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HomeMy Public PortalAbout9707 RICHMOND WAY_Plumbing__ C. -' ' " VVORKERS'COMPENSATION DECLARATION APPLICATION FOR' Pd NIXING PERMIT I hereby offirmrthat I have a certificate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No, mpany �' 33t — Pol Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING © Certified copy is filed with the county building inspec- ADDRESS '9'7'88—Richmond Way tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Tewle City Date 10-16-86 Applicant OWED Brn-s_ Pl hcf- WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER Owen Development (This section need not be completed if the work involved by MAIL the permit Is for one hundred dollars($100)or loss.) LAVATORY ADDRESS 2035 S. Myrtle Ave. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner SINK CITY Monrovia TEL.N0.359-3211 so as to become subject to the Workers'Compensation Laws. / DISHWASHER CONTRACTOR Owen Bros. Plumbing, Inc. Date Applicant CLOTHES WASHER ADDRESS 4265 N. Baldwin Ave. NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY Compensation NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM El Monte 443-0078 with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. 231 741 CLASS C36-20 LICENSED CONTRACTORS DECLARATION GAS SYSTEM OUTLETS DISTRICT NO. P OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 rJv (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION DATE ✓ Q License Number 231 741 Lic.Class r36-7n FI C.7 Contractor ()WPn BrnG_ Plhmnte 10-16-86 eIM ❑ I am exempt under Sec. a B.BP.C. for this reason Plan check fee COW,• Date: Cr PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Low for the following reason (Section 7031.5, Business and Professions 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). ;9 5 7 9 8 A CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for # 0 0 0 0 0 5 the performance of the work for which this permit is issued I o o 91L 5 0 (Sec. 3097, Civ. C.). Lender's Name 1 0.2 9-8 6 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 St% ate laws regulating Plumbing, and hereby out ize present ives this County to enter upon the v -m ned o er r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 10-16-86 nature of Permit Date • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1110040013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID 1 BIIILDING ADDRESS: 1 ITR: 43189 IT: 17 I 1 9707 RICHMOND WY 1 (ASSESSOR INFORMATION NUMBER: IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917803932 1 I I NEAREST CROSS STREET: 18589-019-051 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, Cl I 107 BATHTUBS/SHOWERS 2.00 FIX 32.50 1 1 ITENANTO 113 DISHWASHERS) 1.00 FIX 16.30 (ISSUED ON: PROCESSED BY: PLAN BY: 1 I 125 LAVATORIES/SINKS 5.00 FIX 81.30 110/04/11 SR 1 I 145 WATER CLOSET/URINAL 3.00 FIX 48.80 1 I 1OWNER: TEL. NO: 163 WATER PIPING BR/FIX 5.00 FIX 33.60 FINAL DATE FINAL BY: CODE: 1 1KERSHAW, ALLAN - i TOTAL FEES 240.30 19707 RICHMOND WA 1 I 1TEMP 917803932 I 1D8ScR PTION OF WORK 1 I 1PLUMBING FOR KITCHEN AND THREE BATHROOMS REMODEL 1 1APPLICANT: TEL. NO: 1HYLTON, DONALD (626) 938-1595- 1 1228 E. BADILLO ST. I 1SPECIAL CONDITIONS: 1 1COVINA, CA 91723 1 I 1CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 1PROTECH CONSTRUCTION (626) 359-8283- 1 111626 GOLDRING ROAD LIC. NOI UNDER SLAB WORK I 1ARCADIA, CA 91006 452024 B * 1 � I IWATER SERVICE I I I I 1PLASTIC YIN METAL YIN I I I 1ARCHITECT OR ENGINEER: TEL. NO: 1 1ANDERSON, BRUCE (626) 938-1595- 1 TROUGH PLUMBI 1 tl 1228 E. BADILLO ST. LIC. NO: 1 I I COVINA, CA 91723 3341 i (GAS PIPING 7j 1 1GAS VENT I I I 1HOT WATER HEATER I I I 1 1 I 1PLUMBING FIXTURES I I I I 1 1LAWN SPRINKLERS 1GAS TEST 1 I I OTILITY COMPANY NOTIFIED IcWV I I I 1GRAY WATER SYSTEM I I I 1 I I I I I I I I I I I i* ADDITIONAL DATA ON FILE I I I I I I I I I .I 1REPORT ID: DPR263 ROUTE TO: BS0508 1 I I I