HomeMy Public PortalAbout9453 PENTLAND ST_Plumbing__ -,J t WORKERS COMPENSATION DECLARATION • ' T PLUMBING_ PERMIT
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hareby.;pffirm that200026 DPW 4/87 APPLICATION" FOR
,l have a certificate of consent to self in 76A667A '4 - '
sure o<a,cernficdte of Workers Compensation Insurance`ora CE,817(REV-8/86)' n
ce hfed copy thereof (Sec 3800 Lab C ) ., _ _ r •'! ,
Policy No Compony - - ` COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
> r+ -s6 . .• , r try s , z ' , r _ 1 ,
Certtfiad copy rs(hereby furnished • * v `
I - `FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / /
Certified copy Is fled with the county budding mspection ADDRESSLsa-N 5
'N Cr ^department p. e- `� ` , �.`, , NUMBERi T FIXTURE OR ITEM @ FEE _ LOCALITY - v
Fn7 St+.' 4 .•.oV3 's_`. r yv - 0 0 ' `� WATER CLOSE7(TOILET) -
Date - �Apphcont NEAREST ^ , -+ `
$, 1 ♦n BATH TUB CROSS ST C
CERTIFICATEIOQEXEMPTION FROM,-WORKERS-' r, _ - aw d _ f
5t i t COMPENSATION INSURANCE '+, t ) OWNER �' �p 4'�a
A4 ,moo - x s �. SHOWER v
. section need not ha completed If the work Involved by , _ MAIL
�the,pernilt Ii for_one�hundred dollars,($100) or less )' '"';- LAVATORY - ADDRESS
I certify that in the performance of the work for which this per °
mit is issued I shall not employ any person in SINK any manner�so ^ - Cltt TEL N0;;?87-i007 '
aslto be omthe Wo ers C pe s ion La s .•. z
t+ r 1� DISHWASHER ><, y �d . R a '
CONTRACTOR � ,,�J ria P
�Dat`e� Apphc CLOTHES WASHER
'
NOT JE T APP ICANT If aft m vig.this C rh cote of Ex -' ADDRESS ,SrQ-yY1fy• /�S Q9 , r
c^'^ - - SWIMMING POOL RECEPTOR 1141' 1 .• 7
em'ption you should become su lett to,the Wor ers Compen , - �'�. x - t I NO `-
EL
lotion provisions of the Labor Code you must forthwith comp-•s _ ^ LAWN SPRINKLER SVSTEM CITY' r � F '
ly with such prov-iisions or this permit shall be deemed revok STATE _ UC
ed ' 9 ' .' " ' , `' -- r_ w ^ p` WATER'HEATERy ' + ^ LICENSE NO- r CLASS '
LICENSED CONTRACTORS DECLARATION' :j ' .c DISTRICT N P ESSED BY
I hereby,offirm that I am licens`e`d under provis,ons,of Chapter' a GAS SYSTEM OUTLETSc7 In D
�(�)
9,( with Section 7000)of Division 3 of the Business t OUTLETS OVER
• and Professions Code and my license is in full force and of-%1 5 PER SYSTEM FINAL r '
fact • „ VALIDATION >
' 'tom , t DATE �� 'Q a
License Numbai LI< Class. w' t ri ` _ • U7
FINAL '^
Contractor " Dote
'M I am exempt under Sec
B 8P C for this reason, fi ` d
„ -Q Plan check feet �_ ^ - , r, z
• s Date PLUMBING PERMIT ISSUING FEE $
Signature
e' TOTAL FEE
' SINGLE FAMILY' s T ` t-'� 5 r
Plan check applicant
5
• HOME OWNER-BUILDER DECLARATION .-
I hereby affirm that I am exempt from the Contractor s License. o I _ ,+ a. " • . - • 4" ' - AC CT.A } /
Noma .•L ,
Law for the following reason (Section 7031 5' Business and ,
Professions Code) Address y - 3307 16.50
I, as rnot intended
owner of thel.pr'operty will do the work and the City.'=w .- I -,Tel No "c ° + s,.ti< . '1t 1 ITM .J
O str
' ucture Is d or offered for sole(Section 7044- `TQTAL^' ��7 .er0
Business aProfessions nd ProfCode) , • , , - 7 ,
MCK 16.51'
4 T ^CONSTRUCTION LENDING AGENCY r '
hereby affirm+that there is o construction lending agency for C `< -- f
ihe�perfo`rmancerof the workffor wFnch this permlt,is`issued ` • ' , ,. y p,
(Sec 3097',Clv'C ) q •."' ', ' °e s d _ ` r I t�
Le der s Name
DODO-0001 .9/18/89
AN 8:45.
° Lenders Address c - -
I certify,ihat I have read this aph
pllcaon,and state that the
above information Is correctyI agree to comply with all County,
ordinances and Stale`Iaws regulating Plumbing and'hereby — ► ,/< t
yr authorize`representatives oftithis County,to enter upon the,
a e m
on o 'rt y rYnspection,purp4D.
s
SEE REVERSE FOR EXPLANATORY LANGUAGE -
yl - atu�e of Per it 4 ' Dote 'r f' T , u
COUNTY OF LOS ANGELES TEMPLE CITY k 0508 PLUMPING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1007150010
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ITR 14572 LT 399453 PENTLAND ST
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803843
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
8590-008-004 01 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY Cl
07 BATHTUBS/SHOWERS 1 00 FIX 16 30
TENANT 25 LAVATORIES/SINKS 2 00 FIX 32 50 ISSUED ON PROCESSED BY PLAN BY
45 NATER CLOSET/URINAL 1 00 FIX 16 30 07/15/10 SR
51 IOW PRS GAS 5 OUTLET 1 00 SYS 16 30
OWNER TEL NO TOTAL FEES 109 20 F.TNAL DATE FINAL BY CODE
TSAI, RU BIN (626) 327-2234-
9453 PENTLAND ST d 6
TEMP 917803843 DESCrtlPTION OF WORK
PLUMBING FOR KITCHEN AND BATHROOM REMODELING
APPLICANT TEL NO
LI, JAMES
SPECIAL CONDITIONS
I
M
ACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
BUILDERS, INC (626) 356-2788-
GOLDRING RD LIC NO UNDER SLAB WORK
IA CA 91006 609931 B
WATER SERVICE
PLASTIC Y/N METAL YIN
ARCHITECT OR ENGINEER TEL NO (
ROUGH PLUMBING
LIC NO (/ N
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
CY]V
(GRAY WATER SYSTEM
REPORT ID DPR263 ROUTE TO BSO508