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Home My Public Portal About6163 RENO AVE_Plumbing__ WCFKERS'COMPENSATIlJNDECLARATION e4PpLIC14Tl®N F®R PLUMBING PERMIT T� • 20.0076 DPW 4/90 I hereby, pfrirni that I have a certificate of consent to self in- 76A667A sure,-or a certificate of Workers'Compensation Insurance,or a ' -Certified Eopy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. ompa+oy ❑ Certified copy is hereby furnished. f��' �, BUILDING / r� ❑ FOR APPLICANT TO,FILL IN(PRINT OR TYPE) ADDRESS 4V 14_ Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY t WATER CLOSET(TOILET) Date J ; (_,—Applicant�sT/j � NEAREST p BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' 3 COMPENSATION INSURANCE SHOWER OWNER `9` i4 (This soction need not be completed if the work Involved by MAIL the permit is for one hundred dollars($100)or loss.) LAVATORY ADDRESS -;7). QZ) N V 2= I certify that in the performance of the work for which this per- SINKCITY E TEL. NO� mit is issued, I shall not employ any person in any manner so os to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date• Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, x- em tion,you should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR-, P Y I PCITY TEL. NO. � sation provisions of the LaL,•f:ar)e,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE �i LIC. ed. WATER HEATER LICENSE NO. to d 1®0 CLASS e-,.ye LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and m license is in full force and ef- 5 PER SYSTEM FINAL Y VALIDATION fect. ?) • HOSE BIB DATE ,Z- License Number 61 Lic. Class 3303 403•L90 FINAL Contractor - Date �� BY 1 ITEMS I am exempt under Sec. A TOTAL 403 =BOR B.BP.C. for this reason Plan check fee ® CHECK 403•80� Date: PLUMBING PERMIT ISSUING FEE$ r CHANGE °Go'* Signature TOTAL FEE n SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant 0000-0001 7/25/96 1 hereby affirm that I am exempt from the Contractor's License Name 7650 1 AN110 18 Law for the following reason (Section 7031.5, Business and Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered forsale(Section 7044, Business and Professions Code). 110. 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.). G( I 11�( Lender's Name I Ij/. 1 l 1 Y� " Lender's Address 4 4 , ` 'I +t , ,-t ��e 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-me tioned property for inspection purposes. P% 2C. SEE REVERSE FOR EXPLANATORY LANGUAGE V24-0 Signatur of Permittee r Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9612040009 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: S PAID BUILDING R S:TR: 5904 LT: 51 6163 RENO AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801533 ASSESSOR INFORMATION R: NEAREST CROSS STREET: 5384-002-029 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY 05 BACKFLOW DEVICE(S) 1.00 DEV 16.35 TENANT: TOTAL FEES 44.10 S ED . PROCESSEDLAN EXPIRES ON: 12/04/96 TC 12/04/97 OWNER: TEL. 0: FINAL DATE FINAL BY: CODE: TAK KUEN CHAN 6163 RENO AV TEMP 917801533 ESCRPT ON OF WORK INSTALL LAWN SPRINKLER SYSTEM FOR NEW RESIDENCE APPLICANT: TEL. NO: LAC CONSTRUCTION (818) 280-8193- �� 5 ECIAL CONDITIONS: CONTRACTOR: TEL. 0: ®� APPROVALS- DATE INSPECTOR SIGNATURE LAC CONSTRUCTION CORP. (818) 280-8193- 1434 S. SAN GABRIEL BLVD. LIC. NO DER SLAB WORK SAN GABRIEL, CA 91776 703142 ATER SERVICE ARCHITECT0 ENGINEER: PLASTIC Y/N METAL Y/N OUG G LIC. N0� nttn GAS PIPING PUBUC W®Fol'S S VENT OT WATER HEATER O Uj�, PLUMBING FIXTURES o o L '�, 0 ®�® GAS TEST ®� �1UTILITY COMPARTY07rMU CW GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508