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Home My Public Portal About10619 OLIVE ST_Plumbing__ WORKERS'CQMPENSATION DECLARATION tAREPLICATION FOR PLUMBING-PERMIT I hereby-affirgi that I bave a certificate of consent-to self 20-0026 DPW 6/87 - - 'Sjysure, or-a certificate of Worker%'Compensation Insurance, 76A667A ' �; IL JI or_'a,clip-, ed cotes' CA'tQherepT C. 3800 Lab. C.) Q ' COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS P❑oiWiT ccy N'619 t' s�1LLa�oVmpany- m �./s//'spe J— Certified copy is hereby furnished. BUILDING• y- ,. FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS. OLA V� G Certified copy is filed with the county building inspec- . tion department. �/�/��j 1 �/J�/ //^� I NUMBER FIXTURE OR ITEM ® FEE LOCALITY IG Date -IQ'/t� AppIigant.0WM PL,861 ! 13 WATER CLOSET . NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROS$ST. COMPENSATION INSURANCE i OWNER SHOWER [�RA1� (This section need not be completed If the work Involved by I the permit is for one hundred dollars($100)or less.) 5' LAVATORY MAIL ADDRESS LO, I certify that in the performance of the work for which this I permit is issued, I shall not employ any person in any manner ; SINK CITYF J 1 T so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date. Applicant CLOTHES WASHER ADDRESSq.6J ° f NOTICE TO APPLICANT: If, after making this Certificate of ii SWIMMING POOL RECEPTOR _ Exemption, you should become subject to the Workers' CITY Compensation provisions of the Labor Code, you must.forth- LAWN SPRINKLER SYSTEM r with comply with such provisions or this permit shall be STATE 1 deemed revoked. ' WATER HEATER LICENSE NO. J/ CLASS " LICENSED CONTRACTORS DECLARATION DISTRICT NO. c PROCESSED BY I hereby affirm-that I am licensed under provisions of Chapter 9 " GAS SYSTEM OUTLETS cv �p (commencing with Section 7000)of Division 3 of the BusinessOUTLETS OVER and Professions Code,and m license is in full force and effect. 5 PER SYSTEM. ' y � FINAL VAUDATION �y ��-•� I, DATE .2Ar License Number Lic. Class y5l ��y a I; �i 1 �i I FINAL I NOM O ,- �+� Contractor( 1V A61 Date a1 ` BY. TOTAL 34€ m83O I am exempt under Sec. tE.] ;r L 616f 14 B.&P.C. for this reason �{yC�� O' t Plan check fee ® � GE ,!11 er Date: j PLUMBING PERMIT ISSUING FEE Signature i. TOTAL FEE 011]I 1( 1111IJI 1 x•/10/95 ' Plan check applicant €] } y°e',� SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License ' Address - Law for-the following.reason (Section 7031.5, Business and Professions Code.):. j I City Tel. No. ❑ I, as ownei of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). 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.). I Lender's Name Lender's Address I certify that I have'read this.applicdtion 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 above-mentioned' ro rty for.inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE nature of P rm ee ` Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT („hereby,.affirm that I have a certificate of consent to self in 6�7A 6 DPW 4/90sure,or a certificate of Workers'Compensation Insurance,or a certifi copy thereof(Spec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS P- _y'Nb" d� 71P —ITCompany � �� Certified copy is hereby furnished. ❑ Certified co is filed with the count ogisp FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING n Y y @ FEE ADDRESSdep rtmen.. NUMBER FIXTURE OR ITEM LOCALITY Date LApplicant WATER CLOSET(TOILET) NEAREST ERTIF CATE OF EXEMPTION FROMBATH TUB CROSS ST. COMPENSATION INSURANOWNER (This section need not be completed if the wSHOWERork involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL.NO. mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER RACTOR& ly5 'GeNT Date Applicant CLOTHES WASHER ADDRESS -Z q5' NOTICE TO APPLICANT: If, after making this Certificate of Ex- em tion,you should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR �/V Irv-24 P Y I P , CITY TEL.NO. safion provisions of the Labor Code,you must forthwith comp-I LAWN SPRINKLER SYSTEMS �0 ly with such provisions or this permit shall be deemed revok- STATE / LIC. ed. WATER HEATER LICENSE NO. S�3�SJ CLASS L Z� LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter ! GAS SYSTEM OUTLETS �� i ✓�p'�'� 9(commencing with Section 7000)of Division 3 of the Business OUTLETS.OVER Q and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. Z HOSE BIB DATE 0 -�`- a License Number �� Lic. Class FINAL A G Contractor 5 to q Z49'14d/ _ BY . 9l..70 C I am exempt under Sec. V B.&P.C. for this reason Plan check fee 011111. l 1 ITEM y Date: PLUMBING PERMIT ISSUING FEE$ Q �1°7 Signature SINGLE FAMILY TOTAL FEEPlan check applicant /• O CHANGE °00 HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Name t�� ,�J/ Law for the following reason (Section 7031.5, Business and ^Q001 95 Professions Code): Address 2471 1 Ph 4.1154 I, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, Business and Professions Code). 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.). 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 nd State la s egulating Plumbing, and hereby authorize e v s f this County to nter Pon the clhnv - ned Oro l e t for inspection pur oses u/ 7,0 SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permitte D e r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9703260032 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: EGA ID: ES PAID G—ADDRESS: ON FILE 10619 OLIVE ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 ASSESSOR I ORMA 10 NUMBER: NEAREST CROSS STREET: 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY 05 BACKFLOW DEVICES) 2.00 DEV 32.70 TENANT: TOTAL FEES 60.45 ISSUED ON: PROCESSED 8 LAN B EXPIRES ON: i 03/26/97 TC 03/2 /98 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: LIANG, ZHAO QING (818) 279-1359- 10619 OLIVE ST Z� TEMPLE CITY, CA DESCRIP71ON OF WORK SPRINKLER SYSTEM APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO' UNDER SLAB WORK WATER SERVICE RC TCT 0 NG R: p; PLASTIC Y/N METAL Y/N ROUGH LIC. NO: S PIPING S VENT WATERHOT E PLUMBING U ES LAWN SPRINKLERS GAS-TEST UTILITYCOMPANY NOTIFIED cw— GRAY WATERSS REPORT ID: DPR263 ROUTE TO: BS0508