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Home My Public Portal About6129 MUSCATEL AVE_Plumbing__ :vr ' WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 20-0026 DPW 4/87 n 1iEreby,.affirm that I have a certificate of consent to self in- 76A667A 'ILJII ssure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified copy thereof(S c. mp Lab. .) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No�Company Certif ed copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS • Certified copy is filed with the county building inspection �Iclepar ment. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date ppIIcant WATER CLOSET(TOILET) NEAREST BATH TUB CROSS ST. ERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY EL. NO. mit is issued, I shall not employ any person in any manner so i as to become subject to the Workers'Compensation Laws. DISHWASHER �t/� CONTRACTOR JEV Date Applicant CLOTHES WASHER V+� ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT N� _CO// PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER JQ fed,Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL �� VALID ION a Q DATE C License Number V Lic. Class V FIN A W Contractor Date�O!PAr BY O I am exempt under Sec. W IL B.&P.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ o Signature OTAL FEE T SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION pp 1 1 5 6 A I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and o 0 0 0 0 5 Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. 1 . 02250 structure is not intended or offered for sale(Section 7044, 0 0 0 2 2 5 0 x Business and Professions Code). CONSTRUCTION LENDING AGENCY I "�, 1 6-8 8 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.). 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 above-mentioned roperty for inspecti n p pose o r* SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee D to WORKERS'that PhaveNSATION DECLARATION 20-0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT I herebys affirm that Phave a certificate of consent to self in 76A667A sure,or a certificate of Workers'Compensation Insurance,ora CE 817(REV.8/86) certified copy thereof(Sec. 3800, Lab. C. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No.-TV97 Company 2f� A69/20 Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESSAl, L dee rime t. NUMBER FIXTURE OR ITEM @ FEE O LOCALITY�4 a y k C Date Applicant �� WATER CLOSET(TOILET) NEAREST nr -v /GG C7 CERTIFICATES OF EXEMPTION FROM WORKERS' ® BATH TUB b CROSS 5T COMPENSATION INSURANCE SHOWER OWNER C��Ja (This section need not be completed if the work involved by / ,y the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS IJI Q!J //j'� I certify that in the performance of the work for which this per- SINK 6 0 07mit is issued, I shall not employ any person in any manner soCITY as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTORG11/ �� /4/0Data Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATERLICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETSs 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 1 5 PER SYSTEM FINAL V LIDATION fect. �( DATE — i d License Number 32% Lic. Class O FINA cc V Contractor r ' � �O[1 Date ! BY O 1 am exempt under Sec. W B.BP.C. for this reason ® cc Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ S Signature TOTAL FEE SINGLE FAMILY ;E 0 2 5 9 A HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name 0 0 0 0 0 5 Law for the following reason (Section 7031.5, Business and I o c 3 4.y 0 Professions Code): Address 1, as owner of the property, will do the work and the City Tel. No. 0 0 -34L5 05 structure is not intended or offered for sale(Section 7044, Business and Professions Code). > 07.22 -88 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 above-mentioned property or inspection purposes. 'L l� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of PermitT Dat ION WOthat I have a certificate of consent to 76AS88DPwelBe APPLICATION FOR PLUMB NG PERMIT 76A687A I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) Policy iN ,/ �;-/ �' Company:1/ % COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. • � �A+qy�� /� 1� Certified copy is hereby furnished. ❑ Certified copy is filed with the county building Inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS department. '�' NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date pf �� Applicant �'. —� WATER CLOSET CNEAREST ROSS ST. it I CERTIFICATE OF EXEMPTION M WORKERS' BATH TUB COMPENSATION INSURANCE ASSESSOR ` �/ D (This section need not be completed if the work involved by the SHOWER MAP BOOK �J /O PAGE PARCE permit is for one hundred dollars($100)or less.) LAVATORY OWNER I certify that in the performance of the work for which this permit AIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS become subject to the Workers'Compensation Laws. DISWASHER CITY lYm 7�A(!/ TEL.NO. � Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of G/ Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR 9 provisions of the Labor Code,you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITYt!'s * L'& G/�j/TEL.NO.G2 �/�` I hereby affirm that I am licensed under provisions of Chapter 8 WATER HEATER STATE / 1 / (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. (�J t��,/ CLASS Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. P CESSED BY �j 5 PER SYSTEM License Number g Uc.ClassFINAL V_A DATE VgM TIONd35og4ul Contractor Date 1 ITM5 FINAL � ❑ I am exempt under Sec. f BY TOTAL 5 B.&P.C.for this reason Date: Plan check fee ® K 155070 Signature PLUMBING PERMIT ISSUING FEE$ CHIMEXD ❑ SINGLE FAMILY TOTAL FEE Plan check applicant Q� "Q 1 11/23/92 DECLARATIO - pty I hereby affirm thaE am exempt tifrom the Cont ac orfs License Law Name 6707 1 0- $o4Z_� for the following reason (Section 7031.5, Business and Professions Address Code): City Tel.No. ElI,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.3087, 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 above-mentioned property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Ainnwtura Permlttea borth COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0807150025 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I ITR: 5903 IT: 53 UN: .002 I 1 6129 MUSCATEL AV N I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ SGAB CA 917752624 [ [ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN 1 15386-009-052 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl 1 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 I TENANT: TOTAL FEES 43.95 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I 107/15/08 SR 01/11/09 1 1OWNER: TEL. NO: I IFINAL D TE FIN Y: CODE: I IMOO, CHING YANG (626) 287-0879- 1 1 1 16129 MUSCATEL AV I 1 1 ISGAB 917752624 1 1 DaSCIZIE#rION OF WORK I IGAS LINE FOR HVAC SYSTEM I TEL. NO: (SAME AS OWNER - 1 I 1 I I ISPECIAL CONDITIONS: 1 I I ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE [ ISAME AS OWNER - I I I I LIC. NO I 1UNDER SLAB WORK 1 I 1 I IWATER SERVICE 1 1 1 I IPLASTIC Y/N METAL Y/N 1 1 1 [ARCHITECT OR ENGINEER: TEL. NO: I I I I I I - I IROUGH PLUMBING 1 1 1 I LIC. NO: I I I I I GAS PIPING I 1 IGAS VENT [ 1 I IHOT WATER HEATER I [ 1 1 I PLUMBING FIXTURES I I 1 1 I LAWN SPRINKLERS I I I 1 [ IGAS TEST I 1 1 1UTILITY COMPANY NOTIFIED[ I 1 I I I� I 1 I I [ [GRAY WATER SYSTEM I I I I I I I I I I I I I I I I I I 1 I I I I I I I I I I 1 I I I I I I I I 1 (REPORT ID: DPR263 ROUTE TO: BS0508 I I I