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Home My Public Portal About5744 PRIMROSE AVE_Plumbing__ WORKERS'COMPENSATION DECLARATIOU�11 •41 APPLICATION FOR PLUMBING PERMIT +M a I hereby affirm that I have a certificate of conseFP'to se'1 76A66117A, 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 BUILDING AND SAFETY 1 policy No. Company } } Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING J�,� Certified copy is filed with the county building inspec- ADDRESS S744 e-timaose A'` tion department, NUMBER FIXTURE OR ITEM @ FEE ' � LOCALITY Date Appli4ant `Z, WATER CLOSET A� /Z NEAREST CERTIFICATE OF.EXEMPTION FROM'WORKERS' 'Z BATHTUB It �7 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($100)or less.) 2, LAVATORY II y ADDRESSJ7 y t`IfI.��IV11/LrJ �l'v� I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK ' (Z„ p CITYTEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER f ,p 1 CONTRACTOR L PLV�llipl�t Date Applicant CLOTHES WASHER ADDRESS ' NOTICE TO APPLICANT: If; after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Q Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY /I ASL�G► with comply with such provisions or this permit shall be STATE LIC. deemed revoked. ' WATER HEATER r/ LICENSE NO. CLASS 'LICENSED CONTRACTORS DECLARATION DISTRICT N gROCE�SSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM 7 OUTLETS (commencing with Section 7000)of Division 3 of-the Business OUTLETS OVER j and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL y DATE ) VALIDATION V License Number. /( Lic. Class p� FINAL Q , Contractor Date BY ❑ I am exempt under Sec. B.BP.C. for this reason _11"'o / Z Plan check fee Date: I PLUMBING PERMIT ISSUIN9 FEE$ /D SD Signature TOTAL FEE rf(7 Plan check applicant SINGLE FAMILY 'HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ I, as owner of.the property, will do the work and the 9 1! A structure is not intended or offered for sale (Section 7044, Business and Professions Code). , j "n o 0 0 0 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction Lending.agency for the performance of the work for which this permit is issued Y^ (^ , (Sec. 3097, Civ. C.). I � 1 ; 7 _s :, 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 I ordinances.and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentio d pro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature P r lit Date t , '• COUNTY OF LOS ANGELES TEMPLE CITY # 0508r PLUMBING.PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS L PL 0508 9701280002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA i PHONE: (818) 285-0488 EXT: LEGAL ID: ES DPRI__G SS: TR: 6561 LT: 652 X5744 IMROSE-AV: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: '-r-TEMP-CK 917802507 ASSESSOR INFORINATION NUMBER: I NEAREST CROSS STREET: 8587-016-019 01 PERMIT ISSUANCE FEE 27.75 iTHOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY 13 DISHWASHERS) 1.00 FIX 16.35 TENANT: TOTAL FEES 44.10 ISSUED ON: PROCESSED : PLA Y: EXPIRES ON: 01/28/97 TC 01/28/98 OWNER: TEL. 0: FINAL DATE FINAL BY: CODE: OVERLEASE CHARLES E;CATHERINE A /� 5744 PRIMROSE AV ��0910 TEMP 917802507 DESC91PXION 9F WORK CHANGEOUT OF DISHWASHER APPLICANT: TEL.