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Home My Public Portal About6004 ROSEMEAD BLVD_Plumbing__ WORKERS'COMPENSATION DECLARATION S1 APPLICATION FOR PLUMBING PERMIT I hereby affiLjn'tltat I have a' certificate of consent to self CE ce en (,z-ao) insu .a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C:) COUNTY OF LOS ANGELES 1 ' BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ❑ NUMBER FIXTURE OR ITEM • FEE ADDRESS Certified copy is filed with the county building inspection department. I WATER CLOSET LOCALITY Date p Applicant NEAREST /� I BATH TUB CROSS ST. ( 11(h &A CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER LAVATORY MAIL } (This section need not be completed if the work involved ADDRESS CL by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.NO. ( V I certify that in the performance of the work for which thisDISHWASHER CONTRACTOR permit is issued, I shall not employ any person in any ner O so as t 'hryeco}m�e/subject to the rkers' a at on IL ws. CLOTHES WASHER ADDRESS U DateJ� �`- -Applicant SWIMMING POOL RECEPTORi a NOTICE TO APPLICANT': If, after making Iiia Certificate of CITY TEL.NO,-2ttil Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE �7 / LIC. { Compensation provisions of the Labor Code,you must forth- LICENSE NO / 7 ( CLASS J with comply with such provisions or this permit shall be j WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PR CESSED. Y LICENSED CONTRACTORS DECLARATION OUTLETS OVER ��-U I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL �Q-�� VALIDATION ness and Professions Code, and my license is in full force and55 ? A DATE effect. l FINAL � License Numb ` Lic.Class r BY Contractor I Date. F1I am exempt f.0 the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ 1 �/ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic.or Reg.No. ` Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 7031.5, Busi- City Tel.No. ness and Professions Code): 8 q 1 P ❑ I,Jas owner of the property, am exclusively contracting o. n with licensed contractors to construct the project 0 0 0 n (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY r I hereby affirm that there is a construction lending agency ° ' '3 for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). �,(�9- i Lender's Name Lender's Address I certify that I have read t application and state that. the above mforma 'on i rrec agree o comply with all County SEE REVERSE FOR.EXPLANATORY LANGUAGE ordinate a S to law regula g Plumbing, and hereby autho ` e s to ves f this ounty to enter uponthe abov e e pr r r'ins ction s t ignat re of-VeYWC e WORKERS'COMPENSATION.DECLARATION 176A667A I hereby affirm that I have a certificate of consent to self .-CF-817112-80) APPLICATION FOR PLUMBING" PERMIT' insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.c.) COUNTY OF LOS ANGELES / � BUILDING AND.SAFETY Policy No. Company I ' El Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN (PRINT OR TYPE) OADDRESS i Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE department. • WATER CLOSET LOCALITY "� _ �,¢� Date Applicant 5 NEAREST 17 r•� / CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE � SHOWER OWNER fir. (This section need not be completed if the work involved LAVATORY MAIL , by the permit is for one hundred dollars ($100) or less.) ADDRESS / SINK CITY TE O.t� 7 ILO I certify that in the performance of the work for which this DISHWASHER V permit is issued, I.shall,not employ any person in any manner CON ACTOR so,as to become subject to the ' ers'Com ns ion L CLOTHES WASHER . C ADDRESS" 4 ` O Date''t✓-'?-A:Applican0, .fMX.k SWI'MMI'NG POOL RECEPTOR r ls'r r U NOTICE TO APPLICANT: ing this Certificate o CITY TlilA ��;" tN1 W Exemption, you. should become subject to the,Workers' LAWN SPRINKLER SYSTEM y.STATE 0- Compensation provisions of the Labor Code,you must forth- LICENSE NO:�tr ` » CLASS ' �"'-M. with comply with such provisions or this permit shall be WATER HEATER: deemed revoked.. GAS SYSTEM OUTLETS DISTRICT �NO. PROCESSED LICENSED CONTRACTORS DECLARATIONOUTLETS OVER OQ r I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 700.0)of Division 3 of the Busi- FINAL rr VALIDATION ness and Professions Code, and my license is in full force and DATE effect. License Number 'Lic.Class AffFB.1NAL �� r AX ] Contracto ' `%"' � ate 2--27-51' l I amexempt from the licensing requirements as I am a Plan check fee `" licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code): TOTAL FEE. Lic,or Reg:No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name �( � Address I hereby affirm ,that :I am exempt from the Contractor's o, , U 2�2.A License Law.for the following reason (Section..7031.5, Busi- City I.No. ness and Professions Code): # 0 0 0. o o 1, as owner of the property, am exclusively contracting with licensed contractors, to construct the project (Section 7044,Business and Professions Code). _ ? � 613,0C CONSTRUCTION LENDING AGENCY i. I hereby affirmthat there is a construction lending agency o - 61 'CCv for the performance of-the work for which this permit is issued.