HomeMy Public PortalAbout6243 RENO AVE_Plumbing__ WOFEKER'SCOMPENSATION DECLARATION 200026 DPW 9189 APPLICATION
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I hereby affirm thaY'l 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.)
Policy No. .2 Sompany F,i^'[!
�� r , COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
r� Certified copy is hereby furnished. ^� ,�_ )
IJ Certified copy is filed with the county building Inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 6 2 3 0&7LJ0 p J
department. _ NUMBER FIXTURE OR ITEM @ FEE
LOCALITY
Date = Applicant WATER CLOSET
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. 0 vu
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the work Involved by the SHOWER MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) LAVATORY OWNER rt> ��
I certify that in the performance of the work for which this permit MAIL
Is Issued, I shall not employ any person in any manner so as to SINK ADDRESS L 2 _� /�-U C—
become subject to the Workers'Compensation Laws.
DISWASHER CITYA _•� TEL NO. 9"67
Date Applicant CLOTHES WASHER CONTRACTOR t
NOTICE TO APPLICANT: If, after making this Certificate of �J ( 1+ A NJ�G'Z_
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS 1!Z •�S G J�
provisions of the Labor Code, you must forthwith comply with such
provisions /—
or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY �_ TEL.NO. 7 /-E/(�[�
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I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER
(commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. s�6 CLASS N` Q
Professions Code,and my license is in full force and effect. I OUTLETS OVER
_ I 5 PER YSTEM DISTRICT NO. P BY Q s��
License Number 54 3! Lic.Class .` w
FINAL VAJ.1 AflON
DATE a
ContractoDate L �'L�.'. �r'° C4
r
-r7, Z
El am exempt under Sec. BY AL y ;`
B.&P.C.for this reason 71717�FL me
Plan check fee ®
Date: F: :'. A i°25
Signature i��
PLUMBING PERMIT ISSUING FEE$ r:I :,
❑ TOTAL FEE
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Plan check applicant
SINGLE FAMILY 12 id`�iaF
HOME OWNER-BUILDER DECLARATION Name
1 hereby affirm that I am exempt from the Contractor's License Law '_`:
for the following reason(Section 7031.5, Business and Professions Address
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).
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 nspec• n purposes. qSEE REVERSE FOR EXPLANATORY LANGUAGE
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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1305020013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: ]
ITR: 5904 IT: 56 ] 6243 RENO AV I
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917801535 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN 1
15384-001-021 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI
I 107 BATHTUBS/SHOWERS 1.00 FIX 16.20 1 ]
ITENANT: III CLOTHESWASHER(S) 1.00 FIX 16.20 (ISSUED ON: PROCESSED BY: PLAN BY: 1
1 125 LAVATORIES/SINKS 1.00 FIX 16.20 105/02/13 SR J
1 45 WATER CLOSET/URINAL 1.00 FIX 16.20 1 J
1OWNER: TEL. NO: �47 WATER HEATER(S) 1.00 WTH 16.20 IFINAL DOME FINAL CODE: 1
1MEDI A AARRENOMA DO,MARGARET M (626) 452-1807- 1 TOTAL FEES 108.80
ITEMP 917801535 [ IDEISMIPTION OF WORK (/ 1
I I ISHOWER, CLOTHESWASHER, LAVATORIE, WATER CLOSET AND WATER 1
I I I ATE I
1APPLICANT: TEL. NO: I I I
[LUDWIG, KIRK W (626) 434-0362- 1 1 1
12615 BASHOR ST 1 ISPECIAL CONDITIONS: 1
IDUARTE CA I I J
I I I I
ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1
1ACTIVE CONTRACTORS (626) 434-0362- 1 1 I
IPO BOX 692 LIC. NO I 1UNDER SLAB WORK I 1 I
IWILDOMAR CA 92595 932342I 1 I 1
IWATER SERVICE I I 1
I I IPLASTIC Y/N METAL Y/N I I J
(ARCHITECT OR ENGINEER: TEL. NO: I I L I I
1 - 1 [ROUGH PLUMBING ]
1 LIC. NO: J 1 I
IGAS PIPING
1 1 IGAS VENT I I 1
I ]HOT WATER HEATER 1 I I
I ] IPLUMBING FIXTURES 1 [ 1
I I I I [ I
I ILAWN SPRINKLERS I [
I J IGAS TEST
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] I JUT LITY COMPANY NOTIFIEDI I 1
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] I GRAY WATER SYSTEM I I I
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IREPORT ID: DPR263 ROUTE TO: BS0508
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