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Home My Public Portal About9935 OLIVE ST_Plumbing__ .'WORKERS,COMPENSATION DECLARATION 20.0026 DPW 490 APPLICATION FOR PLUMBING PERMIT Ihereby,affirm that I have a certificate of consent to self in- 76A667A sure,ora certificate of Workers'Compensation Insurance,ora certified copy thereof(Sec. 3800, Lab. C.)' +, COUNTY OF LOS ANGELES Policy No. 339011-00 Company Golden F.aol ' . ; DEPT. OF�PUBLIC WORKS Certified copy is hereby furnished. BUILDING ` FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS 9935 Olive department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Temple City Ddte1-1-97 ApplicantOwen Bros. Plumbing-3F_ lumbin WATER CLOSET(TOILET) NEAREST BATH TUB �pc CROSS ST. Baldwin Ave. ' CERTIFICATE OF EXEMPTION FROM WORKERS' tDb 'COMPENSATION INSURANCE SHOWER NOWNER Owen Development (This section need not be completed if the work involved by I MAIL the permit is for one hundred dollars($100)or less.) L4LAVATORY ADDRESS 4275 N. Bladwin Ave I-certify that in the performance of the work for which this per- SINK CITY TEL.NO. mit is issued, I shall not employ any person in any manner so V / El Monte 350-0345 as to become subject to the Workers'Compensation.Laws. DISHWASHER %� CONTRACTObwen Bros. Plumbin Inc. Date. Applicant CLOTHES WASHER ADDRESS 4265 N. Bladwin Ave NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen-CIN El Monte TEL.NQ.'+43-0078 sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. f- WATER HEATER UCENSE•NO.23 1 741 CLASS C36-20-16 LICENSED CONTRACTORS DECLARATION O DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS ` 9(commencing with Section 7000)of Division 3 of the Business I OUTLETS OVER D and Professions Code, and my license is in full force and ef- i 5 PER SYSTEM FINAL 7' VALIDATION fect. I HOSE BIB DATE �— G{p�/ >. License Number 231-741 Lic. ClassC36-20-16 C FINAL C Contractor OWPn RroG_ '21mhDate9-30-97 BY I am exempt under Sec. 8.8P.C. for this reason Plan check fee ► v Date: PLUMBING PERMIT ISSUING FEE$ a Signature TOTAL FEE / SINGLE FAMILY 6 O I HOME OWNER-BUILDER DECLARATION Plan check applicant r� I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and I AGCT.T Professions Code): Address3303 ryo 10 I, as owner of the property, will do the work and the City Tel. No. ITEMS structure is not intended or offered for sale(Section 7044, Business and Professions Code). TOTAL 289.' 10 CONSTRUCTIONLENDING AGENCY u u�� 2.03 •PN��r'!�QC"� CHECK 289010 I hereby affirm that there is a construction-lending agency for 16.04.095, S the performance of the work for which this permit is issued g��yl� ,'� pp�� pp ( �j CHANGE .00 (Sec. 3097, Civ. C.). CO[)E Au.gsf� I�L7. S�d�JS�l�li�l�i�J \�/ ®� f�� + — flfl I�rr p p n RB Lender's Name SECTIQ'uJ �� kdti �hIIIG ��k�uti�*l� ��lJlva�illCi� I� mfr V 0000-0001 2/15/96 Lender's Address CODE- �� 4;�^ad uJD- RD TO LsISn[y: 48781 1 AM10:31 I certify that I have read this application and state that the , above information is correct.I agree to comply with all County "(d) COPPER L�i��'E F011-1WTER PIPING ordinances and State laws regulating Plumbing, and hereby l\ authorize representatives of this County to enter upon theSG9Q�d �A�9 p C"fL9�b� G��►� LESS THAN abo e-mentioned prop for inspection purposes. Z66/'l� TYPE ftff REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee D e WbRKERS'COMPENSATION DECLARATION 20-0026 DPW 4/90 APPLICATION FOR PLUMBING PERMIT I h6reby, affirm that I have a certificate of consent to self in- 76A667A sure,or a certificate of`porkers'Compensation Insurance, r a certified�o trio ec. 3800, Lab. C.)/`'� dJ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Poll cy N — 6 Company y Certified copy is hereby furnished. /_/_i FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS i a •d'�� clgd a f ' NUMBER FIXTURE OR ITEM Q FEE �j1inenJK fin LOCALITYDdte 1Applicant l�°��.., f( `� ,c WATER CLOSET(TOILET)_ NEARESTL 10'r GC CERTIFICATE OF EXEMPTION FROM WORWRS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the work Involved by MAIL the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL. NO. mit is issued, I shall not employ any person in any manner so as to be me subject to the Workers'Conn nsation Law DISHWASHER Date Applicant CLOTHES WASHER CONTRACTOR �• �` 7G� l�rj NOTICE TO APPLICANT: If, after maki this Certificate of Ex- ADDRESS f v tll' j �r.../'� J em tion,you should become sub'e o the Workers'Compen- sation SWIMMING POOL RECEPTOR P Y ICITY-GcL 1J?0 n TEL.NO. provisions of the Labor Cods,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE f G` LIC. ed. WATER HEATER LICENSE NO. l CLASS._ LICENSED CONTRACTORS DECLARATION DISTRICT Nb. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER vQ and Professions Code, and m license is in full force and ef- 5 PER SYSTEM FINAL Y ;?(_--4VALIDATION fect. (�� "� HOSE BIB DATE lV_ License Number k /Lic. Class Q ;Io r C4 Date l U . �(6� FINAL �'I �(e ys Contractor. BY 33076 43.40 G ❑ I am exempt under Sec. TjE� V B.BP.C. for this reason3 Plan check fee � TOTAL 43 o 40 Dot PLUMBING PERMIT ISSUING FEE$ CHECK (too ? Signature TOTAL FEE fg� D CHANGE . Ifs SINGLE FAMILY HOME NER-BUILDER DECLARATION Plan check applicant I hereby affirm at I am exempt from the Contractor's License Name � �—�� 6/20/96 Law for the fo owing reason (Section 7031.5, Business and Professions Code): Address 7021 1 AM 9:54 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 and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-m tinned property for inspection pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign re of Permit ee Da e