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Home My Public Portal About5807 ROSEMEAD BLVD_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 �j insure, or a certificate of Workers'Compensation Insurance, 76A667A lul or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No.-�'6,—a�-�.Company ❑ Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS J-1O 7 , Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCAU Date Z-Appligant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. COMPENSATION INSURANCE OWNER SHOWER "• �': (This section need.not be completed if the work involved byMAIL t the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner SINK O2 7T CITY TEL.NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER ONTRACTOR Date —Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR ? Exemption, you should become subject to the Workers' CITY TEL.NO. Compensation provisions of the Labor Code, you must forth- a� with comply with such provisions or this. LAWN SPRINKLER SYSTEM p.y p permit shall lie STATE LIC. 'deemed revoked. / WATER HEATER /c>L .S LICENSE NO. g CLASS LICENSED CONTRACTORS DECLARATIONDISTRICT NO. PROCESSED BY I hereby affirm-that I am licensed under provisions.of Chapter 9 GAS SYSTEM OUTLETS .(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER !/O and Professions Code,and my license is in full force and'effect.. 5 PER SYSTEM FINAL . VALIDATION DATE ^Z License Number e� A OEOP Lic. Class 68 a '`{ �7 C yA - FINAL Contractor ZyZ51,!1111-' �/� Date / I - _ BY C ❑ I am exempt under Sec. j 23 0L B.BP.C. for this reason "'`' T Plan check fee / r t ''`�' 'v _ tG/ Date c7F �t7 Lw'_7 ).Cw.a1�t PLUMBING PERMIT ISSUING FEE$ Signature - - TOTAL FEE v3_307 Plan check applicant ).I ijil- 'SINGLE FAMILY E S .._,_ HOME OWNER-BUILDER DECLARATION Name !r,),�L ,:r�''m •�...+• I hereby affirm that I am exempt from the Contractor's License Address CHECK Law for the following reason (Section 7031.5, Business and Professions Code): City Tel.. No. HAP15E. a; ❑ 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). ® 1 I31131 1.-0031 •'}f /92 CONSTRUCTION LENDING AGENCY _ 0.� i C-� ,7�„<< I hereby affirm that there is a construction lending agency for - ; I r =' -= 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 orPoo dinances 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 • Signature of Permittee Date -4'W6RKER'S COMPENSATION DECLARATION { 20.0028 DPW 9/89 I hereby affirm that:I qave a certificate of consent to self insure, 76A887A APPLICATION FOR'PLUMB G MI or a certificate of Worger's Compensation insurance, or a certified copy thereof.(Sec.3800 Lab.C.) Poli No. Company. COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑cy . a� �,�Z 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 -e. Date Applicant_�� WATER CLOSET NEAREST .. CE6TIFICATE OF CROSS ST.EXEMPTION FROM WORKERS' BATH TUB ASSESSOR COMPENSATION INSURANCE. (This section,need not be completed if the work.Involved'by the SHOWER • MAP BOOK PAGE PARCEL permit Is for one hundred dollars($100)or less.) OWNER I certify that:ln the performance.of the work for which this permit LAVATORY Is issued, I shall not employ any person in any manner so as to SINK MAIL .ADDRESS become subject to the Workers'Compensation