HomeMy Public PortalAbout6037 PRIMROSE AVE_Plumbing__ WORKERS'COA(IFENS/LTION DECLARATION AP.P`ICATION FOR PLUMBING PERMIT
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I her b. affJrm that 1'htive a'certificate of consent to self 7BA667A
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insure, or a certificate of Workers;Compensation Insurance, CE 817(REV.8/86)
or a certified copj,thereof(Sec. 3800, Lab. C.)
Policy Na. nauca�na Company ,, „ 1--casualty
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
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C=esp� �� ualty
❑- Certified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN..(PRINT OR TYPE) 6037 PrinlroSt
Q Certified copy is filed with the:county building inspec- ADDRESS .
tion deportment. NUMBER FIXTUREOR.ITEM @ FEE LOCALITY
2-24-87 . Owen Bros. Plbg. WATER CLOSET' ��. T le Cit
Date Appli4ont NEAREST -
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB _ CROSS ST. _
COMPENSATION INSURANCE OWNER V.I•:P. Builders. ;
SHOWER
(This section need not be completed it the work involved by 205 Sall Gabriel Blvd.
the permit is For one hundred dollars $100 or less. MAIL
p ( ) ), LAVATORY r ADDRESS
I certify that in the performance of the work for which this
permit is issued,I shall not employ any person in any manner SINK l7 �' CITY San Gabriel TEL.NO-309-9333
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR Owen Bros. Plumbin Inc.
Date Applicant CLOTHES WASHER ADDRESS 4265 N. Baldwin Ave.
NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR'
Exemption, you should become subject to the Workers' CITYEl Monte TEL.NO.443-0078
Compensation provisions..Of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM '
with'comply with such provisions or-this permit shall be STATE
ANSE NO. 231 741 LIC • C36-20
deemed revoked. WATER HEATER
LICENSED CONTRACTORS DECLARATION DISTRICT NO. 'PROCESSED BY
I hereby affirm that I am licensed under provisions.of Chapter 9 GAS SYSTEM 57 OUTLETS
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL' _ _ VALIDATION C
.DAT t
License Number 231 741 Lic. Class l[36-20
FINA C
Contractor. Owen B a_ P1 bgate 2-24-87LL
BY
❑ 1 am,exempt under Sec:- -- (�.5,9 ]A a
B::&P.C. for this reason
Plan check fee , # 0 0.0 0 0 5
Date: PLUMBING PERMIT ISSUING FEE$ ( o o 8 a 5 0
Signature.
TOTAL FEE
. 0 0•o88,5pCX) .
Plan check applicant
SINGLE FAMILY 022787
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
structure is not intended or'offered for sale (Section
7044, Business and Professions Code).
CONSTRUCTIONLENDING 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 to enter upon the
W
entioned pro erty for inspection purposes:
SEE REVERSE FOR EXPLANATORY LANGUAGE
2-24-87
nature of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1208220006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ITR: 44381 IT: 1 UN: D 1 1 6037 PRIMROSE AV [
FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:[ TEMP CA 917802006 [
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LAS TUNAS
15385-007-034 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
I 147 WATER HEATER(S) 1.00 WTH 16.20 ,[ 1
ITENANT: I TOTAL FEES 44.00 (ISSUED ON: PROCESSED BY: PLAN BY:
108/22/12 SR 1
(OWNER: TEL. NO: I 1EINAL DATE FIN Y: CODE:
FUNG KAI TAK;STELLA W (626) 823-7505- 1 I Z I
6037 PRIMROSE AV
ITEMP 917802006 1 DESCRIPTION OF WORK 1
I 1 I NSTALL A TANKLESS WATER HEATER [
I
[APPLICANT: TEL. NO: 1 I I
IX-TREME BUILDERS INC. (626) 786-2347- [ 1 1
12509 EUCLID CRESENT 1 ISPECIAL CONDITIONS: [
1UPLAND, CA 91784 I I
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ICONTRACTOR: TEL. NO: I [APPROVALS DATE INSPECTOR SIGNATURE 1
IX-TREME BUILDERS INC. (909) 931-4464- 1 1 I
12509 EUCLID CRESCENT EAST LIC. NO 1 [UNDER SLAB WORK I [ I
(UPLAND, CA 91784 6271428 1 I I I I
[ IWATER SERVICE
[ IPLASTIC Y/N METAL Y/N [ I I
[ARCHITECT OR ENGINEER: TEL. NO: I I [ I
I - I IROUGH PLUMBING
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1 1HOT WATER HEATER "�^ 1
I I IPLUMBING FIXTURES I I I
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1 I 1GRAY WATER SYSTEM I I I
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IREPORT ID: DPR263 ROUTE TO: BS0508 I [ I I
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