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Home My Public Portal About6211 MUSCATEL AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm,that I have a certificate of consent to self in- j6�7A 6 DPW�� sure,-.or a certificate of Workers'Compensatiqn Insurance,ora certified copy thereof(Sec. 3800, Lab. C.) nn No. Company P-01 i? — e l� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY Date Applicant WATER CLOSET(TOILET) ql O® a.J NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' JrBATH TUB CROSS ST. COMPENSATION INSURANCE IOWNER (This section need not be completed if the work Involved by ® MAIL the permit is for ono hundred dollars($100)or loss.) LAVATORY 96 60ADDRESS I certify that in the performance of the work for which this per- s� SINK CITY TEL.NO. mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER _ CONTRACTOR Date. Applicant CLOTHES WASHER ` a NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS bAAAI emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR sation provisions of the Labor Code,you must forthwith comp- CITY , TEL.NO. P Y P- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- p STATE LIC. ed. WATER HEATER Y LICENSE NO. CLASS G LICENSED CONTRACTORS DECLARATION DISTRICT NO. Pg6¢ESSEb BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS Q ,J3—UA 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL V ATION Z fect. 2 HOSE BIB 20 DATE �?jrp 16� > License Number Lic. Class G6� 1�.bm 6 JI 06 Lm �/1 L� FINAL Contractor 1I DateJh C BY a 1 am exempt under Sec. 5 B.&P.C. for this reason ACCT4 oa Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ i� 3303 413°70 Signature 1 ITEM SINGLE FAMILY TOTAL FEE o70 HOME OWNER-BUILDER DECLARATION Plan check applicant TOTAL '�-+ I hereby affirm that I am exempt from the Contractor's License Name CHECK 413070 Low for the following reason (Section 7031.5, Business and CHANGE "00 Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, cW0-0001 4/ 4/96 Business and Professions Code). 5694 1 AN 11 27 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 abovmention° property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o -Permittee Date i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 f PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9609300007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID IBU L NG ADDR SS: TR: 5903 6211 MUSCATEL AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ;TEMP CA 91780 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY 05 BACKFLOW DEVICES) 1.00 DEV 16.35 TENANT- TOTAL FEES 44.10 09/30J96 TC PROCESSED BY: PLA Y: 0EXPIRES�ON: 9/30/97 I OWNER: TEL. NO: FINAL DATE FINAL BY' CODE: LIU, RICHARD (818) 574-1246- P.O. BOX 1775 f 71i 91780 DESCRIPTIUN OF IJURK NEW SPRINKLER SYSTEM NEW RESIDENCE APPLICANT: TEL. 0: I ; SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TELN0: ' __~=`�• -'f APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO ,: A '``� '/��~ `'� �` .�� UN—DER SLAB WORK WATER'SERVICE '.�; / (. ��; ��. �'t V- r a' PLASTIC Y/N METAL Y/N ARCHITECT OR ENGI EER: TEL. NO: 1 r y'; ; `i — . . ,. ROUGHIPLUMBING LIC. N0: GAS PIPING GAS VENT HOT WATER HEATER ' LMBING FIXTURES-- LAWN SPRINKLERS GAS TEST TILITY COMPANY NOTIFIED' GRAY WATERS STEM REPORT ID: DPR263 ROUTE TO: BS0508 I ,