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Home My Public Portal About10520 OLIVE ST_Plumbing__ „ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT G 1 hereby affirm that I have a certificate of consent to self 76A667A ! insure, of a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES Z BUILDING AND SAFETY P❑oficy NP r_' Gompar T ) ; Certified copy. s hereby furnished. • FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING � a�,�r �/ Certified copy is filed with the county building Inspec- ADDRESS P S/ //�” tion department. NUMBER FIXTURE OR ITEM Q FEE 1. rNEARE TY HP Date. I-AZY'Appli;ant c j .0 c-1� WATER CLOSET ST L CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB ST. .QAI _ COMPENSATION INSURANCE SHOWER R (This section need not be completed if the work involved by the permit is for one hundred dollars '$100 or less. p ( ) ) LAVATORY ADDRESS I certify that in the performance of the work foi which this permit is issued, I shall not employ any person in any manner SINK CITY TEL.N y-,570 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of _5 . v Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO. �_ L with comply with such provisions or this.permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS L L LICENSED CONTRACTORS DECLARATION DISTRICT NO. PNOCESSEQ BY I hereby affirm that'I am licensed under provisions of Chapter9 GAS SYSTEM OUTLETS S_.- �/ (commencing with Section 7000)of Division.3 of the Business OUTLETS OVER >. and Professions Code,and my license is in full force a effect. 5 PER SYSTEMFINAd r Y t DATEL VALIDATION V License Numb r Lic. ClassCT' R j7y(r FINA 0 Contract Date r BY / V ❑ 1 am t under Sec. d 3� y o � // - � B.BP.C. for this reason Z Plan c ck fee Date: PLUMBING PERMIT ISSUING FEE$ Signature Q rO , TOTAL FEE 3 () SINGLE FAMILY Plan-check applicant HOME OWNER-BUILDER DECLARATION Name J �,4 A I hereby affirm that.I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and o ° 0,0 0 5 Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the pc °�O 3 Q 5 0 structure is not intended or offered for sale (Section pop7044, Business and Professions Code). 6 CONSTRUCTION LENDING AGENCY P7 3 1 _P 4 1 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 CLesentatives d State laws regulating Plumbing, and hereby of this•County to enter upon the ned prop rty for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Per ittee Date 76A667 (=-817) - 1/75 ' A � APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT'OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: ADIDRESS HARVEY T. BRANDT, COUNTY ENGINEER 6LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST NUMBER FIXTURE OR ITEM @ FEE CROSS ST. " 2.00 OWNER L �/ WATER CLOSET MAIL BATH TUB 2.00 ADDRESS SHOWER 2.00 CITY & �p TEL. NO. LAVATORY 2.00 CONTRACTOR SINK 2.00 ADDRESS 2�J7zz (,1 U re 1� DISHWASHER 2.00 CITY J• l U TEL. NO. JC 5_,/:,73 CLOTHES WASHER 2.00 STATE :)72 ? J CLIC LASS •C 3G •' LICENSE NO. SWIMMING POOL�RECEPTOR 2.00 DISTRICT NO.GZ ROUP ONE PRO ESS BY LAWN SPRINKLER SYSTEM. 2.00 _r R_ WATER HEATER 2.00 INDUSTRIAL WASTE APPROVAL p� GAS SYSTEM OUTLETS 2790 �n INSPECTION RECORD V OUTLETS OVER 5 PER SYSTEM •30 C V ' W Cf- y • Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ TOTAL FEE APPROVALS DATE INS PEC TO R'9 31GNATU RE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT I HEREBY AC9NOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING s PLUMBING. GAS TEST ✓ / 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REGUIREO BY LOS ANGELES COUNTY AND STATE OF _ CALIFORNIA OR'THAT 1 AM THE LEGAL OWNER OF, AND MYEND TO ' RESIDE IN THE ABOVE DESCRIBED E PROPERTY. FINAL SIGNATU RE OF PERMITTEE PERMIT VALIDATION CN. 0; CASH PLAN-CHECK VALIDATION CN. O. CAs 7 1 2C2,I;M1N 15 5 D 7 5 0 1&z�3 �76 A667A APPLICATION'FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST. SHOWER OWNER ' /1 LAVATORY MAIL ADDRESS -a o SINK CITY. ^ TEL.NO. DISHWASHER CONTRACTOR�Lj. CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR _ / �+ CITY r�t �.(�{f„I�L�Z TEL.N0�77�.1d`oL LAWN SPRINKLER SYSTEM STATEq LIC. WATER HEATER LICENSE NO.x�'f 1� CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING Q GAS VENT V HOT WATER HEATER Q PLUMBING_JZT.URES A GAS TES `� et v�;r_r. �yv. -'1 i PIOTI check fee UTILITY CO.NOTIFIED Z PLUMBING PERMIT ISSUING FEE$ n TOTAL FEE 0 FINAL Plan check applicant PLAN CHECK VALIDATION. Ll/ Name Address City Tel.No. `8 3 6 7 A I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES �{ o o D o 0 5 AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS _ O p b1 0.00 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE L I LEGAL OWNER OF.AND TEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL ' PROPERTY. - o 0 0 I a o c SIGNATURE �/, '(/ / J� h _`\ 1226-79 OFPERMITTEE DISTRICT NO. P CESSEDBY INDUSTRIAL WASTE APPROVAL COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0310070014 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: S PAID S : TR: 11290 LT: 7 BL: B 10520 OLIVE ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802864 ASSESSOR 0 0NUMBER: NEAREST CROSS STREET: 8585-021-040 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 2.00 FIX 32.40 TENANTIF 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED : PLAN B EXPIRES ON: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 10/07/03 JK 04/04/04 TOTAL FEES 92.55 OWNER: TEL. NO: FIN L 0 TE AL BY: CODE: JOHNSON, T.J./SEEMA (626) 403-7151- 10520 OLIVE ST. U TEMPLE CITY 91780 DESCRIPTION OF WgRK PLUMBING FOR ADDITION/REMODEL APPLICANT: 0• PAUL DAVIS RESTORATIONS (714) 228-0895- 14670 FIRESTONE #406 SPECIAL CONDITIONS: LA M I RADA 90638zl CONTRACTOR: TEL. N0: Cy '~' �Jj � � APPROVALS DATE INSPECTOR SIGNATURE PAUL DAVIS RESTORATION (714) 228-0895- N. 14670 FIRESTONE BLVD LIC. NO r j" )\\, �. UDE S OR LA Mi RADA, CA 90638 510431 B '� WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR G 0: 11" ROUG P MB N PENA, JOSE (714) 835-94 �_`-_ 914 S. MAIN ST. STE. #105 LIC. NO• _ J I ' I n/ SANTA ANA, CA 62701 NONEiI ' G __ _! I I -, I I I 1,�1 GAS PIPING Imo- ------- - ---- -- ---- -- - I GAS VENT ri 15 il(� r�.�J;'1HOT WATER HEATER --- --_ ----- ------ --- -----rPLUMBING FIXTURES LAWN SPRINKLERS GAS TEST �i I '�,'II.,,iV j�� /.B! s/ UTILITY CO P NY 0 I D CWV / _l1Lr",E � '�'%� � G ATRSS REPORT ID: DPR263 ROUTE TO: BS0508