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Home My Public Portal About4903 RYLAND AVE_Plumbing__ RS'COMPENSATION DECLARATION 7BAes7w I her that I have a7 certificate of consent to self ce e17(2-60) APPLICATION FOR PLUMBING P E R M I T insur E.tificate of Workers'Compensation Insurance,or :01icy certified copy thereof(Sec.3800,Lab.C.) ( J� ('C, � COUNTY OF LOS ANGELS /" BUILDfNG AND SAFETY No. Company �� Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING 2 Certified coNUMBER FIXTURE OR ITEM 0 FEEIETADDRESS p3 L copy is filed wiItc), unty building inspection r nt. r', WATER CLOSET LOCALITY ^�Date. Applicant tu� c�,5 NEAREST BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE • SHOWER OWNER ` LAVATORY MAI L (This section need not be completed if the work involved ADDRESS �j� 2 c�o O by the permit is for one hundred dollars ($100) or less.) SINK �A CIT `Y,'0KC TEL.NO U I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR O O so as to become subject to the Workers'Compensation Laws. CLOTHES WASHERADDRESS f U Date Applicant 3 SWIMMING POOL RECEPTOR d NOTICE TO APPLICANT: If, after making this Certificate of CITY ti Q V ( TEL.NO ,3 to _Fxamption, you should become subject to the Workers' LAWN SPRINKLER SYSTEMSTATE LIC. 2 7—Co`mpensation provisions of the Labor Code, you must forth- LICE SE NO. CLA C(o C with comply with such provisions or this permit shall be WATER HEATER - deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PR SSE Qay-l LICENSED CONTRACTORS DECLARATION OUTLETS OVER e- I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code, and my license is in full force and DATE I' n�\ir effect. l�f?f Cat c IOr c pa0 FINALL/ ` License Nu � Lic.Class e3H� C�� BY Contractor Date oL I am exempt from the licensing requirements as I am a Plan check feed/ / licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE , Lie.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): Y2 15 5 A I, as owner of the property, am exclusively contracting , with licensed contractors to construct the project ## o'c o 0 0 5 (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY ? 0 0 1 2 5 0 I hereby affirm that there is a construction lending agency o 0 0 1 2 5 p-6 for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). 202-81 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby aut r'. representatives this C my to enter upo the ab v entioned p Vrtor ins ct- n purposes natu of Permitte Date WORJ,C i9S'.COMPJJ1SATION DECLARATION 76AS67A 4I,hereby stf �,,,that I. have a>• certificate of consent to self ce 817(2-80) APPLICATION R O R PLUMBING PERMIT �p Insure,or a certificate of Workers"Compensation Insurance,or u a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES �/ 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 y - (/ /A Aid- Certified copy is filed with the county building inspection LOCALITY `� department. WATER CLOSET Date Applicant NEAREST BATH TUB CROSS ST. •e- } CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE "y� SHOWER OWNER MAIL a. (This section need not be completed if the work involved LAVATORY ADDRESS O- by the permit is for one hundred dollars ($100) or less.) SINK CITY I�/ U . . I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR permit so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS U %Date Applicant LU SWIMMING POOL RECEPTOR 0. NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. U) Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compensation provisions of the Labor Code,you must forth- LICENSE NO. CLAS with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETSI Z DISTRICT NO. E SED LICENSED CONTRACTORS DECLARATION OUTLETS OVER J �^ 01-, I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL• ness and Professions Code,and my license is in full force and DATE VALIDATION effect. FINALI License Number Lic.Class BY •" '' *� Contractor Date. /L F1 I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ 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 O 3 3 9 A Address ' o o.o'o c 5 ' I hereby affirm that I am exempt from the Contractor's - License Law for the following reason (Section.7031.5, Busi- City ToL No. 2 0 - 1 9.GO ness and'Professions Code):• 91 I, as owner of the property, am exclusively contracting o 0 0 1 9.Q 0 with licensed contractors to construct the project , (Section 7044,Business and Professions Code). 0 7 1 4-81 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 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 property for inspection purposes. 