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Home My Public Portal About6022 ROSEMEAD BLVD_Plumbing__ I WORKER'S COMPENSATION DECLARATION 20.0028 DPW 9/89 APPLICATION FOR' PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self Insure, 7eA567A or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) Policy No. Company COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑ Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS �Q ZZ O��JVIiS Certified copy is filed with the coun i ' g i p ion demartmenj NUMBER FIXTURE OR ITEM @ FEE _ LOCALITY 22 Date 4JApplicant - WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FRO CROSS ST.WORKERS' BATH TUB ASSESSOR COMPENSATION INSURANCE MAP BOOK PAGE PARCEL (This section need not be completed If the work involved by the SHOWER permit is for one hundred dollars($100)or less.) LAVATORY OWNER U2..C..L I certify that in the performance of the work for which this permit MAIL c7� is issued, I shall not employ any person in any manner so as to SINK ADDRESS become subject to the Workers'Compensation Laws. (9 B DISWASHER CITY TEL.NO. Date ppf, of CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR 4(-S LOI)DISCAPK provisions of the Labor Code,you must forthwith comply with such ADDRESS 11JLS2-7Ai1zQ r5-r. provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM e� LICENSED CONTRACTORS DECLARATION CITY '�UAfl TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER CL STATE (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS CENSE NO. 5q73 13 p CS C.r 2 (C', Professions Code,and my license is in full force and effect. DISTRICT NO. P BY Q OUTLETS OVER I�n 5 PER SYSTEM A� License Number Sq-) 313 Li..Class C1 L FINALDATE �q-Z� VALIDATI'UMMS a Contractor C 9A0 Date [ J❑ TOTAL �. 0 m 5.�.�Cr FINAL I am exempt under Sec. BY �j CHECK 10113.65_ B.&P.C.for this reason V Date: Plan check fee , CHANGE XIII Signature PLUMBING PERMIT ISSUING FEE$ g' ❑ TOTAL FEE pr Id, 0000-01301 5/18/93 SINGLE FAMILY Plan check applicant 9770 1 Af ?;6 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): ❑ City 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 pplication and state that the above , iaafu frr comply with all County ordinances sumbing, and hereby authorize oenter upon the above-mentioned X sas. SEE REVERSE FOR EXPLANATORY LANGUAGE / S. f Date WORKER'S COMPENSATION certificate of consent to 7M687q PW9/69 APPLICATION FOR PLUMBING PERMIT I.h�eby 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. Company 994965 Republic Indemnity COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) ABUILDING DDRESS 60Z3-6 ' ROSEMEAD BLVD. Certified copy is filed with the county bull 'ng inspection department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY TEMPLE CITY Date 6/24/93 Applicant WATER CLOSET NEAREST CROSS ST. CERTIFICATE OF EXEMPTION FR04 WORKERS' 9 BATH TUB COMPENSATION INSURANCE ASSESSOR (/ (This section need not be completed if the work Involved by the SHOWER MAP BOOK �iJ�! PAGE4:7Z61 I PARCELeo6& permit is for one hundred dollars($100)or less.) LAVATORY y a5 OWNER MUR—SOL INC. I certify that In the performance of the work for which this permit O/ MAIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS 132 LA PORTE become subject to the Workers'Compensation Laws. DISWASHER CITY ARCADIA TEL.N9447-0558 Date Applicant CLOTHES WASHER 7S CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of FRANK MARRONE & SONS INC. Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR 9860 LOWER AZUSA ROAD provisions of the Labor Code,you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION �S -CITY EL MONTE TEL.No444-2548 I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LIC NSE NO. 397884 STATE CLASS C/36 � Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY Ix 397884 C/36 C/16 5PER SYSTEM i7 License Number Lic.Class Q U FINAL J, 7 VALIDATION F. Marrone & Sons 12/31/92 DATE VVJJ C CL Contractor Date. ❑ I am exempt under Sec. FINAL B.&P.C.for this reason Date: Plan check fee 001. Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE 71^— Plan check applicant � •'" -�- LE._I SINGLE FAMILY '•^1!�_ HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law +'- . a• r for the following reason(Section 7031.5, Business and Professions Address i^j Code): F1 1, Tel.No. I,as owner of thero ert ,will do the work and the structure J P P Y is not intended or offered for sale(Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 1+j -t t�E :t !j'JG 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 pr t or' cti n urpory;s. /� SEE REVERSE FOR EXPLANATORY LANGUAGE S gnatureof Pennittee i Date/G