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HomeMy Public PortalAbout5721 ROSEMEAD BLVD_Plumbing__ 20-W26 WORKER'S have aceSATION DECLARATION to 7MO67 DPW 9/89 APPLICATION FOR PLUMBING PERMIT ll I here6°y afflr¢i that I have a certificate of consent to self Insure, 79A867A or 8*e011fica4e of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) Poli No.//J/f y COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑cy �Company_—�9�l �!�© . : c 1 Certified copy is hereby furnished.❑ BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS .;0 • Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date ZZApplicant WATER CLOSET NEAREST d CROSS ST. CERTIFICATE OF EXEMPTION FRO WORKERS' SAT14-FHB ASSESSOR COMPENSATION INSURANCE (This section need not be completed If the work Involved by the SHOWER MAP BOOK I PAGE PARCEL permit is for one hundred dollars($100)or less.) �1 LAVATORY a OWNER I certify that in the performance of the work for which this permit d Is Issued, i shall not employ any person in any manner so as to SINK MAIL �w become subject to the Workers'Compensation Laws. ADDRESS�`e DISWASHER TEL NO. Date Applicant CLOTHES WASHER ONTRACTOR �- NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR HIM I n v provisions of the Labor Code,you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM r; 1 1 LICENSED CONTRACTORS DECLARATION CITY TEL`. d �'s I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER A/ du- A IL (commencing with Section 7000)of Division 3 of the Business and STATE LIC.' Q Professions Code,and my license is in full torte and effect. GAS SYSTEM OUTLETS ° �9 e LICENSE NO. CLASS' - 3 V o� OUTLETS OVER / DISTRICT NO. PA MSM BY ([ pS 5 PER SYSTEM �•15-car �(o License Number 55i[l-2 .:e Lic.Class o% 7Z xem 7� /mss _ �I / 'v FINAL T~F7 V o DATE Z-lo� VALIDA710`N _ W Contractor e��- (� � ° °"-s 3 d /����ii-✓'nate /�if 42_ s •.�I�i ��-_ o .��}C/) ❑ CQ f AP.SC7,1 e�a5e C>2 0 ' FINAL � � 875.3Q ���+ 8 I am exempt under Sec. BY _i E � L� BAP.C.for this reason ,� - Data. CAA Plan check fee p , A F 1 Signature PLUMBING PERMIT ISSUING FEE$ 9 TOTAL FEE o? c i�1301,j"H�(_Ii ice/115/921 SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Address Code): El 1, 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. 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. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature ermittee Date ' COUNTY"OT+ LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1002090001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I I ON FILE I I 5721 ROSEMEAD BL I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 91780 I (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: LAS TUNAS I 15397-012-043 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl I 117 FLOOR DRAIN(S) 6.00 FIX 97.20 I I (TENANT: 19 FLOOR INK(S) 4.00 FIX 64.80 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I IYOSHINOYA TEMPLE CITY STORE 25 LAVATORIES/SINKS 3.00 FIX 48.60 102/09/10 SR 02/09/11 I 1 45 WATER CLOSET/URINAL 2.00 FIX 32.40 1 I (OWNER: TEL. NO: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 FINAL DATE F AL Y: CODE: I IYOSHINOYA AMERICA, INC. (310) 527-6060- 1 TOTAL FEES 286.95 1991 W. KNOX ST. I ITORRANCE CA 90502 1 [DESCRIPTION OF WORK I I I IT.I. PLUMBING I I I I (APPLICANT: TEL. NO: I IMIZUNO (213) 487-9964- 12917 TEMPLE ST. 1 SPECIAL CONDITIONS: I ILOS ANGELES CA 90026 I I 1 (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I ISHIN SHIN CONSTRUCTION CORP. (626) 279-7991- I I I 19324 E GARVEY AVE #J LIC. NO 1 [UNDER SLAB WORK EL MONTE CA 91733 858568E Y IWATER SERVICE IPLASTIC Y/N METAL Y/N I I I (ARCHITECT OR ENGINEER: TEL. NO: I I I I (ATELIER-U (213) 487-9964- I [ROUGH PLUMBING 1 12917 TEMPLE STREET LIC. NO: I I lI1 ILOS ANGELES, CA 90026 NONE 1 GAS PIPING 1 I I 1 IGAS VENT I I I I 1 [HOT WATER HEATER 1 1 1 [PLUMBING FIXTURES I I (LAWN SPRINKLERS I I I I 1 I IGAS TEST I I I [UTILITY COMPANY NOTIFIED( 1 1 I I ICWV I I I 1 I [GRAY WATER SYSTEM I I I I I 1 1 I I I 1 I 1 I I I I I I I IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0611200013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 ERT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 5721 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, C 26 MISCELLANEOUS FIXTUR 1.00 FIX 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: YOSHINOYA WEST INC. 11/20/06 JK 05/19/07 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CALAC INVESTMENT 3709 r SAN DIEGO, CA9211137 DESCRIPTION DV WORK PLUMBING BACK FLOW FOR SODA MACHINE APPLICANT: TEL. NO: DONG PHU LUU (626) 448-3562- 2108 PENNSYLVANIA AV SPECIAL CONDITIONS: COLTON, CA 92324 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE DONG PHU LUQ (626) 448-3562- 2108 PENNSYLVANIA AVE LIC. NO ' UNDER SLAB WORK COLTON, CA 92324 654302 C36• WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER I` PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM i , REPORT ID: DPR263 ROUTE TO: BSO508 I