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Home My Public Portal About6030 ROSEMEAD BLVD_Plumbing__ I WORKER'S I have a certiIONficate of consent to 76-0028DPW 9,B9 APPLICATION FOR PLUMBING PERMIT 78A867A 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.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the co iIdInl/ion department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY Date 4:Z' 12 I3 Applicant WATER CLOSET NEAREST CROSS ST. CERTIFICATE OF EXEMPTION FR M RKERS' BATH TUB 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($100)or less.) LAVATORY OWNER I certify that in the performance of the work for which this permit MAIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS become subject to the Workers'Compensation Laws. f DISWASHER CITY TEL.NO. Date Applicant CLOTHES WASHER CONTRACTOR n NOTICE TO APPLICANT: If, after making this Certificate of s �A�DS�Ap Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code,you must forthwith comply with such ADDRESS 7 TI4 1 12J) . provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM (, LICENSED CONTRACTORS DECLARATION CITY U��-� /�� TEL.NO. �3 > I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS CENSE NO. 66` -7 l3 CL11 STATELICASS UZ-7 Professions Code,and my license is in full force and effect. c'�I y� �f OUTLETS OVER DISTRICT NO. PROCESSED BY cc License Number [ `7 5 PER SYSTEM vef a Llc.Class !/ t /' ��,��U q FINAL �_�3..G�� VALIDATION a Contractor c"amu-tom"+' Date S �� ACCT04 E cc 4 FINAL s ,�I.)7 1Li1Jai�7 2 ❑ I am exempt under Sec. gy B.&P.C.for this reason 00. 1 iTEi�1 Plan check fee Date: Signature PLUMBING PERMIT ISSUING FEE$ TOTAL 100.65 TOTAL FEE ®�, CHECK 100.65 ❑ SINGLE FAMILY Plan check applicant CHANGE .00 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 00W-0001 5/11/93 Code): - ❑ City Tel.No. 9771 1 AM 7:56 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 application and state that the above , Information is correct. I ree o comply with all County ordinances and State laV lumbing, and hereby authorize represents,. o enter upon the above-mentioned grape for / //) SEE REVERSE FOR EXPLANATORY LANGUAGE AlaruattfrAo'Permittee Date *, AAfpRKER'SCOMPENSATION DECLARATION ��7DPW 9/a9 APPLICATION FOR PLUMBING PERMIT I hil' by'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. 994965 Company Republic Indemnity 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 —0030 ROSEMEAD BLVD. Certified copy is filed with the county build' g Inspection department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY TEMPLE CITY CA Date 6/24/93 Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' O BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR pAGE��Cp PARCEL Q� (This section need not be completed if the work Involved by the SHOWER MAP BOOK 07"" permit Is for one hundred dollars($700)or less.) LAVATORY OWNER MUR-SOL, INC. I certify that in the performance of the work for which this permit MAIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS 132 LA PORTE become subject to the Workers'Compensation Laws. DISWASHER CITY ARCADIA TEL.N0447-055 Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of FRANK MARRONE & SONS INC. Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 9860 LOWER AZUSA RD. provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY EL MONTE, CA TEL.No.444-2548 } 1 hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE C (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSENO. 397884 CLASSC 36 Professions Code,and my license is in full force and effect. 7 V OUTLETS OVER DISTRICT NO. PROCESSED BY Ix 397884 0/36 C/16 5 PER SYSTEM �Qd' C� �_�� License Number Lic.Class L FINAL VALIDATION W F. Marrone & Sons 12/31/92 DATE 6�2�-�3 a Contractor Date U ❑ I am exempt under Sec. FINAL 2 B.&P.C.for this reason Date: Plan check fee , Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE M6 110 Q Plan check applicant � SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name Art 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 3 iL'rii, I,as owner of the property,will do the work and the structureY'TTAL 1 i Is not intended or offered for sale(Section 7044, Business '.s AL and Professions Code). , C.�I»rr __•1L } liiJo� CONSTRUCTION LENDING AGENCY I. VLC +jJ q•� 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.) _i llr_l:i-:I_ 11 4t'1�# _ i`2 Lender's Name 57 E 1 i Lender's Address I certify that I have read this application and state that the above 001.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 MY22=', // n SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu a of Permittee Date