HomeMy Public PortalAbout6038 MUSCATEL AVE_Plumbing__ ��- WCARKERS'CgMPENSATION DECLARATION ,q PPL Irk /;a Y M N FOR
P L n 11 Gi�MIC P p�Eft�1/ 17
Y 20-0026 DPW 4/87 6'� FS l4slr�1 ff If' V t1�Yll [lI�J� fps d\Cd4'7t] ll
sixebiylbirm thvY I have a certificate of consent to self in- 76A667A
sere,Cr a ifertificate of Workers'Compensation Insurance,or a CE 817(REV.8/86)
• certified copy thereof(Sec. 3800, Lab. C.)
Policy No.��e�Company COUNTY OF LOS ANGELES DEPT. OF PUBLICWORKS
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 ADDRESS mcna
department. @ FEE
LOCALITY
Date 7- Applicant C YI WATER CLOSET(TOILET)
NEA RxS7
i{7j r
CERTIFICATE OF EXEMPTION FROM WORBATH TUB CROSS ST.U V
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed if the work involved by MAIL -
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS p P
I certify that in the performance of the work for which this per- / SINKCITY TEL. NO.
`
mit is issued, I shall not employ any person in any manner so ' s
as to become subject to the Workers'Compensation Laws. DISHWASHER n
CONTRACTOR l�D
Date Applicant CLOTHES WASHER ADDRESS >? `
NOTICE TO APPLICANT: If, after making this Certificate of Ex- AIM
SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY TEL NO.
cation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM t
ly with such provisions or this permit shall be deemed revok- STATE LIC
ed. WATER HEATER ii O LICENSE NO. 2 6 CLASS
LICENSED CONTRACTORS DECLARATION V DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter ! GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER (�
fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL _ VAL AT90GN O
/Z DATE
License Number 2 Lic. Class /� V
7 FIN I=
Contractor Date L BYO
t—
I am exempt under Sec. W
IL
B.&P.C. for this reason
Plan check fee _
Date: PLUMBING PERMIT ISSUING FEE$ (037
Signature TOTAL FEE Y60 5—d
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby affirm that I am exempt from the Contractor's License Name 2 0 2 9 3 A
Law for the following reason (Section 7031.5, Business and
Professions Code): Address # 0 0 a o 0 5
I, as owner of the property, will do the work and the City Tel. No. ( o o 4 6 5 0
structure is not intended or offered for sale(Section 7044, 0 - 46505
Business and Professions Code).
CONSTRUCTION LENDING AGENCY 07.28-88
1 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.). L
Lender's Name 's 7�t L1
Lender's Address da-)&_J
I certify that I have read application and state that the
above information is correct.I agree to comply with all County D
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned property for inspection purposes.
— Z SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee <3 1 v f Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1002160002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID I BUILDING ADDRESS:
ITR: 5903 LT: 66 I 6047 MUSCATEL AV N
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ SGAB CA 917752656 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
15386-008-038 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
I 147 WATER HEATER(S) 1.00 WTH 16.20 [ I
[TENANT: 63 WATER PIPING BR/FIX 5.00 FIX 33.75 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: [
1 +64 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 102/16/10 SR 02/16/11 1
1 TOTAL FEES 93.90 1 I
OWNER: TEL. NO: I IFINALDATE FINAL BY: CODE:
SHIN, DAVID (626) 232-7411- [ 1
16047 MUSCATEL AVE. 1 I ]
ITEMPLE CITY CA 91780 I IDESCRIPTION OF WORK I
I I ]COPPER RE-PIPE, NEW WATER HEATER AND WATER MAIN
]
(APPLICANT: TEL. NO: 1 I 1
IS O S PLUMBING (626) 859-0301- [ I ]
1729 E. ARROW HWY. [ ISPECIAL CONDITIONS: I
IAZUSA, CA 91702 [
CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I
IS 0 S PLUMBING (626) 859-0301- 1 1 1
1729 E ARROW HIGHWAY LIC. NO I [UNDER SLAB WORK I I
[AZUSA, CA 91702 693502 C36 I I ] I 1
I IWATER SERVICE ] [ [
I I IPLA$TIC Y/N METALN 171 [
ARCHITECT OR ENGINEER: TEL. N0:
I - I IROUGH PLUMBING 1 I
[ LIC. NO: I
I I I
I I IGAS PIPING I I I
[GAS VENT
I I I
I [ [HOT WATER HEATER
I IPLUMBING FIXTURES I I I
ILAWN SPRINKLERS I ]
I I I
IGAS TEST I I I
I I I
] I (UTILITY COMPANY NOTIFIEDI I
I I I� I I I
[ I IGRAY WATER SYSTEM
I I I
I ] I I I I
I I I I I
I I I I I I
IREPORT ID: DPR263 ROUTE TO: BSO508 1 I [
I I ] I I I