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HomeMy Public PortalAbout5417-5429 ROSEMEAD BLVD_Plumbing__ WORKERS',COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A667A PW 4 87 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 '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 inspection ADDRESS NUMBER FIXTURE OR ITEM FEE _ department. - @ LOCALITY d WATER CLOSET(TOILET) l Date- Applicant � NEAREST' n CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. P�1. COMPENSATION INSURANCE OWNER ` SHOWER . (This section;need not be completed if the work involved by, MAIL the permit.is for one hundred dollars ($100)or less.) - LAVATORY ADDRESS I.certify'that in the performance of the work for which this per-. SINK ©� CITY mit is 1 shall not employ any person inany manner so TEL.NO. as to-beco�suAecttoeWorkers'Comp_�ion Laws. DISHWASHER CONTRACTOR Dateppli CLOTHES WASHER NOTICE TO AP NT: If, after making this.Certificate'of Ex- ADDRESS em tion,you should become'sub ect to the Workers'Com en- SWIMMING POOL RECEPTOR P Y I P CITY TELs NO. cation 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 LICENSE NO. CLASS LICENSED CONTRACTORS•DECLARATIONDISTRICTWp. PROCESSED BY. r Z I hereby affirm that.f GAS SYSTEM OUTLETS am licensed under provisions of Chapter - ( 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER '. andPiafessions Cod5 PER SYSTEMVALIDATION my license is in full force and ef- FINAL ,i'y� r � fect. DATE ®' O License Number Lic. Class FINAL Contractor _ Date -s, _ 0, 6 C� I am exempt under Sec. / i /�� . LM B.&P.C. for this reason • Plan cheek fee Date: PLUMBING PERMIT ISSUING FEE $ t 9 0 5 5"A , Signature TOTAL FEE SINGLE FAMILY # o 0 o io 0 5 HOME OWNER-BUILDER DECLARATION Plan check applicant ) -:0,31L50 I hereby affirm that I am exempt from the Contractor's License Name Law for the-following reason (Section 7031.5, Business and ° o ° 3 I,5 0'0' Professions Code): ', Address 0226' 88 V 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—Vt n _ Lender's Address�Q �� �i�P�o�-f' Akl I certify that I have read this application and'state that the A�'� 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 abfof insp ction purpose . SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I thereby,affirm that I have a certificate of consent to self 78A867A insure, or o Certificate of Workers' Compensation Insurance, CE 817(REV.8/86) or a certified copy thereof (Sec. 3800, Lab. C.) ���,,� � COUNTY OF LOS' ANGELES DEPT. OF PUBLIC WORKS Policy No. Company ��''(•'t)� rtified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �-7 p� Certified copy is filed with the ou building inspec- ADDRESS � 7, iti�ndep�ATE NUMBER FIXTURE OR ITEM � FEE LOCALITY Date Appli4ant WATER CLOSET NEAREST EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed If the work Involved.by SHOWER MAIL 9 the permit is for one hundred dollars ($100)or less.) LAVATORY —ADDRESS l o� Qln o 1 certify that in the performance of the work for which this. permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR t% ► Date Applicant ( CLOTHES WASHER6 00 ° ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you, should become subject,to the Workers' . CIT TEL ` . NO.�� Compensation provisions of the Labor•Code, you must forth- LAWN SPRINKLER SYSTEM 6 O with comply'With such provisions or this permit shall be STATE LIC. t deemed revoked. WATER HEATER /) LICENSE NO. '�6 � � CLASS `-C-3 LICENSED CONTRACTORS DECLARATION V DISTRICT NO. P CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS +^ (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER ` and Professions Code,and my license is-in full force and effect. 5 PER SYSTEM FINAL �� .Cj VALI TION DATE 0 Z'J License.Num er _Lic. Class FI L Contractor Date Z66 I am exempt under Sec. B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature- TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name. ` �7 8 2 5 A I hereby affirm that I am exempt from the Contractor's License Address J V FAL i �1L �C SQ1 Law for the following reason (Section 7031.5, Business and S1 # o 0 0 0 0 5 Professions Code): City Tel. No. L5-c3 1 G' ❑ I, as owner of the property,. will do the work and the ( 0 0 3 4 5 0 structure is not intended or offered for sale (Section 7044, Business and Professions Code). ® 0 0 0 3[)'S Q v CONSTRUCTION LENDING AGENCY 09,02-87 1 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 oyt orize representatives of this County to enter upon the a ve-met( ,, ed property for inspection urpos SEE REVERSE FOR EXPLANATORY LANGUAGE Z S gna ure o Permittee Date -t ' ,WORKERS COMPENSATIO DECLARATION APPLICATION F®R LUMBING PERMIT 7� r� 1,he,eb,*affirm that I have"a cert. icate of consent to self 76A667A U nsuve: _o,cevAificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a'certified"copy thereof JSec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.I3�87ompany J'rPOOOOO=lp•'�— Certified copy is hereby furnished. ® FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 54 osemead Blvd Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Temple City 9-2-86 Owen Bros. Plbcf. 