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Home My Public Portal About6026 PRIMROSE AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION •- 20-W26 DPW 4/90 APPLICATION FOR PLUMBING PERMIT I hereby, affirm tHat I have a certificate of cdnsent to self in- 76A667A sure;or gcertificate of Workers'CompensationInsurance,or a �• certified copX thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) _ — Certified copy is filed with the county building inspection ADDRESS p department. NUMBER FIXTURE OR ITEM @ FE LOCALITY Ddte Applicant WATER CLOSET(TOILET) NEAREST _ CROSS ST. BATH TUB CERTIFICATE OF EXEMPTION FROM WORKERS' , COMPENSATION INSURANCE - SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS14 i/¢ I certify that in the performance.of the work for which this per- SINK CITY TEL.NO mit is issued, I shall not employ any person in any manner so pf^ s- as to become subject to the Workers'Compensation Laws. DISHWASHER e CONTRACTOR Date Applicant CLOTHES WASHER I ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption,you should become subject to the Workers'Compen- CITY TEL.NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. od• WATER HEATERLICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION t DISTRICT NO. PROCESSEI)BY I hereby affirm that I'am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fed,Professions Code, and my license is.in full force and ef- 5 PER SYSTEM o FINAL VALIDATION } HOSE BIB 2 License Number Lic. Class `, a FINAL _ C� Contractor Date BYQ ACCTeV .I,am exempt under Sec. 3303 317,10 ~U B.&P.C. for this reason1 ITEMS N Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ o�y O TOTAL 317 . 10 z Signature TOTAL FEE CHECK 317.10 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant CHANGE .00 I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address 0000-0001 5/28/96 0 1, as owner of the property, will do the work and the City Tel. No. 6606 1 AMIV 16 structure is not intended or offered for sale(Section 7044, Business and Professions Code). pop- CONSTRUCTION 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 laws regulating Plumbing, and hereby authorize representatives of this County Jo enter upon the above- entignedp operty for inspection purposes. "Vj1 �/ �C�• —Q� SEE REVERSE FOR EXPLANATORY LANGUAGE Signat re of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 I PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0202040013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: FEFS PAID BUILDING DD • TR: 6561 LT: 259 6026 PRIMROSE AV 'FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802033 ASSESSOR I 0 A IO SER: NEAREST CROSS STREET: GARIBALDI 5385-013-017 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY 55 GAS METER (PRIVATE) 1.00 MET 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED-BY: P N EXPIRES ON: 02/04/02 JK 08/03/02 OWNER: TEL. NO: FINAL DA E FINAL BY: CODE: SHERMIM KONG (626) 309-9972- ,;7 - Z (o 6026 PRIMROSE AVE TEMPLE CITY 91780 DESCRIPTION.- - OF WORK RELOCATE GAS METER APPLICANT: TE 0: KELVIN KONG (626) 309-9972- 6026 PRIMROSE AVE SPECIAL CONDITIONS: TEMPLE CITY 91780 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE CONTINENTAL CONSTRUCTION CO. (626) 378-1882- 6028 PRIMROSE AVE LIC. NO UNDERSLAB-WORK- TEMPLE-CITY, B ORTEMPLE-CITY, CA 91780 664434SC39 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: OUG P BING LIC.-NO: GAS PIPING GAS VENT OT WATER HEATER PLUMBfNG FIXTURE N P INKL R GAS TEST ' X70 -1 I FI7 COMPANY NOT C V GRAY WATERSYSTEM REPORT ID: DPR263 ROUTE TO: SS0508