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Home My Public Portal About6217 MUSCATEL AVE_Plumbing__ e WORKERS'COave aSATIOicate o corse N APPLICATION FOR PLUMBING PERMIT I hereby,affirm that 1 have a cerfifieate of consent to self In- 20-0026 DPW 4/90 - sure,or a certificate of Workers'Compensation Insurance,ora 76A667A certified copy thereof(Sec. 3800, Lab. C.)' Poli o. Company COUNTY OF LOS ANGELES DEPT. OF,PUBLIC,WORKS c Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) )_� G� Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM � ADDRESS l7 &4 LA4 department. @ EE LOCALITY DcIte Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROMWORKERS' q BATH TUB CROSS ST.. COMPENSATION INSURANCE SHOWER OWNER `e ,S�p l) u (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL.NO. mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR &4 1 LS"r Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS SWIMMING fid emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR CITY TEL.NO. sation provisions of the Labor'Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATEA-tLIC ed. WATER HEATER LICENSE NO. — CLASS L LICENSED CONTRACTORS DECLARATION DISTRICT NO. PR Eb BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALI ATION fect. �L HOSE BIB DATE } License Number o"L� Lic. Class L� a 1� Al �V1,r FINAL d �i ) U Contractor , !Date BYim ❑ .I am exempt under Sec. B.&P.C. for this reason Plan check fee- n Date: PLUMBING PERMIT ISSUING FEE$ Q z Signature TOTAL FEE SINGLE FAMILY ACCTev HOME OWNER-BUILDER DECLARATION Plan check applicant 3303413.703o70 I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and 1 ITEMS Professions Code): Address TOTAL 413.70 1, as owner of the property, will do the work and the City Tel. No. 413.70structure is not intended or offered for sale(Section 7044, CHECK Business and Professions Code). ► CHANGE .00 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 0000-0001 4f 4/96 (Sec. 3097, Civ. C.). - • , 5695 1 • AM11,27 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 abovemention�dproper„ for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i Signature -Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9609300006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGALD: FEES PAID BUI DING-ADDRESS: TR: 5903 LT: 59 6217 MUSCATEL AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 00000 ASSESSOR INFORMATION NUMBER: DEAREST CROSS STREET: 5386-009-015 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY 05 BACKFLOW DEVICE(S) 1.00 DEV 16.35 TENANT: TOTAL FEES 44.10 ISSUED ON: PROCESSED BY: PLAN B EXPIRES-ON: 09/30/96 TC 09/30/97 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: LIU, RICHARD H (818) 574-1246- P.O. BOX 1775 TEMPLE CITY,CA 91780 DESCRIPTION OF woRK SPRINKLER SYSTEM FOR NEW RESIDENC APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO UNDER SLB WORK WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TE . NO: ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT OT WATER HEATER PLUMBING FIXTURES LAWN-SPRINKLERS GAS TES UTILITY COMPANY OT F D C V GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS050B