HomeMy Public PortalAbout6024 RENO AVE_Plumbing__ COMPENSATION DECLARATION ' �PPLECA` N FOR PLUMBNG PERNT
that�l hays a e�tifi date of consent to self in- 76A667APW 4/87 n
ertificat,of Workers'Compensation Insurance,ora CE 817(REV.8/86) cul
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N copy thereof (Sec.`3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
No, Company
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspection ADDRESS �
!
department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
WATER CLOSET(TOILET) ��)) 5 �f
Date Applicant ! t t/� NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' f BATH TUB ' .d do CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER _�4=T e� �Ze�
(This section need not be completed if the work involved by 16 0MAIL ,/�
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 'd®t�Y /�we7
I certify that in the performance of the work'for which this per- SINK CITY TEL. NO. C (�
mit is issued, I shall not employ a person in any mann so ���m�G��! 3�1T O
as to b/ecome subject to the Wor Comp t' n TWI
DISHWASHER CONTRACTOR ✓
Date • Applicant CLOTHES WASHER ADDRESS
NOTICE O A LICANT: If, after ma ing this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subje t to the Workers'Compen- CITY ffV TEL. NO.
sation provisions of the Labor Code,'You must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO.' CLASS
LICENSED CONTRACTORS DECLARATION
GAS SYSTEM OUTLETS (//'QD�ICT)v5�. P67BY
I hereby affirm that I am licensed under provisions of Chapter S(
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER i
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL �j V IDATION Y'
fect. DATE
O
License Number Lic. Class U
FINAL
Contractor Date BY O
h
I am exempt under Sec.
0.
B.BP.C. for this reason Plan check fee D W
Date: PLUMBING PERMIT ISSUING FEE$ 086 1.3 A
Signature
TOTAL FEE
SINGLE FAMILY # o 0 0 0 0 5
HOME OWNER-BUILDER DECLARATION Plan check applicant 1 - 40,50
1 hereby affirm that I am exempt from the Contractor's License Name o 0 0 4 Q 5 0�!
Law for the following reason (Section 7031.5, Business and
Professions Code): Address 1 216-87
I, as owner of the property, will do the work and the City Tel. No.
structure is not intended or offered for sale(Section 7044,
Business and Professions Code). D
�• CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the workf r hich this permit is issued
(Sec. 3097, Ci.v. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the D
above information is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
1 authorize representatives of this County to enter upon the
a e-mentioned p rty f i p tion purposes
!S SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign ture of Permittee tate
COUNTY.OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0906040012
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
[LEGAL ID: I FEES PAID I BUILDING ADDRESS: I
[TR: 5904 LT: 143 UN: .002 [ [ 6024 RENO AV [
[FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ TEMP CA 917801530
[ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: HERMOSA
15384-017-007 101 PERMIT ISSUANCE FEE 27.75 [ [THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C
[ i125 LAVATORIES/SINKS 1.00 FIX 16.20 [ [
[TENANT: TOTAL FEES 43.95 [ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
[ I _
106/04/09 SR 12/01/09
I I I
[OWNER: TEL. NO: FI D TE FIN BY: CODB: [
ARCHULETA ALLISON (626) 437-8826- [ i [
6024 RENO AV rl [
[TEMP 917801530 [ [DESCRIPTION OF WORK [
[ I (CONNECT TO EXISTING GARAGE HAND SINK [
[APPLICANT: TEL. NO: [ [ [
[STP ENTERPRISES INC. (626) 533-1324-
5454 TEMPLE CITY BLV I [SPECIAL CONDITIONS: [
[TEMPLE CITY CA 91780 [
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[CONTRACTOR: TEL. NO: [APPROVALS DATE INSPECTOR SIGNATURE [
ISTP ENTERPRISES, INC. (626) 287-7544- �I [ [
15454 TEMPLE CITY BLVD. LIC. NO [ [UNDER SLAB WORK [ [
ITEMPLE CITY, CA 91780 598157BC36 [ [ [
I I IWATER SERVICE [ [
I I [PLASTIC Y/N METAL Y/N I 1
ARCHITECT OR ENGINEER: TEL. NO: II I I
- I IROUGH PLUMBING
LIC. NO: II I [ [ [
[GAS PIPING
GAS VENT
[ [ IHOT WATER HEATER I [
I I I I
[ [ [PLUMBING FIXTURES I I I
I (LAWN SPRINKLERS I I [
I •I I I I I
[ I IGAS TEST I I
I �I I I I
[ [ (UTILITY COMPANY NOTIFIED
I rl Icwv I I
I I I I I I
JI IGRAY,WATER SYSTEM
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I 1IREPORT ID: DPR263 ROUTE TO: BS0508 [ [ [ [
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