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Home My Public Portal About6408 OAK AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION ��saea7n I hereby affirm that I have w certificate of consent to self CIE 017(z-ao) APPLICATION FOR PLUMBING PERMIT insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANG LES /1 BUILDING AND SAFETI�� Policy No. Company �S� r Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS (p Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ® FEE department. WATER CLOSET LOCALITY Date Applicant NEAREST / ,yam BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' Al COMPENSATIO.N INSURANCE SHOWER OWNER (This section need not be completed if the work involved LAVATORY MAIL by the permit is for one hundred dollars ($100) or less.) ADDRESS �{ fJUM) SINK CITY �� L C. TEL.NO.� I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS Date Applicant SWIMMING POOL RECEPTOR NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compensation provisions of the Labor Code,you must forth- WATER HEATER LICENSE NO. CLA S with comply with such provisions or this permit shall be deemed revoked. GAS SYSTE OUTLETS ( � TRICT NO. P CESSED LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM / 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDA ON ness and Professions Code,and my license is in full force and DATE effect. FINAL License Number Lie.Class BY Contractor Date I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- /�yyam� iness and Professions Code). TOTAL FEE f!J o T/ Lie.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 7031.5, Busi- City Tel.No. ness and Professions Code): 38 1.0 A I, as owner of the property, am exclusively contracting with licensed contractors to construct the project .1 o o o o o 5 (Section 7044,Business and Professions Code). 2o o1000 CONSTRUCTION LENDING AGENCY 0 0 0 1 Ll 0 0 v 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.). 01.20-81 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned p operty for inspection purposes. -912 i nature of ermittee Date y- M�� i I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9612300001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL D: FEES PAID BUILDING ADDSS: ON FILE 6408 OAK AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801337 ASS SSOR I FOR 0 UMBER: NEAREST CROSS STREET: 5382-014-042 01 PERMIT ISSUANCE FEE 27.75 , THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY 47 WATER HEATER(S) 1.00 WTH 16.35 TOTAL FEES 44.10 SS ED . PROCESSED Y: P PRS ON: 12/30/96TC 12/30/97 OWNER: TEL. NO: FINAL DATE FINAL-BY: C ZYCH FRANK L;LINDA M (818) 574-7252- 6408 OAK AV TEMP 917801337SCR P 0 0 pp REPLACE 20 GAL. WATER HEATER WITH 50 GAL. APPLICANT: TEL. SAME AS OWNER - �' - ` ,�+®� SPECIAL CONDITIONS: CONTRACTOR: TEL. 0: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO ;�� +: ` r / �, + R SLAB WORK WATER SERVICE iif PLASMIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: i LIC. N0: ROUGH B G GAS !PIPING S EVEN �S`�' �•� 1 �� HEA7ffR- PLUMBING FIXTffR S GAS TEST - '� UTILITY COMPANY-NOTIFIEff CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508