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HomeMy Public PortalAbout5219 PAL MAL AVE_Plumbing__ s ION 'WORKER'S have a certificate of consent to 7W67 DPW 9/89 APPLICATION FOR PLUMBING PERMIT I hereby affirn'1 that��have a certificate of consent to self insure, 75A667A or a certificate of Wcgker's Compensation Insurance, or a certified copy therec4.(Sec.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified Lopy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy Is filed with the county building inspection ADDRESS /N Y department., NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant f WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. BATH TUB COMPENSATION INSURANCE ASSESSOR (This section need not be completed If the work Involved by the SHOWER,• MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) LAVATORY OWNER AIL m� I certify that in the performance of the work for which this permit �� w� is issued, I shall not employ any person in any manner so as to SINK ADDRESS �2� IppVL become subject to the Workers'Compensation Laws. DISWASHER CITY' TEL.NO.A Date `� pplicant V v� CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certifica a of ✓ Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS S provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY e6a I(J P�,- TEL.NO l bf d I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000)of Division 3 of the Business and ' CET SE NO.� 6 CLASS U Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS OUTLETS OVER DISTRICT NO. PROCESSED BY License Number 54A&`3 i Lic.Class 5 PER SYSTEM 1 A Q FINAL d y LUL( DATE �Z VF1iIr ©LION Contractor [ te — _ 370, 17` 6` fn ❑ I am exempt under Sec. FINAL L.1 I e ITEMS B.&P.C.for this re n "5D Plan check fee , TOTAL :175.65 Signature / PLUMBING PERMIT ISSUING FEE$ CHECK 175.65 ❑ TOTAL FEE CHANGE .00 SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name 130003-{300 f 6/28/03 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Address j5C(7 A10°0�1:j Code): ❑ City Tel.No. I,as owner 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.) 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 S to law re ting Plumbing, and hereby authorize rep ntative f this ounty to en r upon the above-mentioned Pr�ter ' s� � 2 9 SEE REVERSE FOR EXPLANATORY LANGUAGE Date i i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0905070019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS: I ITR: 12205 IT: 4 1 I 5219 PAL MAL AV 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917803436 1 (ASSESSOR INFORMATION NUMBER: 11 I NEAREST CROSS STREET: FREER I 18585-022-005 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl 1 164 WATER PIPNG <- 1 1/2 1.00 LIN 16.20 I I [TENANT: [ TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I 105/07/09 SR 11/03/09 1 (OWNER: TEL. NO: 1 I INAL DAT FINAL BY: CODE: [ 1BARRETO, ROSA - I II 15219 PAL MAL AV -` I (TEMP 917803436 IDESCRIPTIOkP OF WORK 1 1. IREPLACE MAIN WATER LINE FROM METER TO THE HOUSE (APPROX 80 [ FEET) P.V.C. WITH COPPER TYPE L PIPE [APPLICANT: TEL. NO: } I [ IHURTADO (626) 276-3605- 1 [ I [P.O. BOX 1536 1 ISPECIAL CONDITIONS: IDUARTE, CA 91010 1 I I I I I ICONTRACTOR: TEL. NO: [APPROVALS DATE INSPECTOR SIGNATURE 1 IGUILL'S, INC. (626) 814-1670- I 1 I 11853 BRADBURY AVE. LIC. NO I [UNDER SLAB WORK I I [ [P.O. BOX 1536 893464C27 I I I IDUARTE, CA 91009 I [WATER SERVICE [ [ I IPLASTIC Y/NMET Y/N I [ I (ARCHITECT OR ENGINEER: TEL. NO: I I � Ir✓�r�I''n1 I - IROUGH PLUMBING LIC. NO: I I I I (GAS PIPING GAS VENT I I I [HOT WATER HEATER I [ [ I I (PLUMBING FIXTURES I I [ LAWN SPRINKLERS [ [ [ I II IGAS TEST I I 1 I I1 [UTILITY COMPANY NOTIFIED( I [ I I ICWV I I I I IGRAY WATER SYSTEM I [ 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 I I [ I I I I I I I