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HomeMy Public PortalAbout9937 OLIVE ST_Plumbing__ .WORKERS'COMPENSATION DECLARATION 20-004e DPW 4/90 APPLICATION FOR PLUMBING PERMIT I h reb , affirm that I have a certificate of consent to self in- sure,or certiflcate of Workers'Compensation Insurance,or a 76A667A. /1 certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS `tILJ1� Policy No.. 339011-O . ompany Golden Eagle Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified co is filed with the county building ADDRESS 9937 Olive PY� ty g inspection department. NUMBER FIXTURE'OR ITEM Q FEE--��pp'�� LOCALITY Date 1-1-97 Applicant Owen Bros. Plumbi WATERCLOSET(TOILET) !Jv NEAREST Tem le City ATH TUB Baldwin Ave, CERTIFICATE OF EXEMPTION FROM WORKERS' BCROSS ST.OWNER P COMPENSATION INSURANCE a Owen Development Y SHOWER (This section need not be completed if the work Involved by MAIL the permit is fgr one hundred dollars($100)or less.) 14LAVATORY 6 ADDRESS 4275 N. Baldwin Ave I certify that in the performance of the work for which this per- SINK ) CITY TEL.NO. mit is issued, I shall not employ any person in any manner so ( E1 Monte 350-0345 as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Owen Bros. PL i Date- Applicant CLOTHES WASHER ADDRESS 4265 N.B aldwin Ave NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should becorpe subject to the Workers'Compen- CITE' E1 Monte TEL.NO.443-0078 sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO.C36-20—1 6 CLASS C36-2016 LICENSED CONTRACTORS DECLARATION O DISTRICT NO. PROCESSEb BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS �,yt� 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER iq A� and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL feet. / VALIDATION HOSE BIB DATE W >. License Number 231-741 Lic. Class C36-20-16 AL FINAL O Contractor Owen B oa. '21mb Date 9-30-97 . BY V D: O I am exempt under.Sec. V B.BP.C. for this reason Plan check fee , H Date: PLUMBING PERMIT ISSUING FEE$ �� Z Signature TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name 5 Law for the following reason (Section 7031.5, Business and A44ToV Professions Code): Address F1 I, as owner of the property, will do the work and the City Tel. No. 335Q3 2$9"1Q structure is not intended or offered for sale(Section 7044, 1 ITEMS e Business and Professions Code). Ii(t7.�+S`'}.�� i fir••.^nom^.. e TOTALo 10 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for r�r; rn�^ -, r•, r, CHECK: 289.10 the performance of the work for which this permit is issued �� "!C'6'._-:`_':-=��- """ `'�``�� ��� CNGE (Sec. 3097, Civ. C.). eQQ srE ,11 Lender's Name C005 EIS 0000—QQ01 2/15/96 Lender's Address nq I certify that I have read this application and state that the a���� �+® L r� ��n� G� �y?4 il; P���6V� 9 1 Ahl1Q�31 orbove d nancesrmation is and State lawstregulating Plumbing,comply h all d hereby SHALL HAVE s VrO 6GHT EDT LESS TWAN110' authorize representatives of this County to enter upon the above-mentioi0pty for inspection purposes. TYPE 5�� pe �PE u� /S SEE REVERSE FOR EXPLANATORY LANGUAGE Loot M_J_q e7 I rgnoture of Permittee Date WORKERS'COMPENSATION DECLARATION 20-0026 DPW 4/90 APPLICATION FOR PLUMBING PERMIT I hereby„affirm.that I have a certificate of consent to self in- 76A667A sure,or a certificate of Workers'Compensate n Insurance,or a ce;tif0.015 3800, Lab. C.) COUNTY OF LOS.ANGELES DEPT. OF PUBLIC WORKS Policy No. G Company Certified copy is hereby furnished. •/'/- .0 FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS Certified copy Is filed with the ounty but cling-inspection depa t NUMBER FIXTURE OR ITEM @ FEE LOCALITY Ddte Applicant. WATER CLOSET(TOILET) NEAREST ` CE9FIC kE OF EXEMPTION FROM WORKERS' 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 ^ . �Q 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 Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY - NNA_A.'I/\7TEL.NO. I�-(®� r sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS a i ly with such provisions or this permit shall be deemed revok- o STATE (� LIC. ed. WATER HEATER LICENSE NO. / CLASS LICENSED CONTRACTORS DECLARATION DISTRI O. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS , Q' 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER 6 and Professions Cgde, n' I' is in full force and 5 PER SYSTEM FINAL VALIDATION fect. )`(�/J (_,(d HOSE BIB DATE �— --� a License Nu.... De • (c. Clas FINAL V Contractor © v blot' BY ACCTn4 ft I am exempt under Sec. 3303 43°40 V B.BP.C. for this reasonPlan check fee 1 ITEMS d Date: PLUMBING PERMIT ISSUING FEE$ n TOTAL 43.40 i Signature /1 0 CHECK 43.40 TOTAL FEE' J SINGLE FAMILY CHANGE .00 HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and 0000_0001 6/20/96 Professions Code): Address F1 I, as owner of the property, will do the work and the City Tel. No. 7023 1 QM gos'c 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- entioned property for inspection purposes. M SEE REVERSE FOR EXPLANATORY LANGUAGE S' ure of Permittee Date 4 i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1301100015 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: ] ON FILE [ [ 9937 OLIVE CT I I [FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ TEMP CA 917803239 1 [ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: BALDWIN 18588-019-014 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY CAI I '107 BATHTUBS/SHOWERS 3.00 FIX 48.60 I I ITENANT: 113 DISHWASHER(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: I 1125 LAVATORIES/SINKS 5.00 FIX 81.00 101/10/13 SR I 145 WATER CLOSET/URINAL 2.00 FIX 32.40 1 (OWNER: TEL. NO: I TOTAL FEES 206.00 IFINAL DATE FI BY: CODE: [ [PAN, SHU (626) 280-9317- I 19937 OLIVE COURT I I ITEMPLE CITY CA 91780 1 ID CRIPTION OF WORK I I [REPLACE TWO SHOWERS, ONE TUB, FOUR LAVATORIES, TWO WATER ] ICLOSETS, DISHWASHER AND SINK I (APPLICANT: TEL. NO: 1 I I ISAME AS OWNER I I ISPECIAL CONDITIONS: I I 1 ]CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR ISAME AS OWNER _ i I SIGNATURE UR8 I LIC. NO I (UNDER SLAB WORK I I I IWATER SERVICE ] I I I 1 IPLASTIC Y/N METAL Y/N I I I [ARCHITECT OR ENGINEER: TEL. NO: 1 I I I I I - I IROUGH PLUMBING I I I LIC. N0: I I [GAS PIPING I I IGAS VENT ] I I I I IHOT WATER HEATER I I I I I IPLUMBING FIXTURES I I [ ILAWN SPRINKLERS IGAS TEST I I (UTILITY COMPANY NOTIFIED[ I I CWS► I I (GRAY WATER SYSTEM I I I I I I I I I I I I I I I I I I I I IREPORT ID: DPR263 ROUTE TO: BS0508 1 I I 1 I I I I I