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Home My Public Portal About6149 RENO AVE_Plumbing__ �RKERS'COMPENSATION L;FCLARATION A Pl1-,ICATiON FOR PLUMBING PERMIT .rI hereoy affirm that I have a certificate of consent to self 76A667A •insure, w_V c4wtificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certifi o y thereof(Sec. 380 b. C.) �n COUNTY OF LOS ANGELES BUILDING AND SAFETY Poli cy Noy Company Vc� t�if�iecl etfed copy is hereby furnis ed. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING copy is filed with the county building inspec- ADDRESS J tion de art m nt. NUMBER FIXTURE OR ITEM @ FEE LOCALITY � 7 Co r Date Applicant I WATER CLOSET v NEAREST RTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB Ila da— CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be complotod if tho work Involved by 6 MAIL SHOWER Yd' rL6 the permit is for one hundred dollars($100)or loss.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued,.I shall not employ any person in any manner SINK CITY � TEL. NO. 19 � so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER 10ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR ` Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY `r V le/ TEL.NC%� with comply with such provisions or this permit shall be STATE /�� LIC. LICENSE deemed revoked. WATER HEATER NO. CLASS LICENSED CONTRACTORS DECLARATION 0 DISTRICT NO. P ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 C GAS SYSTEM OUTLETS 0 St V U y (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and m license is in full force and effect. 5 PER SYSTEM 4 Y FINAL VAL14ATION C DATE _ License Number Lic. Class q �� - FINAL Contracto Date BY U ^ AIA❑ IL I am exempt under Sec. y B.BP.C. for this reason C Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ ;93664, A Signature TOTAL FEE $' c o o a o 5 Plan check applicant SINGLE FAMILY ( 0 0 5 8 5 0 HOME OWNER-BUILDER DECLARATION Name 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 o 5 a 5 0� Professions Code): City Tel. No. L 2 16 8 5 ❑ 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 laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the bov mention pro rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 1 �• " COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0601250002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5904 IT: 49 UN: .002 6149 RENO AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801533 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ROSEMEAD 5384-002-026 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: 11 CLOTHESWASHER(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 17 FLOOR DRAIN(S) 1.00 FIX 16.20 01/25/06 JK 07/24/06 . 25 LAVATORIES/SINKS 2.00 FIX 32.40 OWNER: TEL. NO: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 FINAL DATE NAL BY: CODE: GARCIA, ROBERT (626) 826-1446- 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 6149 RENO AV TOTAL FEES 141.15 TEMP 917801533 DESCRIPTION OF WORK PLUMBING FOR BATHROOM, LAUNDRY ROOM APPLICANT: TEL. NO: HALLAM (909) 305-9933- 133 E. BENITA AVE SPECIAL CONDITIONS: SAN DIMAS, 91773 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE GARCIA, ROBERT (626) 309-9776- 6149 RENO AVE LIC. NO UNDER SLAB WORK Q A TEMPLE CITY, CA 91780 NONE Z114C WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: WESTWOOD DESIGN (909) 305-9933- ROUGH PLUMBING 133 EAST BONITA AVE STE. 202 LIC. NO: SAN DIMAS CA 91773 NONE GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFI [� CKV GRAY WATER' SYSTEM l `{J�f7di`�R.j4r� (o k 20' �2�lCq� REPORT ID: DPR263 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY 0 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0207180005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL • FEES PWID GA TR: 5904LT: 49 UN: .002 6149 RENO AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801533 ASSESSOR INFO 0 NEAREST CROSS STREET: LONGDEN 5384-002-026 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TOTAL FEES 43.95PROCESSED B : 07/18/02 JK 01/14/03 OWNER: TEL. NO: FINAL DATEF NAL.BY: CODE: EGGLES _U3 WILLIAM;LYNNE A (818) 287-0083- n p1%! � J 6149 RENOENO AV TEMP 917801533 DESCRIPTION 3f WORK NEW TUB & SHOWER IN BATH TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - '•;;; 'I =:*"+ LIC. NO UNDER SLAB WORK ,; y, ;; �•i „ WATER SERVICE ARCHITECT 0 ENGINEER: L. 0: PLASTIC Y/N METAL Y/N LIC. NO•' GAS PIPING S VENT R PLUM81NG FIXTURES LAWN SPRINKLERS GAS TEST .;�.: UTILITY COMPANY NOTIFIED GRAY WATER SYSTEM- REPORT S EREPORT ID: DPR263 ROUTE TO: BS0508