—NO: MC DONALD ELECTRICAL SERVICE (909) 885-3817- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: _ » cl " APPROVALS DATE INSPECTOR SIGNATURE 0 MC DONALD ELECTRICAL SERVICE (909) 885-3827- o� „�J� � 337 S. ARROWHEAD LIC. NO (� ,,_" 0Q ER SLAB WORK SAN BERNARDINO, CA 92408 49139 B -- WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR GI 0: ROUGH LIC. NO: L Iiu GAS PIPING AGAS VENT \ ,0 R PLUMBING FIXTURES KL RS �� GAS .S UTILITYCOMPANY NOTIFIED C V GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508 4di COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1209050035 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEfiS PAID I BUILDING ADDRESS: 1 ITR: 6561 IT: 652 I 1 5744 PRIMROSE AV I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802507 [ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 18587-016-019 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl I 164 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 1 ITENANT: 192 NO PERMIT OWNER-BLDR 342.20 DOL 342.20 (ISSUED ON: PROCESSED BY: PLAN BY: 1 1 TOTAL FEES 386.20 109/05/12 SR 1 (OWNER: TEL. NO: 1 IFINAL DAT FI CODE: 1 IOVERLEASE CHARLES E;CATHERINE A - 1 I /J I 15744 PRIMROSE AV I I Jt L� ITEMP 917802507 1 IDEMRIPflON OF WORK 1 I [INSTALL 1" COPPER TYPE IL' WATER MAIN CONNET TO EXISTING [TO EXISTING SPRINKLER VALVES 1[APPLICANT: TEL. NO: 1 1 ROSALES PLUMBING & ROOTER (626) 917-9650- I I I 11703 SO. CONLON AVE 1 ISPECIAL CONDITIONS: [WEST COVINA 91793 [ 1 I (CONTRACTOR: TEL. NO: [ [APPROVALS DATE INSPECTOR SIGNATURE 1 IROSALES PLUMBING AND ROOTER (626) 917-9650- 1 1 I 11703 S CONLON AVE LIC. NO 1 ]UNDER SLAB WORK I I I IWEST COVINA CA. 91791 802004-C36 *I I I I I IWATER SERVI I ] IPLASTIC Y/D MET /N I I (ARCHITECT OR ENGINEER: TEL. NO: I I I I I - 1 IROUGH PLUMBING I I I 1 LIC. NO: 1 1 I I I ] [GAS PIPING 1I I I[GAS VENT I 1 I I I IHOT WATER HEATER I [ I I I [PLUMBING FIXTURES I I ] I ILAWN SPRINKLERS I I I I I GAS TEST I1-1 ] I I [UTILITY COMPANY NOTIFIED[ I I ] I Icw� I I I I I [GRAY WATER SYSTEM I I I I 1 I I I 1 1 I I I I I ] I 1 I I I 1 I 1 I 1 ] ] 1 I I I ] I 1* AbDITIONAL DATA ON FILE I I [ I I I 1 [REPORT ID: DPR263 ROUTE TO: BS0508 ] [ 1 I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1209060008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BIIILDING ADDRESS: ITR: 6561 IT: 652 I 5744 PRIMROSE AV I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917802507 ] (ASSESSOR INFORMATION NUMBER: 1 I NEAREST CROSS STREET: I 18587-016-019 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl I 121 HOSE BIBB(S) 1.00 FIX 16.20 I ] TENANT: 163 WATER PIPING BR/FIX 3.00 FIX 20.40 (ISSUED ON: PROCESSED BY: PLAN BY: ] I I TOTAL FEES 64.40 109/06/12 SR 1OWNER: TEL. NO: I 1FINAL/DATEY FINAL B CODE: 1 IOVERLEASE CHARLES E;CATHERINE A - 1 I 15744 PRIMROSE AV I J?/// /L Q� ITEMP 917802507 I IDESCRIPlIbN OF WORK 1 I I IREPIPE WITH COPPER TO KITCHEN HOT & COLD, REAR HOSE BIB, I 11/4" ICE & WATER TO REFIG (BOX) CONNECT TO EXISTING COPPER I (APPLICANT: TEL. NO: ] I I IROSALES PLUMBING & ROOTER (626) 917-9650- 11703 SO. CONLON AVE I ISPECIAL CONDITIONS: (WEST COVINA 91793 ] ] I I (CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1 IROSALES PLUMBING AND ROOTER (626) 917-9650- 1 1 I 11703 S CONLON AVE LIC. NO 1 (UNDER SLAB WORK I I I (WEST COVINA CA. 93.791 802004-C36 *1 I I I I I (WATER SERVICE I I I I 1 IPLASTIC YIN METAL YIN [ARCHITECT OR ENGINEER: TEL. NO: 1 I I I I ] - I [ROUGH PLUMBING LIC. N0: I _ IGAS PIPING I I ]GAS VENT ] ] I I 1 (HOT WATER HEATER 1 I I 1PLUMBING FIXTURES I I 1 I I (LAWN SPRINKLERS I I ] I 1GAS TEST I I ] (UTILITY COMPANY NOTIFIED] 1 I ICWV I ] I iI IGRAY WATER SYSTEM I I I I I I I I I i I 1 I 1* ADDITIONAL DATA ON FILE [ [ [ [ I I I I I I IREPORT ID: DPR263 ROUTE TO: BS0508 ] I I I