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Home My Public Portal About6016 PRIMROSE AVE_Plumbing__ WORKERSr COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT hereby affirm thin I haft a certificate of consent to self 76A667A sure, or'b certificate df Workers,Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof(Sec.'3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY 0 cy No. IV062379mpany Fremont Certified copy is hereby furnished. BUILDING ® FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 6016 Primrose Certified copy is filed with'the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date 4-28-86 AppligantOwen Rmt;- Plbq- .5 WATERCLOSET 1 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' 4 BATH TUB CROSS ST. COMPENSATION INSURANCESOWNER Ron Owen (This section need not be completed If the work Involved by HOER the permit Is for one hundred dollars($100)or less.) rJ LAVATORY �(, MAIL ADDRESS 5551 N. HalifaX Rd. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner 2 SINK CITY prcacUa TEL. NO.443-6416 so ds to become subject to the Workers'Compensation Laws. DISHWASHER 2 CONTRACTOR Owpn Bros. Plumbing, Inc. Date Applicant 2 CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this.Certificate of 4265 N. Baldwin Ave. Exemption; you should become subject too the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY El Monte TEL.No.443-0078 with comply.with such provisions or this permit shall be STATE_ LIC: deemed revoked. 2 WATER HEATER LICENSE NO. 231 741 CLASS 6-20 LICENSED CONTRACTORS DECLARATION DISY NO� CES D BY I hereby.affirm.that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS v (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect.: 5 PER SYSTEM FINAL V DATION 231 741C3'6-20. DATE Q License Number Ltc. Class FINAL CC Contractoro Mn RmG- P1hQpate 4—.28-86 BY a ❑ I am exempt under Sec. C BAP.C. for this reason LL Plan check-fee ® 0: Date: U, PLUMBING PERMIT ISSUING FEE$ D Z Signature 245 4,']p . TOTAL FEE 1 Plan check applicant # 0 0 0 0 0 5 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I ° 1 54,50 I'hereby affirm that I am exempt from the Contractor's License Address ° ° 154.506 Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. Q i.2 9—8 6 ❑ 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). ' POO CONSTRUCTION.LENDING AGENCY I hereby off irm that there is c 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 orc in nces and State laws regulating Plumbing, and hereby ut rtze representativAos County to enter upon the ove-m ned%propenspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 4. 4-2.8-86 nature of Permit Date WORKERS�CO.MPEI`4SATION DECLARATION APPLICATION FOR PLUMBING PERMIT y affirm that I have a certificate of consent to self 76A667A insure! or'o cePfificate of Workers"Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof(Sec. 3800.1 Lab. C.') COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Ncn7R6937987:ompany- E'- apt Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ® Certified copy is filed with the county building inspec- ADDRESS 6016 Primrose tion department. NUMBER FIXTURE OR ITEM (� FEE 5 WATER CLOSET LOCALITY Temple City _n Date 4-28-86 Appli4antOw B G_ Pl har i NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS.ST. COMPENSATION INSURANCE SHOWER OWNER Ron Owen (This section need not be completed If the work Involved by MAIL. the permlt Is for one hundred dollars($100)or less.) 5 LAVATORY Q ADDRESS 5551 N. Hal]fax Rd. I certify that in the pefformance of the work for which this permit is issued,I shall not employ any person in any manner 2 SINK — CITY Arcadia TEL.NO.443-6416 so as to become subject to the Workers'Compensation Laws. 2 DISHWASHER CONTRACTOR Owen Bros. Plumbing, Inc. Date Applicant 2 CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS4265 N. Baldwin Ave.. Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR .Compensation provisions of the Labor Code,you must forth- LAWN SPRINKLER SYSTEM CITY El Monte, �L NO 443-0078 with comply with such provisions or this permit shall, be • STATE LIC. deemed revoked. 2 WATER HEATER LICENSE NO.. 231 741 CLASS C36-20 LICENSED CONTRACTORS DECLARATION Ja DISTRICTN� PRT/7 I hereby affirm that I am licensed under provisions of Chapter 9 2 GAS SYSTEM OUTLETS t//) (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is iii full force and effect. 5 PER SYSTEM FINAL VALID ION 231 741 DATE K License Number Lic. Class C36-20 CI • FINAL V ContractorOWen IRMS._ P11=-Date 4—R2—.9f; BY � IM ❑ lam exempt under Sec. BAP.C. for this reason Plan check fee pW Dater ®� N PLUMBING PERMIT ISSUING FEE$ z Signature' 4 5A6 A • TOTAL FEE Plan check applicant # 0 0 o 0 0 5 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I Q.1 5 4.5 0 I hereby affirm that I.am exempt from the Contractor's License. Law for the following reason (Section 7031.5, Business and Address o 0 154,5053 Professions Code): City Tel. No. o(j,2 9 8 6 ❑ 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 State I s regulating Plumbing,.and hereby 4gTnature horize risAe of this County to enter upon the. ve tifor inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 4-28-86 of Date