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Home My Public Portal About5741 RIO HONDO AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION A APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a' certificate of consent to self CE ce 81 eta (z-eo) insure,or a certificate of Workers'Compensation Insurance,or 'e-17-9certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES ( � =BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) TN NG -r SS �j, dN Y ❑. Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FETY �p - department. WATER CLOSET Date Applicant TBATH TUB T. EOfiiC. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ' SHOWER OWNER LAVATORY MAI L } (This section need not be completed if the work involved ADDRESS w dzNbo A\ O by the permit is for one hundred dollars ($100) or less.) SINK CITYTE.L.NO '7► U I. certify that in the performanceof the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR O so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS U Date ApplicantSWIMMING POOL RECEPTOR rL NOTICE TO APPLICANT: If, after making this Certificate.of CITY TEL.NO. N Exlemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE. LIC. Z Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLASS with comply with such provisions or this permit shall be WATER.HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PR CESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER cs-Dd' I hereby affirm that I am licensed.under provisions.of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINALVALIDATION ness and Professions Code,and my license is in full force and DATE f� � effect. FINAL License Number Lic.Class BY Contractor Date ❑ 4 I am exempt from the licensing requirements as I am a I Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ (� acting in my professional. capacity (Section 7051; Bus- iness and Professions Code). TOTAL FEE l Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name L. I hereby affirm that Iam exempi from the Contractor's Addresg5ll,(t NaJO I,V License Law for the following reason (Section 703.1.5, Busi- CitTel.No ness and Professions Code): , E' 2 3 8 41 A I, as owner of the property, am exclusively contracting # 0 0 0 0 0 5 with licensed contractors to construct the project (Section 7044,Business and Professions Code). 2 0 o 1 2 5 0 CONSTRUCTION LENDING AGENCY o 0 0 1 2 5 0 0 I hereby affirm that there is a.construction lending agency for the performance of the Work for which this permit is U,3 0—$2 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 SEE REVERSE'FOR EXPLANATORY LANGUAGE ordinances and State laws regulating :Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. q'7 2. Signature of.Permittee Date W_^RKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT e e 20-0026 DPW 4%87 O irni that I have a certificate of consent to self in- 76A667A `tlLJll sure,or a egrtificate of Workers'Compensation insurance,or a .CE 817(REV.8/86) cdrtified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No, Company Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) 41 `� �fJ`�,��d V y� Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) ' Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' ( BATH TUB 0 CROSS ST. L—W V— 0O^ t" COMPENSATION INSURANCE SHOWER /* OWNER (This section need not be completed if the work involved byMAILi`��`M the permit is for one hundred dollars($100)or less.) z LAVATORY QD ADDRESS 5-7� A0 oom o I certify that in the performance of the work for which this per- SINK CITY TEL. NO. " mit is issued, I shall not employ any person in any manner so V 1,_.I�P� �i. � 1 as to become subject to the Workers'Compensation Laws. r DISHWASHER Q CONTRACTOR Date-?-P 5—V Applicants te- CLOTHES WASHER �Q NOTICE TO APPLICANT: If, after making this Certificate of Ex- ..--� ADDRESS em tion,you should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR P Y I P CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- `-- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER Q LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION PISIWCT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM '�'OUTLETS ' 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION >_ fect. DATE�O - a License Number Lic. Class O FINAL U 0: Contractor Date BY O I am exempt under Sec. W B.BP.C. for this reason Plan check fee � Date: PLUMBING PERMIT ISSUING FEE$ z 0 2 Q 3 A Signature TOTAL FEE # o 0 0 0 0 5 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant ( o o 7 6 5 Q I hereby affirm that I am exempt from the Contractor's License Name o o 0 7&5 0 cii Law for the following reason (Section 7031.5, Business and O 7 1 5_ Professions Code): Address 88 I, as owner of the property, will do the work.and the City Tel: No. 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 representatives of this County to enter upon the above-mentioned property for inspection purposes. -� -7—fb6�I ' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date UU WORKERS'COMPENSATION DECLARATION 76A667A I hereby Pffirm,,,tligt I have w certificate of consent to self CE 817 1 2-661 APPLICATION FOR PLUMBING PERMIT insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. • Company pp`, Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS �;741 ��) 1 ��, U 1.1V Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE WATER CLOSET LOCALITY ; department. WIPLE Q74 Date Applicant NEAREST r, CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB IcRossST.p� COMPENSATION INSURANCE SHOWER OWNER i't j ��pl IL .q (TMAa his section need not be completed if the work involved LAVATORY ADDRESS67�` .Q 1011100 &Q Q by the permit is for one hundred dollars ($100) or less.) SINK 0 1 CITY MPLF ►ca TEL.N0�72; () I certify that in the performance of the work for which this DISHWASHER 3 CONTRACTOR W permit is issued, I shall not employ any person in any manner 0 so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS tj Datef _ Applicant SWIMMING POOL RECEPTOR a NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Z Compensation provisions of the Labor Code,you must forth- WATER HEATER LICENSE NO. CLASS with comply with such provisions or this permit shall be deemed revoked. GAS SYSTEM OUTLETS DIST�RIICT N�OO. PR CESS`D BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER L I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code, and my license is in full force and DATE J® �— �2 effect. FINAL License Number Lic.Class BY Contractor Date I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions,Code). TOTAL FEE Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 7031.5,• Busi- City Tel.No. �nes and Professions Code): I, as owner of the property, am exclusively contracting A 0 1 9.3 A with licensed contractors to construct the project (Section 7044,Business and Professions Code). tf o o a a o 5 CONSTRUCTION LENDING AGENCY 2 o 0 1600 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is o 0 0 1 6 0 0 0 issued(Sec.3097,Civ.C.). Lender's Name 07,02-81 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. 'f SCJ i Signature of Permittee�� - Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0507290031 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 6561 LT: 1 5741 RIO HONDO AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802433 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: WORKMAN 8587-003-010 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 2.00 FIX 32.40 TENANT: 13 DISHWASHER(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 25 LAVATORIES/SINKS 3.00 FIX 48.60 07/29/05 JK 01/25/06 45 WATER CLOSET/URINAL 1.00 FIX 16.20 OWNER: TEL. NO: 47 WATER HEATERS) 1.00 WTH 16.20 FINAL DATE FINAL BY: CODE: GIMA MICHAEL L;RITA L (626) 287-2556- TOTAL FEES 157.35 L�J^7 5741 RIO HONDO AV ��1 _ _ TEMP 917802433 DESCRIPTION OF WORK PLUMBING FOR BATHROOMS 6 KITCHEN REMODEL APPLICANT: TEL. NO: BOOTH (626) 351-9411- 1453 DAVERIC DR. SPECIAL CONDITIONS: PASADENA, CA 91107 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE CRH PLUMBING, INC. (626) 351-9411- 1453 DAVERIC DRIVE LIC. NO UNDER SLAB WORK PASADENA, CA 91107 30509BC36 WATER SERVICE PLASTIC YIN METAL YIN ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS G 1 GAS TEST UTILITY COMPANY NOTIFIED CNV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508