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HomeMy Public PortalAbout5405 ROSEMEAD BLVD_Plumbing__ r .SNC? KRKR ERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING'PERMIT I hereby affirm=that I have a cE*atificate ;f consent to self 76A667A Z. insure,'or a certificate of V�orkers' Compensation Insurance, CE 817(REV. 10/81) Z 'fl —�� or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES . BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS cy,c, s em' "o- ED R FIXTURE OR ITEM @ FEE NUMBER / R tion department. LOCALITY " Z/ IWATER CLOSET -® Date Applicant ` / CROSS NEARESTT . CERTIFICATE OF EXEMPTION FROM WORKERS' / M c, !�h , COMPENSATION INSURANCESHOWER OWNER (This section need not be completed if the work involved by " the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL, (J ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK �� CITY TEL. NO. so as to become subject to the Workers'Co pensation Laws. DISHWASHER Q(//�� �-- /�. CONTRACTOR Date �-� Applicant A CLOTHES WASHER r/i NOTICE TO APPLICANT: If, after aking this Certificate of a� ADDRESS% Q � � /4A it.,c IJ Exemption, you should become subject to the Workers' of Z ` CITY � TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM El V L3E+t 11 2 with comply with such provisions or this permit shall be STATE LIC. ,� deemed revoked. % WATER HEATER LICENSE NO. p - 2© CLASS G' 3 6 LICENSED CONTRACTORS DECLARATION DISTRICT NO. P j ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 % GAS SYSTEM � OUTLETS & (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER l/!/ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM / FINAL � VALIDATION .� i� (� DATE � y License Number b 2C� Lic. Class 3 Ile t/ 0 Contracto Date ❑ I am exempt under Sec, 0U B.&P.C. for this reason W Plan check fee 11• Date: PLUMBING PERMIT ISSUING FEE$ Z Signature ....._ ®' TOTAL FEE 6 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): City Tel. No. 2 6 06 6 A ❑ I, as owner of the property, will do the work (Section the U 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 _. obove- entioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE %Aignature of Permittee Date _ e COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARi'MENT.OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1207050005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE ( 5405 ROSEMEAD BL IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( SGAB CA 917762212 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: BROADWAY 15388-024-064 IOW PLANCHECK FEE 0.00 164.10 I THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY, Cl I 101 PERMIT ISSUANCE FEE 27.80 1 1 (TENANT: 125 LAVATORIES/SINKS 3.00 FIX 48.60 (ISSUED ON: PROCESSED BY: PLAN BY: I IBYUN / 00—BOOK KOREAN BBQ YONG—BOK 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 110/15/12 SR I 1 155 GAS METER (PRIVATE) 1.00 MET 16.20 I 1 OWNER: TEL. NO: I TOTAL FEES 272.90 IFINAL TE FINAL BY: CODE: IA & M ENTERPRISES — I 11227 FLYNN ROAD #301 ICAMARILLO, CA 93012 IDESCRI TION OF WORK I IPL FOR T.I. FOR EXISTING RESTAURANT NO ALTERATION ON ADA 1APPLIED (E) RESTROOM (E) CHANGING ROOM & (E) KITCHEN APPLICANT: TEL. NO: ' IEDDIE NOH (213) 739-9902— 1 1 13450 WILSHIRE BLVD. ISPECIAL CONDITIONS: ILOS ANGELES CA 90010 ICONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE IYONG HO SEO (213) 368-0204— I I 13700 WILSHIRE BLVD. #427 LIC. NO (UNDER SLAB WORK I I I ILOS ANGELES, CA 90010 954470—B 1 I I I IWATER SERVICE 1 1 1 I I IPLASTIC Y/N METAL Y/N I 1 1 - IARCHITECT ENGINEER: TEL. N0: - I CORBEL ARCHITECTS INC. (213) 739-9902-3 IROUGH PLUMBING �� AN I 13450 WILSHIRE BLVD. SUITE 1000 LIC. NO: i1' ILOS ANGELES, CA 90010 C23320 I IGAS PIPING I I I I I I I 1 I IGAS VENT I I I 1 I 1 IHOT WATER HEATER 1 1 1 I I I I I I I I IPLUMBING FIXTURES 1 1 1 I I I I I I ILAWN SPRINKLERS I I I I I I I i I IGAS TEST I 1 11 I 1 (UTILITY COMPANY NOTIFIED( I 1 I I I I I I I ICWV I I I I I I I (GRAY WATER SYSTEM I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I I I I I I I I I I I I I I I I I I I I I I I I I I i I I I I I I I IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I