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HomeMy Public PortalAbout5819 ROSEMEAD BLVD_Plumbing__ ION 20.0o2 WORKER'S have .a certificate of consent to 76A666DP4V8/89 APPLICATION FOR PLUM G PERMIT I hereby affirm that I have a certificate of consent to self insure, 78A887A or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) �iO/b 77 COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS, :,'t; DEPT.OF•P.UBLIC WORKS DIV. Policy Nd r ��fompany �a( � 3 ❑ Certified copy is hereby furnished. BUILDING [- FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the count building In pec' department. �.y Q NUMBER FIXTURE OR ITEM @ FEE LOCALITY �l Q�p�k Date �LAppliCa "�"-v WATER CLOSET �( CERTIFICATE OF EXEMP FROM OkERS' BATH TUB r NEAREST Q) • t!�S I COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work Involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY -wniq Is Issued, I shall not employ any person in any manner so as tof, SINK SSD p MAIL I(�(� � become subject to the Workers'Compensation Laws. O ADDRESS DISWASHERCITY � TEL.NO. Date Applicant ' CLOTHES WASHER CONTRACTOR +�� NOTICE TO APPLICANT: If, after making this Certificate of �Q binq Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR �� i provisions of the Labor Code,you must forthwith comply with such ADDRESS IS©�� ICCP provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION WATER HEATER CITY el'0 TEL.t,6h ILA X?,'-21369 > I hereby affirm that I am licensed under provisions of Chapter 8 ATE a ion vIslon 3 of the Professions andtmy license isIn full force and effect.ossa and GAS SYSTEM OUTLETS LI E SE NO. CLASS L OUTLETS OVER DISTRICT NO. I �+�PPROCESSED BY 5 PER SYSTEM License Number S_Cj� `f'9 Lc.Class rl OOd 5il�lk o �o L�ir/��Lit�� e�__ r (9 1=1oor drains DATE to_(3 4,L,- Da v VALIDATION, n Contractor I l� Date ~� ❑ I am exempt under Sec. BY AL ? • B.f;<P.C.for this reason Date: Plan check fee , Signature PLUMBING PERMIT ISSUING FEE$ a9-' 4� - ❑ TOTAL FEE Plan check applicant ;:,•s i -,� SINGLE FAMILY 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 1. :-i . r •�-R _5'. : E Code): •1L- �_.-_ _ ❑ City Tel.No. _. _. .. w I,as owner of the property,will do the work and the structure ' "' .-1 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 ;a performance of the work for which this permit is issued (Sec.3087, Jut - '- Civ.C.) Lender's Name Lender's Address I certify that I have read t appiicat n and state that the above , Information is c rect. I a ee to comqry with all County ordinances and State laws egulatng Plu ng, and hereby authorize representatives of is Co my t nter upon the above-mentioned proper ecti n pur os SEE REVERSE FOR EXPLANATORY LANGUAGE ' -12 Sigr�ature 01;;er i ee Date WORKER'S COMPENSATION DECLARATION 76As67APw9,a9 APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self Insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) Policy No pony Com * Ul r COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑ Certified copy is hereby furnished. L FOR APPLICANT TO FILL IN(PRINT OR TYPE) BDDRE S Certified copy is filed with the county wilding inspectio departm nt. NUMBER FIXTURE OR ITEM @ FEE ^��i Q� - LOCALITY Dat ! 7 Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed If the work Involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) LAVATORY OWNER G I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to SINK ADDRESS • become subject to the Workers'Compensation Laws. 14, DISWASHER CITY TEL.NO.g)Z1 3 Date"Date Applicant CLOTHES WASHER _r /�•n�/ ' — '14�AAllr NOTICE TO APPLICANT: If, after making this Certific of CONTRACTOR p' (,6 T' Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS ( ; R1�t provisions of the Labor Code,you must forthwith comply with such U54— provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY yptv TEL.NO.�' } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER r� v a (commencing and Section my license Is Invision 3 of the full fora and effect.Business and GAS SYSTEM OUTLETS �� CENSE NO. 64,e7. CLASS ✓ V 5835 5 PER SYSTEM T OVER DISTRICT �4fO. PROC�c�ESSED BY 1Z �e.�.. Q / r], 5 PER SYSTEM GZ'� License Number (Q l Lic.ClassFINAL F' J� DATE 0,� Z VALIDATION a / Contractor Date (/ _ 3,41, FINAL Z I am exempt under Sec. BY B.&P.C.for this mason Date: Plan check fee , Signature PLUMBING PERMIT ISSUING FEE$ 1-?�/ ❑ TOTAL FEE /G''y .3 Plan check applicant h 5 SINGLE FAMILY _ j �h�� HOME OWNER-BUILDER DECLARATION Name �� 4 ■* I hereby affirm that I am exempt from the Contractor's License Law n ;- for the following reason(Section 7031.5, Business and Professions Address "� I 3307 1101•`-' Code): _ ❑ I,as owner of the property,will do the work and the structure City Tel.No.'?f fRY 1 ITEMSS is not intended or offered for sale(Section 7044, Business TOTAL 1(31.33 and Professions Code). CFfECK 101.3,.x,3 CONSTRUCTION LENDING AGENCY ■IJO I hereby affirm that there is a construction lending agency for the CHAWK performance of the work for which this permit is issued(Sec.3097, Civ.C.) M-OM1 8/27/9:: Lender's Name 5229 1 AM 8:55 Lender's Address I certify that I have read this application and state that the above pop.information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize represent tyres of this County o enter upon t e above-mentioned prop 1 inspection urp ✓'� e� SEE REVERSE FOR EXPLANATORY LANGUAGE Sl§rfafure of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0403250006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILDING ADDRESS: ON FILE 5819 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 25 LAVATORIES/SINKS 2.00 FIX 32.40 TENANT: TOTAL FEES 60.15 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: ONO HAWAIIAN BARBECUE 03/25/04 VG 09/21/04 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CALAC INVESTMENT p 3709 CONVOY ST. SAN DIEGO, CA9211137 DESCRIPTION OF WORK INSTALL 2 NEW SINKS APPLICANT: L. 0: LA INTERNATIONAL PLUMBING (626) 448-3561- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE LA INTERNATIONAL PLUMBING (626) 448-3562- 10418 FERN ST. LIC. NO UNDER SLAB WORK SOUTH EL MONTE, CA 91733 786053 C36 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR NGINEER: TEL. NO: LIC. NO: ROUGH PLUMBING �f GAS PIPING GAS VENT HOT WATER H A ER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST T LITY COMP XNTNUTI-FIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508