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Home My Public Portal About9083 OLIVE ST_Plumbing__ WORKER'SCOMPENSAicate of consent to 7MB67 DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I.hereby affirm that I.have a certificate of consent to self Insure, ora certlficlite of Worker's Compensation Insurance,or a certified copy thereof(Sec.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company E3Certified copy is hereby furnished. I FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy isfiled with the county building Inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCAL Date Applicant WATER CLOSET NEAREST C% A� CERTIFICATE OF EXEMPTION FROM WORKERS" CROSS ST. COMPENSATION INSURANCE BATH TUB ; ASSESSOR (This section need not be completed if the work Involved by the SHOWER MAP BOOK I-PAGE PARCEL permit is for one hundred dollars($100)or less.) WNER I certify that in the performance of the work for which this permit LAVATORY ` is Issued, I shall not employ any person in any manner so as to SINK MAIL ADDRESS6 3 r� become subject to the Workers'Compensation taws. Q�tv DISWASHER Ogg- t,/ �� TEL.NO.�� g Date Applicant CLOTHES WASHER 'O CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of .Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS J provisions of the.Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000)of Division 3 of the Business and STATE LIC.GAS SYSTEM OUTL•ETS CENSE NO. CLASS V Professions Code,and my license is In.full force and effect. OUTLETS OVER I DISTRICT NO. PROCESSED BY 5 PER SYSTEM Q f7 Q License Number Lic.Class v U ` J DATEFINAL ON• LU/ / VALIDATION-DATE � Contractor Date CO E] I am exempt under Sec. BY AL 0 _ B.&P.C.for this reason Plan check fee , ACCT e s ' Date. Signature PLUMBING PERMIT ISSUING'FEE$ \ 41 TOTAL FEE ITEMS SINGLE 11 SINGLE FAMILY Plan check applicant TOTAL 41 85. HOMEaWNER-BUILDER DECLARATION Name. (';HECK 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and-Professions Address CHANGE aCID Code): ' City Tel.No. I,as owner of the property,will do the work and the structure Is not Intended or offered for sale'(Sectlon 7044, Business , 13900-13001 12117/9 1 and Professions Code). CONSTRUCTION LENDING AGENCY I 3057 1 AM11014 I hereby affirm that there is a construction lending agency for the peiformance of the work for which this permit is issued(Sec.3097, '.i Civ.C.) 1 Lender's Name Lender's Address I certify that 1.have read this appjicetion and state that the above ► Information Is.correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatf s,o his County to enter upon the above-mentioned property f to urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE !z V3 Signature of Permittee Date n "WORKERS'COMPENSATION DECLARATION ,APPLICATION FOR PLUMBING PERMIT �I�i�st41ofiirm,thaf`I have a cprfificate,Qf'consent to self 20=0026 DPW 6/87 jisure;,1%,a'tertif!cafe of Workers'Compensation Insurance, 76A667A IL JI Or aYcertified'copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS 1 Po i��++Ccy__'jNo.� Company ertifled copy Whefeby•furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGO ou.V F1Certifiedcopy is filed with the county building Inspec- ADDRESS tion department' NUMBER FIXTURE OR ITEM @ FEE LOCALITY PF 4 Date A li ant WATER CLOSET� 15 NEAREST CERTIFICATE OF EXEMPTIQN FROM WORKERS' BATH TUB CRO55 ST. COMPENSATION INSURANCE SHOWEROWNERi (This section need not be completed If the work Involved by �OV� �c `vQ the permit is for one hundred dollars $100 or less. MAIL i. 9./ p ( ) ) , LAVATORY ADDRESS � I certify that in the performance of the work for which this TEL. NO. ' e permit is issued,1 shall not employ any person in any manner SINK CIT`l fiA so as to become subject to the Workers'Co'tnpensation Laws. DISHWASHER CONTRACTOR Date Applicant ( CLOTHES WASHER' - ADDRESS NOTICE 'TO APPLICANT.: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL.NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE.NO. LASS LICENSED CONTRACTORS DECLARATION ii DISTRICT NO. JARED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM Y OUTLETS 00 (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER I and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL ' DATE VALIDATION '® License Number Lic.Class FINAL d, Contractor Date BY O ❑ I am exempt,under Sec. BAP.C. for•this reason i3. .Plan che(:k fee Z Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan.check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 7031.5, Business and Address ACCT 9a, Professions Code): City Tel. No. 3307 50 I, as-owner of the property., will do the work and the �0 structure is not intended,-or offered .for sale (Section ® 1 ITEMS l ! 7044, Business and Professions Code). TOTAL 40® 113 CONSTRUCTION LENDING AGENCY I'hereby affirm that there is a construction lending agency for CHECK the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). CHANGE Lender's Name ' Lender's Address 0000-0001. 10/27/89 1-.Certifythat 1 have read this application and state that the 6426 aove information is correct. I agree to comply with all County 1 AMiO°a ? ordinances a St to laws regulating Plumbing, and hereby authorize re es t of this County to enter upon the above-me n p or insp ction purp es. SEE REVERSE FOR EXPLANATORY LAI�IGUAGE a Z ignature of.Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0607180002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 11218 IT: 19 BL: D 9083 OLIVE ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803024 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ROSEMEAD 5388-005-020 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY, C 25 LAVATORIES/SINKS 1.00 FIX 16.20 TENANT: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 60.15 07/18/06 JK 01/14/07 OWNER: TEL. NO: DATE FINAL BY: CODE: BRUGGER MARK B;LIA F (626) 287-5580- //(� 9083 OLIVE ST TEMP 917803024 DESCRIPTION" OF WORK PLUMBING FOR KITCHEN REMODEL APPLICANT: TEL. NO: L AND W KITCHENS & BATHS (626) 287-1131- 8812 LAS TUNAS DR. SPECIAL CONDITIONS: SAN GABRIEL CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE L AND W KITCHEN AND BATHS (626) 287-1131- 8812 LAS TUNAS DR. LIC. NO UNDER SLAB WORK SAN GABRIEL, CA 91776 205344B 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 CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508