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Home My Public Portal About9722 RICHMOND WAY_Plumbing__ T a ,WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMN �byj.affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) u or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.IV8623798aompany FreMon - �Z Certified copy is hereby furnished. ® FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS ,8Rid pond Way tion department. NUMBER FIXTURE OR ITEM (� FEE �'- LOCALITY Temple Cit Date 10-16-86 Appli4ant CWen Bros• PlW. 119 WATER CLOSET f NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB / CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed If tho work Involved by SHOWER Owen Development the permit is for one hundrod dollars($IGO)or less.) MAIL T'' LAVATORY ADDRESS 2035 S I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY MOnroVia TEL.N0359-3211 so as to become subject to the Workers'Compensation Laws. ` DISHWASHER 119 CONTRACTOR Owen Bros. Plumbing, Inc. Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making'this Certificate of 4265 N. Baldwin Ave. Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY El Monte TEL.NO. 443-0078 with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. 231 741 CLASS C36-20 LICENSED CONTRACTORS DECLARATION DISTRICT NO. ---PVOCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS U t (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL DATE ✓� �® VALI Ano > License Number^731 7Ljl_Lic.Class C16-2171 J0O C FINA C ContractorCWen Bros. Plba.Date 10-16-86 BY 02 D ❑ I am exempt under Sec. F C B.B,P.C. for this reason 4 Plan check fee D> p Date: 0 Signature PLUMBING PERMIT ISSUING FEE$ 2 — TOTAL FEE 1001,50 SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law 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). CONSTRUCTION LENDING AGENCY Jr 81.L A I hereby affirm that there is a construction lending agency for # 0 0 a o 0 5 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). 10 1 00,50 Lender's Name aa1OQ506 Lender's Address 1 0,29-86 1 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 "aeurizeesentafives of is County to enter upon the ed fro fy Nnspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 10-16-86 rmitfe Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING. PERMOT in,' 6b 1.affirm that I have a certificate of consent to self 76A667A sure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.IV8623798aompany FrwmnnJ- Certified copy is hereby furnished. ® FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS iC)!lmond Way Tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY 1e City Date 10-16-86 Applicant Owen Bros. Plba. WATER CLOSET -� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB / CROSS ST. COMPENSATION INSURANCE 'SHOWER ` OWNER (This section need not be completed If the work Involved by Owen DeVelO rit MAIL the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS 2035 S. , I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any mariner �' SINK -- CITY Mb=via TEL"NO 359-3211 so as to become subject,to the Workers'Compensation Laws. ` DISHWASHER CONTRACTOR -Olden BrOS. Plumbing, Inc. Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of 4265 N. Baldwin Ave. Exemption, you should' become•subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM El Monte 44370078 with comply with such.provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. 231 741 CLASS C36-20 LICENSED CONTRACTORS DECLARATION DISTRICT NO. P CESSED BY I hereby affirm-that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS /J (commencing with Section 7000) of Division 3 of,the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL DATE ✓ VALI®ATI License Number_231 741 Lic. Class.C��-7n C FINA L CbntractoPwen 'Bros. Mg-Date 10-16-86 BY AaC ❑ 1 am exempt under Sec.. F C B.&P.C. for this reason LL • Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature — TOTAL FEE I Az J� Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): ICity Tel. No. ` I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section r. `� ;^ '� N, 7044, Business and Professions Code). A 5 81.-2 A CONSTRUCTION LENDING AGENCY -: I 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 (Sec. 3097, Civ. C.). 10 1 00,50 Lender's Name 100.500 Lender's Address 1 (129-86 I certify that I have read this application and state that the above informat)on is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby ou0mrize eprelentatives of is County to enter upon the 4Sgnvaeg1ureof ned fro ty nspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 10-16-86 Permitte Date