki this rtificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. `� PROC D BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS //1 9(commencing with Section 7000)of Division.3 of the Business OUTLETS OVER fe d,Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDA N DATE License Number Lic. Class V FI Zy 11C Contractor Date I am exempt under Sec. W B.BP.C. for this reason Plan check feeCO)�7947A N Date: PLUMBING PERMIT ISSUING FEE$ Signature # 0 0 0 0 0 5 TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant o 0 2$ 5 p 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 0 o o 2 a 5 Qv I, as owner of the property, will do the work and the City Tel. No. 9 , 8-87 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 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 aboy entioned property f r nspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE S1 ature of Per ltee Di to COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508-9809140040 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEG ID: FEES PAID -B I D NG ADDRESS: TR: 5903 LT: 72 .6031-MUSCATEL AV N FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917752656 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5386-008-049 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT- 21 HOSE BIBB(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN EXPIRES ON: 25 LAVATORIES/SINKS 2.00 FIX 32.40 09/14/98 UT 09/14/99 45 WATER CLOSET/URINAL 1.00 FIX 16.20 OWNER: TEL. NO: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 FINAL DATE FINAL BY: CODE: DAVIS;JOHN (626) 286-5740- 64 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 6031 MUSCATEL AV TOTAL FEES 141.15 SCAB 917752656 DESCRIPTION OF WORK PLUMBING-FOR ADDITION AND NEW MA N WATER LINE APPLICANT: TEL. O: ARMANDO LARA'S PLUMBING SERVICE (626) 794-2242- 1712 MENTONE AVE. SPECIAL CONDITIONS: PASADENA, CA GELES Co CONTRACTOR: ARMANDOLARAIS PLUMBING SERVICE (626)NO: APPROVALS DATE INSPECTOR SIGNATURE 794-2242- d�5 ��Ay 1712 MENTONE AVENUE LIC. NO UNDER SLAB WORK PASADENA, CA 91103 510050 C36 WATER SE IC P N METAL /N ARCH I TECTOR E G E TE 0: ?! ROUGH PL MBI G A9 LIC. NO: {' 1111111 GAS PIPING P U D L C W G� GAS VENT HOT WATER HEATER PLUMBING FIXTURES 00 0jAWN P INKLERS o- b ❑ ��a® GAS TEST I' �5 UTILITY COMPANY NOTIFIED 46��c Serya ice �0 Cw GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508