HomeMy Public PortalAbout6132 OAK AVE_Plumbing__ 0' WO:RICRS'COMPENSATION DECLARAT-ION 76A667A
I hereby affirm that 'I have a' certificate of consent to self ce 617 (2-66) APPLICATION FCM PLUMBING PERM:IT
insure, or a certificate of Workers'.Compensation Insurance,or
a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
'Policy No: Company.
n Certified copy is hereby'furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
ADDRESS
Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE
department. LOCALITY
le
Date •Applicant WATER CLOSET NEAREST /
BATH TUB CROSS ST. '
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER
COMPENSATION INSURANCE SHOWER (, . \
M'AI'L
(This section need not be completed if the work involved LAVATORY ADDRESS ��� .2 t C) O
by the permit is for" one hundred dollars ($100) or less.) SINK
'
CITY t�V1 Cf, TE:L. O.L��,., �3 U
„I certify that in the performance of the work for which this DISHWASHER
permit is issued, I shall not employ any person in any manner CONTRACTOR O
so as to become subject to the Workers'Compensation.Laws. CLOTHES WASHER
ADDRESS
Date Applicant W
SWIMMING POOL RECEPTOR
NOTICE TO A.PPLICANT:'If; after making this Certificate of CITY V TEL.NO. N
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. 2
Compensation provisions of the Labor Code,you must forth- LICENSE NO. CLASS
with comply with such provisions or this permit shall be WATER HEATER
.deemed revoked. GAS SYSTEM OUTLETS r. DISTRICT NO. ESSED BY
.. .. ..
LICENSED CONTRACTORS DECLARATION OUTLETS OVER l V ({'/( •
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION
ness and Prot'essions Code, and'my license is in full force and DATE
effect.
FINAL ,� — I,
License Number Lic.Class BY �� y""'"—�`
,Contractor Date
ElI am exempt from the licensing:requirements as.1 am a Plan check fee '
licensed architect or a registeredprofessional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus—
iness and Professions Code). TOTAL FEE
Lic,or Reg.No. Date Plan check applicant ;
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section.,703 1.5, Busi- City Tel.No.
ness and Professions Code):
wner of the property, a e y contracting
�ast
sedcon o` construct the project'
( e .
1 326A
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.).// 26- .- 130.0
Lender's Name ,,� _11'
Lender's Address 9.N' 0 0 0 13006
I certify that I have read this application and state that the 07, 17-80
,above information is correct.I agree to comply with all County SEE:REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned property for inspectio urposes,
At)
P mittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0608300002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 6132 OAK AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801653
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN
5385-010-013 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, C
07 BATHTUBS/SHOWERS 1.00 FIX 16.20
TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
45 WATER CLOSET/URINAL 1.00 FIX 16.20 08/30/06 JX 02/26/07
92 NO PERMIT OWNER-BLDR 257.00 DOL 257.00
OWNER: TEL. NO: TOTAL FEES 333.35 FIN���� FIS BY: CODE:
ZBIWIE, ZENG (626) 285-9093- � �G► J
6132 OAK AVENUE
TEMPLE CITY CA 91780 DESCRIPTION OF WORK
REPLACE BATHTUB, LAVATORIB AND WATER CLOSET
APPLICANT: TEL. NO:
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR: TSL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO UNDER SLAB WORK
WATER SERVICE
PLASTIC YIN METAL YIN
ARCHITECT OR ENGINEER: TEL. NO:
ROUGH PLUMBING
LIC. NO:
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
CKV
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508