Laws. DISWASHER CITY TEL.NO. Date Applicant ., CLOTHES WASHER ,NOTICE TO APPLICANT: If, after making this Certificate of CONTRAC70R bN Exemption,you should becomesubject to the Workers'Compensation SWIMMING POOL RECEPTOR z provisions of the Labor Code,you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION WATER HEATER CITY TEL.NO. > I hereby affirm that I am licensed under provisions of Chapter 9. CL (commencing with Section 7000)of Division 3'6f the Business and GAS SYSTEM OUTLETS LI ETN3E NO.J �dv CESS Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY ,t �) 5 PER SYSTEM C License Number -5,�d'l �n Lio Class es P 2t 0 FINAL �I ~t'^ DATE�r,�• VALIDATION _ LL ._.y-i ;SYS Contractor ✓,.P"�t Date L,Mf}: •99.3`cr, ❑ I am exempt under Sec.SFINAL �� ' �+ ? BY f s T t'�..t I•:F B.&P.C.for this reason _ is Plan check fee TOTAL Date: C. F ,/ ,a ro Signature PLUMBING PERMIT ISSUING FEE$' -� --- U El [TOTAL FEE :3-el f•(-IllNE u 13{w SINGLE FAMILY Plan check applicant ��: f,,,,� HOME OWNER-BUILDER DECLARATION Name �ILis l t—�I;it 1 .� /K I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions. Address 3407 1 AM f 12 Code): • City Tel.No. ElI,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 Pol- and 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 urposgs. SEE REVERSE FOR EXPLANATORY LANGUAGE S 810natu 6 of Permit Dat COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1401220016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1 ON FILE I 1 5807 ROSEMEAD BL I (ASSESSOR INFORMATION NUMBER: NEAREST DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 91780 I NEAREST CROSS STREET: 15397-012-043 0W PLANCHECK FEE 0.00 164.10 1 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY CAI I 10W PLANCHECK FEE 0.00 236.60 1 1 ITENANT: 101 PERMIT ISSUANCE FEE 27.80 (ISSUED ON: PROCESSED BY: PLAN BY: 1 ICHUAN'S RESTAURANT 113 DISHWASHER(S) 1.00 FIX 16.20 105/13/14 SR 1 1 117 FLOOR DRAINS) 6.00 FIX 97.20 1 I OWNER: TEL. NO: 19 FLOOR SINK(S) 6.00 FIX 97.20 FIJJAL DATE FY. CODE: I 1 CHEN, QU (626) 616-5089- 123 INTERCEPTOR(S) 1.00 SYS 16.20 1 I 13042 SYCAMORE AVENUE 125 LAVATORIES/SINKS 11.00 FIX 178.20 I 1 ILA CRESENTA CA 91214 141 TRAP PRIMERS) 2.00 SYS 32.40 1Dfi CRIPTIO OF WORK 1 I 145 WATER CLOSET/URINAL 7.00 FIX 113.40 ITENANT IMPROVEMENT - PLUMBING FOR CHUAN'S RESTAURANT I I 147 WATER HEATER(S) 1.00 WTH 16.20 1 1 (APPLICANT: TEL. NO: 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 1 IZHANG, BINGYING (626) 570-9978- 152 ADDN OUTLETS > 5 2.00 OUT 8.40 1 1119 S ATLANTIC BLVD i TOTAL FEES 1,020.10 (SPECIAL CONDITIONS: MONTEREY PARK 91754 ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I 1JY CONSTRUCTION GROUP INC. (626) 332-6789- 1 i 1 11214 E EDNA PLACE LIC. NO I UNDER SLAB WORK ICOVINA CA 91724 963661 1 1 1 WATER SERVICE 1 1PLASTIC YIN METAL YIN 1 1 1 1ARCHITECT OR ENGINEER: TEL. N0: 1DRP INC. (626) 570-9978- 1 1ROUGH PLUMBING r 1119 S. ATLANTIC BLVD. #119 LIC. NO: ,YI,Y 1MONTEREY PARK, CA 91754 NONE 1 IGAS PIPING I 1 1GAS VENT 1 1 1 1 1 HOT WATER HEATER 1 I IPLUMBING FIXTURES 1 I 1 1 1 ILAWN SPRINKLERSII 1 1 1 IGAS TEST 1 I 1 1 1 (UTILITY COMPANY NOTIFIED( I I I I 1CWV I I I I I 1GRAY WATER SYSTEM 1 1 I I I I I I I I I 1REPORT ID: DPR263 ROUTE To: BS0508 I I 1 I I I I I