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HomeMy Public PortalAbout6123 RENO AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT `+ I hereby-affirm that I have a certificate of.consent,to,self 20-0026 DPW 6/87 insure, or a certificate of Workers'Compensation Insurance, 76A667A oda certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING // � 'y Certified copy is filed with the county building inspec- ADDRESS C7�2_ - tion department. NUMBER FIXTURE OR ITEM aa® AEE FM. LOCALITY Date Appligant WATER CLOSET 7 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 10#50 &&SCROSS ST. COMPENSATION INSURANCE SHOWER OWNER (/tJt--.�1- L(�f 4 / (This section need not be completed if the work involved by MAIL ,r the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 6 1 certify that in the performance of the work for which this ) permit is issued, I shall not employ any person in any manner SINK 0 CI �� L� GL TEL.NO. �A7ib so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code , you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO. with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATERLICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION O DISTRICT NO. PROC ED BY I hereby affirm-that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER Q and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL r � �y/ AL1 ION per: DATE / !/ License Number Lic. Class C FINALContractor Date BY �j Q ❑ I am exempt.under Sec. U LrJ B.&P.C, for this reason 0. Plan check fee ® CC Date. PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE c' SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name ACCTag I hereby affirm that I am exempt from the Contractor's License Address 3307 76.511 Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. 1 ITEMS © 1, as owner of the property, will do the work and the IAL ' o structure is not intended or offered for sale (Section 50 7044, Business and Professions Code). CHECK 76.50 CONSTRUCTION LENDING AGENCY CHANGE o10 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.). 13000-13001 5/21/90 Lender's Name GVV06 1 AM 9Q22", 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 above4mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE .,,�, ! L. � .��--moi -- 0 Stinatdde of Permittee Date ION WORKER'S I have a certificate of consent to 20-11026DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I hereby afilim that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof,Sec.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company Certified copy is hereby furnished. rys � El Certified APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS j J� Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM FEE LOCALITY Date Applicant WATER CLOSET NEAREST 'ten_ty�d ' CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.LAW%O''d- COMPENSATION INSURANCE ASSESSOR y� • (This section need not be completed if the work Involved by the 1 SHOWER �� MAP BOOK ��� PAGE PARCEIL/P;L/ permit is for one hundred dollars($100)or less.) LAVATORY OWNER V Ar t l /4 [� I�P� W 6T I certify that in the performance of the work for which this permit MAIL '� Is issued, I shall not employ any person in any manner so as to SINK ADDRESS Cj(Y ��� c/�r become subject to the Workers'Compensation Laws. DISWASHER CITY TEL.NO. � Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. �- I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER �. (commencing with Section 7000)of Division 3 of the Business and LICENSE NO. LIC. (Q� Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS OUTLETS OVER DISTRICT .0 PROCESSED BY 5 PER SYSTEM O License Number Lic.Class I" FINAL !W&DA ION � Contractor Date DATE CA ❑ I am exempt under Sec. gyIAL 3-607 �)l�65 z B.&P.C.for this reason !9'4 1 ITEMS Date: Plan check fee TOTAL 70.65 Signature PLUMBING PERMIT ISSUING FEE$ (� CHECK 70°65 ❑ TOTAL FEE CHAi�.iE ��� SINGLE FAMILY Plan check applicant I7-0-1HOME OWNER-BUILDER DECLARATION Name jWv,) r I hereby affirm that I am exempt from the Contractor's License Law )000-0001 4/2.x/?., for the following reason(Section 7031.5, Business and Professions Address 6 iv3 k:2,70.o A-1.1— 9332 1 AM 3"177 City L� �G L' Tel.NoJy� Y��' 1,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 laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ce Signature of Permitte Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING kRNIT, DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS FL 0508-"9710160001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: 0818) 285-0488 EXT: ID: P ' I D N AD - TR: 5904• LT: 47 1,6123 RENO AV" - ' FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA-917801533 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5384-002-021 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY 25 LAVATORIES/SINKS 1.00 FIX 16.35 TENANT: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.35D ON: PROCESSED BY: E P R ON: TOTAL FEES 60.45 10/16/97 UT 10/16/98 OWNER: TEL. NO: FINAL DATE FINA BY- CODE: YING KUN HUNG;LI JUAN GUAM (626) 285-5669- 6123 RENO AV TEMP 917801533 DESCRIPTION 0. Wo PLUMBING IN GARAGE FOR LAUNDRY FACILITY APPLICANT: TE 0: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: �:'�:.}'� i - APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO UNDER SLAB WORK ' WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT EL. 0: ROUGH8 G LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PLUMB G I TUR S LAWN SPRINKLERS GAS TEST-- UT_a_lTr_C0_ffFXffY__N0_lTnFD CW GRAY WATER SYSTEM I REPORT ID: DPR263 ROUTE TO: BS0508