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Home My Public Portal About5829 ROSEMEAD BLVD_Plumbing__ WORKERS'COMPENSATION DECLARATION M-002APPLICATION PPLIC TIORao C®® PLUMBING Fl AwABING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A666 DPW 4/87 /`1r ��ss/`9 ilr 1- l� t�l4R1V� 1� 1`RV� 1 76A667A sure,ores certificate of Workers'Compensation Insurance,or a CE 817(REV.8/86) certified copy;hereof(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 f�n Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ADDRESS LJ department. @ FEE LOCAL r �i4 Date Applicant WATER CLOSET(TOILET) NEAREST f CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section noed not bo completed if the work involved by MAIL 01 the permit Is for ono hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- ® SINK mit is issued, I shall not employ any person in any manner so CITY TEL. NO. as to become subject to the Workers'Compensation Laws. DISHWASHER I� -d / CONTRALTO � v Date ® Applicd - CLOTHES WASHER , ADDRESS ® NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO - sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS rl'^ LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS.SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER � and Professions Code, and my license is in full force and ef- 5 PER SYSTEMfect. -, FINAL / VALIDATION d ff �y�q �/ DATE License Number . CP/ / Lic. Class V a�f d0, FINAL4Z(&,q, cc Contractor Date BY I am exempt under Sec. v Fy B.BP.C. for this reason P ® g Plan check fee !, Date: PLUMBING PERMIT ISSUING FEE$ 00 Signaturl@_ � - TOTAL FEE �� OC7 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and r.;.• Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. =d-i t' °('I' structure is not intended or offered for sale(Section 7044, c TA. EIM. Business and Professions Code). ® CONSTRUCTION LENDING AGENCY _ I hereby affirm that there is a construction lending agency for CAR, 28°[I'= the performance of the work for which this permit is issued1311 (Sec. 3097, Civ. C.). � °! Lender's Name 0001-11—r01ll 2/26/991 Lender's Address 1 A011e54 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 inspectioigia s. I SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of-PermfIffo Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9701070028 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: EGL D: FEES PA -BUILDING ADDRESS: TR: 3623 LT: 105 5829 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801832 ASSESSOR INFORMATION M R: NEAREST CROSS STREET: HERMOSA 5387-012-018 OW PLANCHECK FEE 0.40 316.62 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 01 PERMIT ISSUANCE FEE 27.75 TENANT: 03 BACKWATER VALVE(S) 1.00 VAL 46.95 SSUED ON: PROCESSED : PLA BY: E P RES 0 17 FLOOR DRAINS) 8.00 FIX 130.80 12/03/97 UT 12/03/98 19 FLOOR SINKS) 6.00 FIX 98.10 OWNER: TEL. NO: 21 HOSE BIBB(S) 5.00 FIX 81.75 FINAL DATE FINAL BY ODE: BANK OF AMERICA - 23 INTERCEPTOR(S) 5.00 SYS 81.75 5'-s4 - D 333 HOPE ST 25 LAVATORIES/SINKS 5.00 FIX 81.75 O LOSA 900711406 26 MISCELLANEOUS FIXTUR 7.00 FIX 114.45 Ns-c-UPTIMON OF WORK 41 TRAP PRIMERS) 2.00 SYS 32.70 PLUMBING FOR NEW DRIVE THRU RESTAURANT 45 WATER CLOSET/URINAL 2.00 FIX 32.70 APPLICANT: L. NO: 47 WATER HEATER(S) 1.00 NTH 16.35 THE GUTIERREZ PARTNERSHIP (909) 598-1518- 49 WATER TREATING EQUIP 2.00 SYS 32.70 404 S. LEMON AVE. #7 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.35 SPECIAL CONDITIONS: WALNUT, CA 52 ADDN OUTLETS > 5 6.00 OUT 25.20 bj�L�TO FEEu 1,135.92 , CONTRACTOR: TEL. NO: (�®� APPROVALS DATE INSPECTOR S GN URE JOHN JANIS PLUMBING (714) 642-7764- 1539 MONROVIA AVE. SUITE 8 LIC. NO �� UNDER SLAB WORK NEWPORT BEACH, CA 92663 554631 \ WATE RVICE P STI /N ETA Y/N ARCHITECT OR ENGINEER: T L. 0: f THE GUTIERREZ PARTNERSHIP (714) 598-1518- 404 LEMON AVE #7 LIC. NO: I , W19R�G 1 WALNUT, CA 91789 C-15523 _�_ ' � ' s FPPING GAS VENT 1 j _ � �, OT WATER HEA ER PLUMBING I RES B � \1if Ys� LAWN SPR NKL RS r:<v 9 "�`\ •. f i'.' :,3Y n GAS TESTS. •. f UTILITY COMPRAW NOT I F I EDcr CW GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9804270031 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL D: FEES PAID BUILDING ADDRESS: TR: 3623 LT: 105 5829 ROSEMEAD SL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801832 ASSESSOR INFORMATION-NUMBER: NEAREST CROSS STREET: 5387-012-018 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 05 BACKFLOW DEVICES) 1.00 DEV 16.35 TENANT: TOTAL FEES 44.10 ISSUED 0 PROCESSED BY: P EXP S ON: PEPE'SBURRITO 04/27/98 UT 04/27/99 OWNER: TEL. NO: FINAL DATE FINAL BY: DE: RUSSI, JOSEPH 000 5829 ROSEMEAD TEMPLE CITY, CA DESCRIPTION OF WOR SPRINKLER SYSTEM APPLICANT: L. NO: VALINDA ASPHALT & CONCRETE (626) 333-0905- 131 S. SIXTH ST. -_ _ _ SPECIAL CONDITIONS: CITY OF INDUSTRY, CA �.•�n.::. per, CONTRACTOR: TEL. N0: , . 9, ,'�.F APPROVALS DATE INSPECTOR SIGNATURE VALINDA ASPHALT & CONCRETE (626) 333-0905- 131 S. SIXTH ST. LIC. NO -' �� ' ER B R CITY OF INDUSTRY, CA 91746 384235 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TE O: - ROUGH PLUMBING LIC. N0: GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFTEU CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508