4nat7of Permittee Date • WOR16,S'COMPENSATION DECLARATION '78AG67A hereb j''affirin that I have a' certificate of consent to self CIS a17 (X-80) APPLICATION FOR PLUMBING PERMIT insure,or a certificate of Workers''Compensstion Insurance,or a certified copy thereof(Sec.3800,Lab.C.) , COUNTY OF LOS ANGELES � _BUILDING AND SAFETY Policy No. Company aa 0 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE ABUILDING DDRESS f V /�(tl(� Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE department. LOCALITY T p WATER CLOSET Date Applicant ]NEARR EST • BATH TUB CROSS ST. b L✓ F• CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER J LAVATORY -MAI L �L >- (This section need not be completed if the work involved ADDRESS .619o, L e;S AQd by the permit is for one hundred dollars ($100) or less.) SIN K CITY TEL.NO. (/9 7t� U I certify that in the performance of the work for which this DISHWASHER tr permit is issued, I shall not employ any person in any manner CONTRACTOR O so as to ecoma subject to the Workers'Compensation Laws. CLOTHES WASHER U ADDRESS Date ,;�( Applicant a 1�/' d1n Nr'R --r SWIMMING POOL RECEPTOR CL NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. N Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compensation provisions of the Labor Cbde,you must forth- WATER HEATER LICENSE NO. CLASS with comply with such provisions 'dr,.this permit shall be deemed revoked. GAS SYSTEM OUTLETS J DISTRICT NO. R ED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER veC/ I hereby affirm that.I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing.with Section 7000)of Division'3 of the Busi- FINAL j / ness and Professions Code, and my license is in full force and DATE .��7�a7/ ALIDATIO effect. FINAL• License Number Lie.Class BY Contractor Date F1 I am exempt from the licensing requirements as I am a Plan check fee ' licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- ;-90766A iness and Professions Code). TOTAL FEE # ° 'O,° ° ° 5 Lie.or Reg.No. Date Plan check applicant 2 °. ° 1'Q00 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. 0 1 4-81 ness en fessi C as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 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 abov -mentioned ptoperty for inspection purposes. 0 /c SI SIgItuIr Date �ry zpr ` 7SASS7 17 11-49 APPLICATION.FOR PERMIT DEPARTMENT OFNG AND SAFETY COUNTY OFF LOS LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER PLUMBING 1 DISTRICT GROUP O P . FOR. APPLICANT TO FILL IN A 0007-.0 PLUMBER / �/Ja(,,PiriitfJ/J�.�I,lf./! RECEIVED BY READY FOR DATE ISSUED /- L.r FIRST IN y s ^ 7 ,o/ ADDRESS _ J � �A 3 L c•(J e / BUILDING CITY TEL.�N_a. (�e�j ADDRESS • COUNTY / LOCALITY ? 1J LICENSE NO. MA '� 1� EXPIRES (O— D NEAREST I PERMIT FEES GROSS 8T. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER ® ` �- �Xll'f.�T6rirGCJl�'••�a MAIL WATER CLOSET(TOILET) @ O.SO S ADDRESS BATH TUB @ 0.50CI TEL. No. SHOWER @ 0.50 1 HEREB ACKNOWLED E THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN MINK 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY- @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL-OWNER OF THE RESIDENTIAL ROPE DESC II�ED__ABOVE. GAS SYSTEM OUTLETS @ 00 o.5 �•�°/ Q� SIGNATURE OF WATER HEATER @ 0.50 PERMITTEE. SLOP SINK @ 13.501 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 J Q HOUSE SEWER @ 0.50 _Z MISCELLANEOUS m APPROVALS DATE INBPECTTPR'S NAME ROUGH PLUMBING GAS PIPING Al !;l/-p GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT I 1.OD GAM TEST UTILITY CO.NOTIFIE TOTAL FEE FINAL Li' COUNTY OF IAS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1210230010 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: I FEES PAID I BUILDING ADDRESS: TR: 17107 IT: 10 1 4903 RYLAND AV IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917804036 I ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LOWER AZUSA 18585-010-006 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: B5 LOCALITY: TEMPLE CITY, Cl I 107 BATHTUBS/SHOWERS 1.00 FIX 16.20 I I TENANT: I TOTAL FEES 44.00 (ISSUED ON: PROCESSED BY: PLAN BY: 1 1 I 110/23/12 SR I (OWNER: TEL. NO: I IFI ATS FI BY: CODE: 1 1TANG CHIEV H (626) 455-0457- I I a 4903 RYLAND AVE A-1/ ITEMP 917804036 I lDgSCRfPTION OF WORK I IREPLACE BATHTUB FOR BATHROOM REMODEL 1 (APPLICANT: TEL. NO: I ISAME AS OWNER I i ISPECIAL CONDITIONS: I I I I I (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE ISAME AS OWNER _ I I ILIC. NO I (UNDER SLAB WORK I I I IWATER SERVICE I I I I I [PLASTIC YIN METAL YIN 1ARCHITECT OR ENGINEER: TEL. NO: I I I I I I - I IROUGH PLUMBING LIC. NO: I I I I I I IGAS PIPING I I IGAS VENT I I I ` IHOT WATER HEATER I I I 1 IPLUMBING FIXTURES I I I ILAWN SPRINKLERS I I I IGAS TEST (UTILITY COMPANY NOTIFIED( I I I I ICWv I I I I 1GRAY WATER SYSTEM I I I I I I I I I I I I I I I I I I I I I [ I I I I I I I I [ IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I I I I I