7 WATER CLOSET Date Applicant NEAREST ' CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars $100 or less. MAIL P ( ) ) 7 LAVATORY — ADDRESS 323 N. Glendale Blvd !' I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY Loos Angeles TEL. NO. 413-6127 so as to become subject to the Workers Compensation Laws. DISHWASHER I corvrRAcroR Owen Bros. Plumbing, Inc. Date Applicant CLOTHES WASHER NOTICE-TO APPLICANT: If, after making this Certificate of ADDRESS4265 N. Baldwin Ave. Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY El Monte TEL. No.443-0078 with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM P Y P P STATE LIC. t: deemed revoked. 7 WATER HEATER LICENSE NO. 231 741 CLASS C36-20 LICENSED CONTRACTORS DECLARATION DISTRICT Ng f R CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 7 GAS SYSTEM OUTLETS a i XU (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINA 4 roof drains -� DATA' VAIZATION License Number 231 741 Lic. Class C36-2O Q FI U. ContractoO-Wen Bros. Plbg_ Date 9-2-86 ❑ I am exempt under Sec. 0 B.&P.C. for this reason Plan check fee/ Date: PLUMBING PERMIT ISSUING FEE$ O Z Signature TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name 6 3 6 b A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address #,o,o 0 0 0 5 Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the Io20250 structure is not intended or offered for sale (Section 7044, Business and Professions Code). ® o - 202505 CONSTRUCTION LENDING AGENCY - 1,20-87 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 oboe,information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby outhor!,�e representative of this County to enter upon the �e/;;-q_�ptione�d prp for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE X 9-2-86 nature of Per iftee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1106150012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: 1 FEES PAID 1 BUILDING ADDRESS: ON FILE 5429 ROSEMEAD BL 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( SGAB CA 917762212 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: BROADWAY 15388-024-041 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY, Cl 1 105 BACKFLOW DEVICE(S) 1.00 DEV 16.30 1 1 (TENANT: 119 FLOOR SINK(S) 1.00 FIX 16.30 (ISSUED ON: PROCESSED BY: PLAN BY: 1 IYUAN LUNG HUNG 125'LAVATORIES/SINKS 4.00 FIX 65.10 106/15/11 SR I 1 145 WATER CLOSET/URINAL 1.00 FIX 16.30 1 1 TOWNER: TEL. NO: 147 WATER HEATER(S) 1.00 WTH 16.30 iFIJ�AL�DA FII�] L BY: CODE: YUAN LUNG HUNG 60 DWV REPAIR OR ALTER 1.00 SYS 16.30 5429 ROSEMEAD BL. 64 WATER PIPNG <= 1 1/2 1.00 LIN 16.30 ISAN GABRIEL 91776 1 TOTAL FEES 190.70 ID SCRIPTION OF WORK I ITENANT IMPROVEMENT PLUMBING FOR DENTAL OFFICE 1 I I I I (APPLICANT: TEL. NO: 1 I 1 (JEFFREY DY (626) 523-6071- I I 1216 S. GRAND AVE #17 I ISPECIAL CONDITIONS: I I I I I I I I I (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE ISAN LUIS BUILDERS, INC. (626) 945-5725- I 1 1 11422 LEMON AVE LIC. NO (UNDER SLAB WORK -T 1 1 BRADBURY, CA 91008 556398 I 1 IWATER SERVICE I 1 I 1 IPLASTIC Y/N METAL Y/N I I 1 (ARCHITECT OR ENGINEER: TEL. NO: 1 I 1 IROUGH PLUMBING 1 1 LIC. NO: I 1 IGAS PIPING I 1 1 I I I I I IGAS VENT 1 1 IHOT WATER HEATER 1 I 1 V-, IPLUMBING FIXTURES 1 1 1 LAWN SPRINKLERS 1 I I V 1 I I 1 IGAS TEST i I I 1 11 1 1 1UTILITY COMPANY NOTIFIEDI I I 1 I 1CWV I I I I 1 1 1GRAY WATER SYSTEM 1 1 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 I I I I I I I I 1 1* ADDITIONAL DATA ON FILE 1 1 1 1 I I I I I I I (REPORT ID: DPR263 ROUTE TO: 9S0508 1 1 1 I I I I I I t COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1201120025 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I ON FILE I 1 5423 ROSEMEAD BL I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( SGAB CA 917762212 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 15388-024-041 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY CAI 1 125 LAVATORIES/SINKS 1.00 FIX 16.30 I 1 (TENANT: 145 WATER CLOSET/URINAL 1.00 FIX 16.30 11SSUED ON: PROCESSED BY: PLAN BY: 1 1 1 TOTAL FEES 60.40 101/12/12 SR 1 (OWNER: TEL. NO: 1 IFIiNAL DATE FINAL BY: CODE: 1 IA & M ENTERPRISES (805) 910-8926- 1 O� 11227 FLYNN RD 301 - t _ 1 CAMARILLO CA 93012 IDENCRIPTION OF WORK IREPLACE 1 LAVATORIE AND WATER CLOSET FOR RESTROOM REMODEL 1 (APPLICANT: TEL. NO: 1 I IBAO, ZHEN (626) 416-9267- I 118037 LA PUENTE RD I ISPECIAL CONDITIONS: 1 ILA PUENTE CA 91744 I (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IJAMES TSAI CONSTRUCTION, 6264832857 (626) 483-2857- I 179 W. MAGNA VISTA AVE LIC. NO 1 (UNDER SLAB WORK I IARCADIA CA 91007 701042 B * I I I IWATER SERVICE I 1 1 (PLASTIC Y/N METAL Y/N I (ARCHITECT OR ENGINEER: TEL. NO: I__ 1 I IROUGH PLUMBING 1 LIC. NO: I I IGAS PIPING IGAS VENT I I IHOT WATER HEATER I I I- I IPLUMBING FIXTURES I I I I I I I I ILAWN SPRINKLERS I I I I I I I I IGAS TEST I I I 11 I (UTILITY COMPANY NOTIFIEDI I I I 11 I ICwV 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 I I I I I I I I I I I I* ADDITIONAL DATA ON FILE IREPORT ID: DPR263 ROUTE TO: BS0508