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Home My Public Portal About9822 RICHMOND WAY_Plumbing__ WORKERS'COMPENSATION DECLARATION APPL PATI N FOR PLUMBING PERMIT I hereby affvrq that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers'Compensation Insurance, 70A667A or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OM C WO Policy No. Company � � � ❑ Certified copy is hereby furnished. BUILDING -y► FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 4,0 Certified copy is filed with the county building inspec- NUMBER FIXTURE OR ITEM (� FEE tion department. 3LOCALITY 6 iZauY2 well, DateAppli4anf Ata ��f%•q�• _� WATER CLOSET Ify 00NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This suction nood not bo eomplotod If tho work involvod by SHOWER �iMAILe;11��r �0 �• 7 �- tho pormit Is for ono hundred dollars($100)or loss.) LAVATORY Ile 0SO ADDRESS :2o 8k 44s 711/yWt5 1 certify that in the performance of the work for which this / permit is issued,1 shall not employ any person in any manner SINK a CITY /�.. GlT� TEL.NO. �.. �� ' so as to become subject to the Workers'Compensation Laws. DISHWASHERl r CONTRACTOR �F Date Applicant CLOTHES WASHER ADDRESS4&J. //�� NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR N `fi rr /J, Exemption, you should become subject to the Workers' CITY TEL. NO-�r Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM ®t''� r6 S`a—S 3� with comply with such provisions or this permit shall be STATE — LIC. deemed revoked. WATER HEATER LICENSE NO.4p 5s�X41• CLASS LICENSED CONTRACTORS DECLARATION D4STR14T NO;J PR ESSED BY I hereby affirm that lam licensed under provisions of Chapter 9 GAS SYSTEM62 OUTLETS C�/1(J�( (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL /�y'� t �'� t t ALIDATION C DATE License Number` 5:20/h. Lic.Class L•-•�_"3 �/ t // _'L fie^ FINAL ContractorC12L :& ry Date%—s rii— BY A ❑ I am exempt under Sec. LIU % C B.BP.C. for this reason heck fee � Plan c Date: PLUMBING PERMIT ISSUING FEE$ Signature V TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name AM." hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and 7 Professions Code): City Tel. No. I ITEM ❑ I, as owner of the property, will do the work and the 16th structure is not intended or offered for sale (Section TOTAL 90 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CUM 9000 1 hereby affirm that there is a construction lending agency for bR,t-.Itit S*• o0D the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name CUB-Gual 9/ 6/39 Lender's Address 5546 1 AM10009 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-mentione_d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Ffermittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0503 0406240018 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDINGADDRESS; TR: 43136 LT: 1 UN: 5 9822 RICHMOND WY FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803966 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GOLDEN WEST 8589-020-083 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY 64 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 TENANT: TOTAL FEES 43.95 ISSU°O ON: PROCESSED—BY: PLAN BY: EXPIRES ON: 06/24/04 JK 12/21/04 OWNER: TEL. NO: k—DR.Orl eL DATE FINAL BY: CODE: WILLIAM SANTILLIAN (626) 451-0938- 17 98?.2 RICHMOND CT ll TEMP 917803966 PTIOOF WORK RUN ONE INCH COPPER LINE THIRTY FEET FROM WATER METER TO SIDE OF HOUSE APPLICANT: TEL. NO: SAME AS OWNER - IISPECIAL CONDITIONS: I CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIUATURE SAME AS OWNER - LIC. NO UNDER WORK WATEF SERVICE PLAST:IC Y/N E YiN �ARCHINECT OR NGINEER: TEL. NO: - i RCUGHRTL BTNG LIC. NO: i i � �A;�"PING i _—— GAS VENT —-- HOi WATER HEATER PLUM ING IX ORES LAWN RPRINKLERS GAS TEST UTILITY COMPANYOTI'rIED GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLur,d!WL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS Pi (1'sm :1409230003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID FEES PAID BU LDI G ADDP. SS: 7 .� TR: :3136 LT: 1 UN: 5 9822 RICHMOND WY FEE DESCRIPTION: QUAtdTITY: UOM: At'•^•UN7:�— TEMP CA 917803QA6 (�.(�s• ASSEEROR I ORMATI NUM R: i NEAREST CROSS STREET: �.I YkJSA 8589-020-083 ,01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 57 GRID: Al LOCALITY: TEMPLE CiTY, C 47 WATER HEATER(S) 1.00 WTH 16.20 TENANT: — TOTAL FEES 43.95 ISSUE ON: PROCES ED : PLAN BY: EXPIRES Or: 09/23/04 JK 03/22/05 owmt:k: TEL. NO: FINAL A7 FINAL BY: CODE: SANTJLLAN, WILLIAM (626) 451-09381,101 - 9822 RICHMOND WA TEMP 917803966 ffirzCRIPIrION OF WOR WATER HEATER CHANGE OUT APPLICANT: TEL. NO: TEKAWA (310) 575-1311- 17119 S. BROADWAY 5e'ECIA CONDITIONS: GARDENA CONTRACTOk: TEL. NO: APPROVALS -� DATE INSP9CT04 91IM UFE ACTION CONTRACTORS (310) 515-1311- 1711 SOUTH BROADWAY LIC. NO UTlOE;R NLAB WORK GARDENA, CA 90248 652535BC36 _ WAT?SERVICE PLAeTIC Y/N METAL Y/N ARCHITECT OR E G.NEEP.: TEL. N0: - � ROUI:H--FL0-1 m7l -iff r — ' LIC. NO: �iAS PIPTt,G -� — GrS'VtN I HOT WATER HEATER. PL *• .NS FIXTURES— L.tNT4 SPRINKLES GAS TEST UNITY L I Y COW P NO I F—I E-U CWL' GRAY, WAI ERS STEM ' I ' REPORT ID: DPR263 — ROUTE TO: BS05O8 _