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Home My Public Portal About5717 RIO HONDO AVE_Plumbing__ WOq.XFR'S COMPENSATION DECLARATION 200028 DPW 9/89 •I-f,a[eby affirm that I have a certificate of consent to self insure, 7M887A APPLICATION FOR PLUMBING PERMIT �t�r�it�catb of Worker's domponsation Insurance, or a certified A,copy,to'treof(See.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. p ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING � V �/►/M Certified copy is filed with the county building Inspection �(1rV ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date_ Applicant WATER CLOSET CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB ASSESSOR COMPENSATION INSURANCE (Thio section need not be completed If the work Involved by the SHOWER MAP BOOK PAGE / PARCEL permit Is for one hundred dollars($100)or less.) LAVATORY ® OWNER I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to SINK ADD ADDRESS become subject to the Workers'Compensation Laws. DISWASHER CITYL� TEL.NO. Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. > I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER IL (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS STAT SE NO. CLASS C Professions Code,and my license is in full force and effect. OUTLETS OVER DPICT NO. r P ESSED B� Ix 5 PER SYSTEM 66�J License Number Lic.Class FINAL DATE . VALIDATION � Contractor Date E] I am exempt under Sec. FINAL B.BP.0 for this reason Date: Plan check fee ® . Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE Plan check applicant SINGLE FAMILY A, HOME OWNER-BUILDER DECLARATION Name I hereby.ff rm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Address Cole): 1 .1—pmC ;I I,es ovmCity Tel.No.er of the property,will do the work and the structure TO TIAL 50- is not intended or offered for sale(Section 7044, Business _. and Professions Code). ® �.HECK :L�.(- CONSTRUCTION LENDING AGENCY 'CANGE o�� 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.) DXCO' Edi 7/91-- Lender's !'a):Lender's Nam o 3 S s (.: s = 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 for ins ction p• poses. SEE REVERSE FOR EXPLANATORY LANGUAGE WCd RV COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby,offirmAthat I have a certificate of consent to self 78A887A ` `insure, or a certificate of Workers'Compensation Insurance, CE 817(REV.8/88) or a certifie6copy thoroof(Sec. 3800, Lab. C.) COUNTY OF Qa®S ANGELES ®EF7'. OF PUBLIC WORKS ® Company i icy No. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) IBUILDING ADDRESS J Certified copy is filed with the county building Inspec- NUMBER FIXTURE OR ITEM @ FEE tion department. LOCALITY L C WATER CLOSET Date Appl lgant NEAREST CROSS ST, CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB � ( COMPENSATION INSURANCE OWNER -Gk! L G Q Q (This soctlon nood not bo complotod IF tho work Involvod by SHOWER �� S �' lVj�rllr the permit is for ono hundred dollars $18a or loss. r U p ( ) ) iAVATORY DDRESS 0 � / Ld I certify that in the performance of the work for which this SINK CITY TEL.NO ' permit is issued, I shall not employ'any person In any manner EP'1 L Z� {��5��y so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR t Date b pplicant �q��C� L, �� CLOTHES WASHER ADDRESS NOTICE T APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY1' TEL.NO. Compensation provisions of the Labor Code, you must forth.- LAWN SPRINKLER SYSTEM 41- with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRIaNO. ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS `l ✓� x (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER lJ U and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL 57 IOGN DATES C License Number Lic. Class FIN Contractor Date BY C I am exempt under Sec. B B.BP.C. for this reason Plan check fee 0721,9A Date: PLUMBING PERMIT ISSUING FEE$ 0 0 0 0 0 5 Signature TOTAL FEE Z. 1' o - 2250 Plan check applicant SINGLE FAMILY - 22505 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address U 61 o-87 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 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. 1 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 for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ryl, ,V— Signature of F.Ibrmittee Dote WORKERS'COMPENSATION DECLARATION fhhrej3y, affirm that I have a certificate of consent to self in- 76A�7q 20-0026 DPW 4/87 APPLICATION FOR PLUM"NG PERMIT /'� sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV.8/86) ' _ certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS r Policy,No. .Company r E `Certified copy is hereby furnished. y g p FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the count building inspection ADDRESS deportment. NUMBER FIXTURE OR ITEM @ FEE � ® LOCALIT tZle Date Applicant WATER CLOSET(TOILET) NEAREST I �.�� CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by "ONLT the permit Is for one hundred dollars($100)or less.) i LAVATORY ?— o Qtio� Aio- I certify that in the performance of the work for which this per- SINK TEL. NO. .— mit is issued, I shall not employ any person in any manner soas to become subject to the Workers'Compensation Laws. DISHWASHER Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL.NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIG. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION c !DISTRICT 140 OCESS I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS O 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fed,Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINA VALIDATION a DAT O License Number Lic. Class V FINAL 1Z Contractor Date BY O I— I am exempt under Sec. W fb B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and AC S Professions Code): Address r1CCTA CK I, as owner of the property, will do the work and the City Tel. No. 5307 3'f .50 structure is not intended or offered for sale(Section 7044, a ITEMS Business and Professions Code). TOTP.L o51D CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for CHECK 34.501 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). CHAINGE ,[If) Lender's Name Lender's Address +� -I�ni iari�r I certify that I have read this application and state that the ® 6278 1 AN 9 0 above information is correct. I agree to comply with all County adinanc s and State laws regulating Plumbing, and hereby authoriz repre Motives of this County to enter up n the above- nt'on property for inspection purp esr' 1 Q) # SEE REVERSE FOR EXPLANATORY LANGUAGE S'�gadture of Plirmittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1212110013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID BUILDING ADDRESS: [ ITR: 6561 IT: 1 BL: .001 1 [ 5717 RIO HONDO AV IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT-1 TEMP CA 917802433 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18587-003-019 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY Cl I 107 BATHTUBS/SHOWERS 2.00 FIX 32.40 I 1 [TAT: Ill CLOTHESWASHER(S) 1.00 FIX 16.20 (ISSUED ON: PROCESSED BY: PLAN BY: 1 I 125 LAVATORIES/SINKS 2.00 FIX 32.40 112/11/12 SR I I 145 WATER CLOSET/URINAL 2.00 FIX 32.40 1 I (OWNER: TEL. NO: 1 TOTAL FEES 141.20 IFINAL DATE FI Y: CODE: 1 AYE AYE MAW I � 15717 RIO HONDO AVE 1 I (! // ;; 1 ITEMPLE CITY 91780 1 JIMSCICIPTION OF WORK 1 I [BLOTSEUB/SHOWER, CLOTHESWASHER, LAVOTORIE, SINK AND 2 WATER 1 I (APPLICANT: TEL. NO: 1 I I ISAME AS OWNER I ISPECIAL CONDITIONS: 1 I I [ ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 (SAME AS OWNER I [ [ LIC. NO [ 1UNDER SLAB WORK I I I I IWATER SERVICE I I I I [ [PLASTIC YIN METAL YIN ARCHITECT OR ENGINEER: TEL. N0: I I� I - I TROUGH PLUMBING LIC. NO: [ GAS PIPING 1 I IGAS VENT I I I I I (HOT WATER HEATER I I I I I I I I IPLUMBING FIXTURES I I I I I I I I ILAWN SPRINKLERS I I I I I I [ [ [GAS TEST [ I UTILITY COMPANY NOTIFIED[ I I [ [ ICWV I I I I [ IGRAY WATER SYSTEM I I I I [ I I I I 1 I I I I I 1 [ I [ I I I I I I I I I I [ [REPORT ID: DPR263 ROUTE TO: BS0508 I I I I