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Home My Public Portal About5031 SANTA ANITA AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT . f hereby affirm that I hove-a certificate gf conserd to self 20-0026 DPW 6/87 �j insure, or a certificate of Workers'Compensation"I'nsurancd, 76AG67A IL JI -or daerfified copy thereof(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 ❑ Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM FEE Cj LocAurvi pL� Date Appligant WATER CLOSET ✓ NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB �� CROSS ST. COMPENSATION INSURANCE SHOWER OWNERL&f (This section need not be comPlotod If the work Involved by MAIL ` the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS V3t—\ J!r I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner r SINK CITY TEL.NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' 1 CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER he LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION f DISTRICT fUO. PROCE ED BY I hereby affirm that I am licensed under provisions of Chapter 9 1 GAS SYSTEM OUTLETS l (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL ` f(7-7) ALIDATION G DATE License Number Lic. Class 0 FINAL I% Contractor Date BY ❑ I am exempt under Sec. b B.BP.C. for this reason Plan check fee F3 Date: PLUMBING PERMIT ISSUING FEE$ Signature � TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name ACCTo4 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address 3307 118.00 Professions Code): City Tel. No. 1 ITEMS ❑ I, as owner of the property, will do the work and the _ structure is not Intended or offered for sale (Section ® TOTAL AL -9 18 o[BCD 7044, Business and Professions Code). CHECK 118.00CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for CHANGE ,131) the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name 00001-00101 5/30/911 Lender's Address 09$1 1 AN :54 1 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 thorizeerepresentatives of this County to enter upon the ove-mention property for inspection purposes. � SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date .r r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0412100010 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID WrODING ADDRESS: TR: 13363 LT: 15 5031 SANTA ANITA AV FEE DESCRIPTION: QUANTITY: UDM: AMOUNT: TEMP CA 917803618 ASSESSOR INFORMATIO BER: NEAREST CROSS STREET: 8574-009-016 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 4.00 FIX 64.80 TENANT: 25 LAVATORIES/SINKS 3.00 FIX 48.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 45 WATER CLOSET/URINAL 3.00 FIX 48.60 12/10/04 JK 06/08/05 TOTAL FEES 189.75 OWNER: TEL. N0: FINAL DATE FINAL BY: CODE: TSANG, CHIU (626) 450-5089- 1108 W. VALLEY BLVD. ALHAMBRA, CA 91803 DESCRIPTIO 0 WORK REMODEL 3 BATHROOMS AND RAPAIR JACUZZI. APPLICANT: TEL. NO: SUN YAUN SUPPLY INC. (626) 926-4016- 6448 OAK AVE. SPECIAL CONDITIONS: TEMPLE CITY CA 91780 CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATUR WENHUA, CHIU (626) 926-4016- 6448 OAK AVENUE LIC. NO UNDER SLAB WORK TEMPLE CITY, CA 91780 799540C36 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECTOR ENGINEER: TEL. 0: ROUGH' PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOT FI CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508