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HomeMy Public PortalAbout5735 RIO HONDO AVE_Plumbing__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0304150008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: --FEES PAID BUILDING AD TR: 6561 LT: 1 UN: .002 5735 RIO HONDO AV FEE DESCRIPTION: QUANTITY: LION: AMOUNT: TEMP CA 917802433 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LIVE OAK 8587-003-011 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSU50 0 0 D . 45 WATER CLOSET/URINAL 1.00 FIX 16.20 05/19/03 JK 11/15/03 . TOTAL FEES 76.35 OWNER: EL. NO: FINAL DATE FINAL Y: CODE: WANG;JIAN JUN (626) 337-1863- ^ , 5735 RIO HONDO /.- TEMPLE CITY DESC� OON OF R PLUMBING FOR ADDITION APPLICANT: T NICK TIMKO (909) 392-8287- 4095 N FRUIT ST #809 SPECIAL CONDITIONS. LA VERNE CONTRACTOR: TEL. 0: APPROVALS DATE INSPECTOR SIGNATURE NICK'S REMODELING (909) 392-8287- 4095 N FRUIT STREET LIC. NO UNDER SLAB WORK SPACE 809 409663 B LA VERNE, CA 91750 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: LIC. N0: ROUGH BI G S PIPING r GAS VENT HOT WATERR PLUMBING FIXTURES UVWISFRUINK RS GAS-TEST UTILITY COMPANY 0 ! I D CWV GRAY WATERSYSTEM REPORT ID: DPR263 ROUTE TO: BS0508 WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT ,141*1 6W,Mfirm that I have a certificate of consent to self in- 76 66�A PW n /87 /1 sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) `IILJI� ce�Jified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company ❑ Certified copy is hereby furnished. BUILDING y Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS d department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY �� ,e Date Applicant WATER CLOSET(TOILET) NEAREST 4/v P, CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. ®,� COMPENSATION INSURANCE SHOWER OWNER �© � (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 4t I certify that in the performance of the work for which this per- SINK P' e mit is issued, I shall not employ any person in any manner so CITY TEL. NO. as to becorge su jecf to the Workers'Compensat' Laws. DISHWASHERFCss CONTRACTOR Date Applicant CLOTHES WASHERIr ADDRESS 77 NOTICE OAP LICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL.NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER 1t®�C_ ) LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTR'*11 ,r, P ED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS U 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL �� VA ATION fect. DATE 9L License Number Lic. Class C3 FI X Contractor Date BJq�� O p A8823A w I am exem t under Sec. B.BP.C. for this reason ® rq Plan check fee .� # 0 0 0 0 0 5 � Date: PLUMBING PERMIT ISSUING FEE$ r Signature TOTAL FEE ,( o o 1 6,5 Q SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant 1. o o o 16505 I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address S;— 40 I&Arft Q 1,2 2—8 8 I, as owner of the property, will do the work and the City Tel. NoJes -0866 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 represenn ives of this County to enter upon the above- ntio e 6 operty for inspection pu pose /, �� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date