(Sec.3097,Cq C.). )' 0227-81 Lender's Name A`P•0- � ' Lender's Address,'% /9),t-,.(� . I certify that I have read this application and state that the i above information is correct.I agree to comply with all-County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned pro er for i spectibn purposes. -' ature of Per .itfee. Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0601170028 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 37830 LT: 1 UN: 9 6004 ROSEMEAD BL 9 FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801558 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5384-016-056 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C 47 WATER HEATER(S) 1.00 NTH 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 01/17/06 JK 07/16/06 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: BADEN ROGER;YUKO (626) 285-7397- 6004 ROSEMEAD BL /- -u _r TEMP 917801558 DDESCRIPTION OF WORK WATER HEATER CHANGE OUT APPLICANT: TEL. NO: TEKAWA (310) 515-1311- 17111 S. BROADWAY SPECIAL CONDITIONS: GARDENA, CA 90248 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE ACTION CONTRACTORS (310) 515-1311- 17111 SOUTH BROADWAY LIC. NO UNDER SLAB WORK GARDENA, CA 90248 65253SBC36 WATER SERVICE PLASTIC YIN METAL YIN ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER i PLUI'IBING FIXTURES LAWII SPRINKLERS GAS TEST UTI;,ITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM i i REPORT ID: DPR263 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 YtJMB-f•NG-PERM-I-T DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS 0598-0004.060075) BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: EGA ID: FEES PAID BUILDING ADDRESS: TR: 37830 LT: 1 UN: 13 (LOD4-R0SEMCA0-8-'13---) FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP-CA-917SOM9- ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5384-016-060 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 47 WATER HEATER(S) 1.00 WTH 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 01/06/00 UT 07/04/00 OWNER: TEL. NO: FINAL DATE FINAL BY: 0 NGUYEN DUNG DUC;DINH XUAN KIM (626) 291-2629- / /) 6004 ROSEMEAD BL TEMP 917801559 DESCRIPTION OF WORK WATER HEATER CHANGE OUT APPLICANT: TEL. NO: ACTION CONTRACTORS (310) 515-1311- 17111 S. BROADWAY SPECIAL CONDITIONS: GARDENA, CA CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE ACTION CONTRACTORS (310) 515-1311- 17111 S. BROADWAY LIC. NO •' =� UNDER SLAB WOR GARDENA, CA 90248 652535036 f WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITEC R ENGINEER: TE N0: -- :` :, ' LIC. NO,-, ROUGH PLUMBING r - � �. ,_ I - - , GAS PIPING -- _ ----- - GAS VENT HOT WATER HEATER - " PLUMBING FIXTURES LAWN SPRINKLER GAS TEST UTILITY COMPANY NOTIFIED CWV GRA ,WATER SYSTEM 1 * ADDITIONAL DATA ON FILE REPORT ID: OPR263 ROUTE TO: BS0508 • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 I PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0111140005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 .PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADl)RESS_- TR: 37830 LT: 1 UN: 12 6004 ROSEMEAD BL 12 ,FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801559 ASSESSOR 0 NEAREST CROSS STREET: LONGDEN 5384-016-059 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 47 WATER HEATER(S) 1.00 WTH 16.20 TENANT: TOTAL FEES 43.95ISSUED ON: S . 11/14/01 JK 05/13/02 . OWNER: TEL. 0: F FINAL BY: CODE: ROSTAFINSKI THOMAS (626) 248-9300- 6004 ROSEMEAD BL - `0z'-- �.-.- TEMP 917801559T 0 0 R C/0 WATER HEATER APPLICANT: TEL. 0: ALAP ASSOC (818) 407-1247- 7229 VARNA ST SPECIAL CONDITIONS: N. HOLLYWOOD -- � CONTRACTOR: TEL. 0: GJ' !!i*�, APPROVALS DA -INSPECTOR SIGNATURE A L A P ASSOCIATES (818) 407-1247- 7229 VARNA ST. LIC. NO , UNDER SLAB WORK NORTH HOLLYWOOD, CA 91605 771905 HI * ;t� \r WATER SERVICE C 0 GINf ' / �_ i" �, _ `;r PLASTIC Y/N METAL Y/N ARCHITELIC. N0:��1 % C I ROUGHPLUMBING ( � GAS PIPING VENT '�'1 r� S R ER - --- - ----- -iL C PLUMBING-FIXTURES 1y LAWN-SPRINKLERS GAS TEST �� l 1 �1'. NOTIFI �c seLl cWV pvice TM" G R S S * ADDITIONAL DATA ON FILE REPORT ID: DPR20 ROUTE TO: BS0508