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HomeMy Public PortalAbout10325 OLIVE ST_Plumbing__ WORKERS'COMPENSATION DECLARATION 76g687q APPLICATION �� y� ®N FOR PLUMBING PERMIT I hereby affirm that I have W certificate of conselit to self ce 617.(z-eo) /"Y P P L I C P'0 T I insureror a certificate of Workers'•CAlpensatidn Insurancb,'or ertified c9 re f c 38a� ab..lST %) � g,�'S� V, ) /l I .COUNTY OF LOS ANGELES 7 � � BUILDING AND SAFETY Policy. o. Company— I. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING i ertified copy is filed with the b' ' ing' pection NUMBER FIXTURE OR ITEM ® ADDRESS FEE OF Dated --r�j i Applicant WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST. oA 0o, CERTIFICATE O XE ION FROM WORKERS" CO NS . ONINSURANCE !. SHOWER OWNER /i (phis section nee of be completed LAVATORY MAILted if the work involved ADDRESS�S��71 by the permit is for one hundred dollars ($100) or less.) SINK } CITY TEL.NO. , lee) f I certify that in the performance of the work for which'this DISHWASHER U permit is issued, I.shall not-employ any person in any manner CONTRACT R so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS 0 Date Applicant NOTICE TO APPLICANT: If,'after making this Certificate of SWIMMING POOL RECEPTOR CITY TEL.NO. �.5�7 W Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compensation 'y n' p provisions of the Labor Code, permit must forth- �( � ` z with comply with such provisions or this permit shall be WATER HEATER LICENSE NO. / CLASS J _ deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PR CE$,SED BY Lfoo, ICENSED 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 ness and Professions Code, and my license is in full force and 31 DATE VALIDATION. effect. �+ _ '• , License Num Lic.ClassFINAL . f BY eF r/ d^ Contractod e�r 1f-� O14 a exempt from the licensing requirements as I am a Plan check fee 3 1' nsed architect or a registered professional engineer —�� acting in my professional capacity (Section 7051, Bus- PLUMBING PERMIT ISSUING FEE$ iness and Professions Code). • TOTAL FEE .ic.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. less and Professions Code): I, as owner of the property, am exclusively contracting ;j. o r with licensed contractors 'to construct the project (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency o 0 1 0, r� l` or the performance of the work for which this permit is ssued(Sec.3097,Civ.C.). ),0 9-Q 1 .ender's Name ,ender's Address CZ) o 110 :tt certify'that I have read this application and state that the p o 0 0 ,bove information is correct.I agree to comply with all County p — o p rdinances and State laws regulating Plumbing, and hereby SEE REVERSE FOR EXPLANATORY LANGUAGE I o 0 0 P3 4bove-me sentati es o this County to enter upon the OD O O c Co r inspection purposes. C� Q G� '1TL. Permittee Date j COUNTY OF LOS ANGELES i TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1110040016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1 1 ON FILE I I 10325 OLIVE ST 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917802861 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18586-028-038 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: 34 LOCALITY: TEMPLE CITY, Cl 1 147 WATER HEATER(S) 1.00 WTH 16.30 I I (TENANT: TOTAL FEES 44.10 (ISSUED ON: PROCESSED BY: PLAN BY: 1 1 i 110/04/11 SR ]OWNER: TEL. NO: I IFINAt DATE FINAL BY: CODE: ICHIEM JASON 110325 OLIVE ST ] 1 1 ITEMP 917802861 I IDESCRIPTION OF WORK I I ]REMOVE/REPLACE GAS WATER HEATER SAME LOCATION 1 ]APPLICANT: TEL. NO: 1 1 1 IFAST WATER HEATER COMPANY (425) 636-7084- I 1 1 112601 132 NO AVE I ISPEC-IAL CONDITIONS: [KIRKLAND, WA 98034 1 1 1 ]CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE I ]FAST WATER HEATER (425) 636-7054- ] 1 1 112601 132ND ST. LIC. NO 1 ]UNDER SLAB WORK I I 1 IKIRKLAND WA 98034 C36931237 I I I I 1 1 1 (WATER SERVICE 1 1 I 1 1PLASWIC Y/N METAL Y/N [ARCHITECT OR ENGINEER: TEL. NO: I I I I I - I [ROUGH PLUMBING I 1 1 LIC. NO: I I IGAs 'PIPING I 1 I I [ IGAS VENT I I I I I IHOT WATER HEATER 1 I 1 I I I I 1PLUMBING FIXTURES 11 1 I I ILAWN SPRINKLERS pp 7G`aI I I 1 �\�' I� Rl ]GAS TEST pE© (UTILITY COMPANY NOTIFIED] I I I ICWV I I I [ IGRAY WATER SYSTEM I I I I I I I I I I I I I I I I I I I I I I I I I I I REPORT ID: DPR263 ROUTE TO. BS0508 [