HomeMy Public PortalAbout5408 PARMERTON AVE_Plumbing__ WORKERS COMPENSATION have ATtoNcateDECLARATION
corse APPLICATION FOR PLUMBING PERMIT '
I hereby affirm that I have o certificate of consent to self 76.4667A • , •
insure or a certificate of Workers Compensation Insurance CE 817 (REV 10/81) -
or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES B1.111111F AND SAFETY
Policy No - Company
Certified copy is hereby furnished BUDING y
❑ �}
Certif ted copy a filed with the county building inspec- FOR APPLICANT TO FILL INRIM OR TYPE) AD RESS QO
tion department NUMBER FIXTURE OR ITEM /@ FEE LOCALITY
Date Apph4anl WATER CLOSET NEAREST /n I
_ CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST - -6
COMPENSATION INSURANCE SHOWER OWNER eW 14)
(This section need not be completed if the work involved by
the permit is for one hundred dollars ($100)or less ) LAVATORY 1 5 MAIL
ADDRESS A
I certify that in the performance ofP the work for which this p
permit is issued shall not employ any person m any manner. SINK CITY l e L TEL NO (l 'O L
so astto be:Pmee,,%./bble'cc't to the Work-s Compensation Laws r DISHWASHER CONTRACTOR '12 _ i---s
Dot e__y �� A PPLcant CLOTHES WASHER ADDRESS 3
NOTICE O PPLICANT If after making this Certificate of -
Exemption you should lbecome subject to the Workers SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth CITY , TEL NO
P P Y_ LAWN SPRINKLER SYSTEM _
with comply with such proaisions or this permit shall be STATE n.s �� '� LIC {
deemed revoked WATER HEATER LICENSE NO d.ry. CLASS t
LICENSED CONTRACTORS DECLARATION DISTRICT NO, SSED BY
I hereby offirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER - R
and Professions Code and my license is in full force and affect 5 PER SYSTEM
FINAL y � 7� VALIDATION V
"J O
License Number 3 j-4a-9 L,c Claes _ 01
/2 1 FINAL / _ ri
Contractor/4 8-(IDYeS�d Ibte�[,� ' BY �"t V"��
EJ W
I am exempt under Sec N
B SP C for this reasonpool. ?
Plan check fee
Data v
S ^7 �Zw PLUMBING PERMIT ISSUING FEE E
gn t r ` l,, r '
TOTAL FEE `
Plan check applicant
SINGLE FAMILY , t
HOME OWNER BUILDER DECLARATION Name _ 1 2 8 6`A
I hereby affirm that I am exempt from the CoNractor s"cense Address
Law for the following reason (Section 7031 5, Busmess and
Professions Code) cit)` Tel No
❑ Y f -
I as owner of the property„will do the work and the ( • • � �.5
structure is not intended or offered for sole (Section _ ', t
7044 Business and Professions Code) , . . . 1 6,00 is
r 1
CONSTRUCTION LENDING AGENCY •O 5 � 7_$4
I hereby affirm thatt there there is a construction lending agency for � , ,
the performance of the work for which this permit s;ssued r
(Sec 3097 Civ C ) _
Lenders Name ,
Lenders Address r
1 certify that I hove read this opphcoeon and staie'thal the ►
above information is correct I agree to comply with all County
ordinances and State jaws regulating Plumbing and hereby
authorize representatives of this County to enter upon the
above entioned roperty for inspection pu os "
P SEE REVERSE FOR EXPLANATORY LANGUAGE ,
Signature of Permittee Doib
c
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 'PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0012120002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
TR 13613 LT 80 5408 PARMERTON AV
FEE DESCRIPTION QUANTITY LK94 AMOUNT TEMP CA 917803505
ASSESSORNEAREST CROSS STREET
8573-007-008 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID L3 LOCALITY TEMPLE CITY
51 LOW PRS GAS 5 OUTLET 1 00 SYS 16 20
TENANT TOTAL FEES 43 95
ISSUED ON PROCESSED BY PLAN BY EXFrWF9—OW-
12112100 UT 06/11/01
OWNER TEL 7
LONDEAN DIANNE C
5408 PARMERTON AV
TEMP 917803505 ftF LKIPI LUN OF
GAS LINE FOR NEW HEATING ND AIR COND SYSTEM
APPLICANT
TEMPO AIR COND 8 HEATING (626) 285-1218-
5937 N OAK AVE SPECIAL CONDITIONS
TEMPLE CITY, CA
P�GELES CO
CONTRACTOR 0 C, APPROVALS DAT
TEMPO AIR CONDITIONING AND HEATING (626) 285-1218- 0 �'
5937 N OAK AVE LIC NO UNDER
TEMPLE CITY, CA 91780 274880020 WATER
SERVICE
ARCHITECT OR ENGINEER TEL--WO- 1/ PLASTIC Y/N METAL Y/N
LIC -NO / 1i 1111
ROUGH PLUMBING
LLGAS PIPING
GMoWC VV�� ETEF—
NG FIXTURES
>�F;+tiLAWN SPRINKLERS
D 0 it f•. GAS TEST
\ A Q 4�g
SerVOe Yhae�et WATER CWVGRAY
REPORT ID DPR263 ROUTE TO BS0508