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Home My Public Portal About5262 SERENO DR_Plumbing__ WOf111t COMPENSATION DECLARATION 7&IM7ADPW eKBa APPLICATION FOR PLUMBING PERMIT I hereby affirm thatt I hphiveve a certificate of consent to Bell Insure or a certificate of Worker a Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) t COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV Policy Na Company ` 1. ❑ certified copy b hereby famished r FOR APPLICANT TO FILL BM(PRINT OR TYPE) ABUILDING DDRESS (p Z• {�j/) ElCertifiedcopy b (�filed with the county building Inspection ^ department NUMBER FD(TURE OR REM 9 FEE LOCALITY C Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCEEEK — (This section need not be coraplatsd H the work involved by the SHOWER MAPPAGE 1PARCEL. permitla for one hundred dollen(i100)M leu) L vJ I certify that In the performance of the work for which this permit LAVATORY r gpggR , is issued I shall not employ any person In any manner so as to 61NI( MAIL ADDRESS' S" L y'n r• become sub) t the Workers Compo tion Laws DI6IVASHEA CRY DateApplrcenl vmv CLOTHES WASHER NOTICE-TO kPPLICANT It after making this Certificate of CONTRAcTopt /�(-- y�yrf hoc /j 57 - Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code you must forthwith comply With Such ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM A4 lLt, LICENSED CONTRACTORS DECLARATION CRY TEL NO } I hereby affirm that I am licensed under provisions of Chapter g WATER HEATER (commencing wnh Section 7000) of Division 3 0l the Business and ' STATE LIC C Professions Code and my license b In lull force and effect OAS SYSTEM OUTLETS LICENSE NO CLASS :361 8 OUTLETS OVER DISTRICT NO PROCESSED BY it 6 PER SYSTEM D Llrome Number Lk Cleee� OA:5 YF Cont --= FINAL ` ALIDATION a Cont,ac DATE ElN I arri exempt uMer Sec FINAL ? BVc J B dP C for this reason cafe Plan check fee _ , ,at;CT,r Signature PLUMBING PERMIT ISSUING FEE S 3307 250.65 ❑ TOTAL FEE Q 1 ITEMS SINGLE FAMILY Plan check applicant TOTAL 250. 65 HOME OWNER BUILDER DECLARATION Name • -' - tur`Y :5ur�c 1 hereby affirm that I enl exempt from the Contractor a License Law TIG for the following reason(Section 7031 5 Business and Professions Address r - � ,Q(i Code) ❑ city TM No t I n owner of the property M y will do e work and the structure '( t Is not Intended or offered for sale (Section 7044 Business T 1 _01500-0001 5/WG3 and Professions Code) 9673 1 Ali 9.15 CONSTRUCTION LENDING AGENCY - 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit b issued(Sec 3007 Civ C) Lender a Name , Lender a Address I certify that I have read this application and state that the shove - - - ► Information Is correct agree to comply with all County ordinances and State laws reguiptingPlumbing and hereby authorize - representati of this ounty,to enter upon the above men oned pr I Ion u BEE REVERSE FOR EXPLANATORY LANGUAGE °� S/ p , Signature of PerifitIMe Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm thpt j have a 16 certificate of consent to self in- 20- DPW y� /-1 sure,or a certificate of Workers'Compensation Insurance,ora 76A667A ce t copy thereof (Sec 3800, Lab C ) C•IILJIIf COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS P lacy Na Company Certified copy is hereby furnished BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) D Certified copy a filed with the county budding inspection ADRESS Zi depoant NUMBER FIXTURE OR ITEM 8 Fff r LOCAL ITYDote rl:�/qv Applicant WATER CLOSET(TOILEr) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the work Involved by MAIL the pertn6 Is for one hundred dollars($100)or less) LAVATORY ADDRESS a R.n I certify that in the performance of the work for which this per- SINK CITY CA.�sS TEL NO mit is issued, I shall not employ any person in any manner so ,M`+p as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers Compen- CITY TEL No 3557412)"1'" sation provisions of the Lobor Code you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE .�s.� UC ed WATER HEATER LICENSE NO 3!» CLASS L Z1- / LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby off irm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �JO and Professions Code and my license is in full force and ef- 5 PER SYSTEM FINALIZAUDATION fect I HOSE BIB DATE �_ License Number S3_35S Lic Class C-724- F�tLT.i ��rs.�/� _/,�/ FINAL C Contro / -Mi LA105-'Dhle�]11Id_ BY 333' r Z.7'UCC cta� I am exempt under Sec I ( 1 I7E ' B 8P C for this reasonTI LU Plan check fee '` = .ITAL 72 -7cd Date PLUMBING PERMIT ISSUING FEE$ , CHECK 72.715; Signature C"GE .10 TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name - - l 1 Uy 12,'94 Low for the following reason (Section 7031 5, Business and 9189 1 PM r.1_, Professions Code) Address I, as owner of the property will do the work and the City Tel No 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 agree to comply with all County ordinances and Stat aws r g lot Ing Plumbing and hereby authorize r atr s t is County to enter upon the abov pro rty inspection pu poses s�� - SEE REVERSE FOR EXPLANATORY LANGUAGE Signoture of Permi tie ate � L COUNTY OF LOS ANGELES TEMPLE CITY 9 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0411290013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT. LEGAL ID TR: 45808 LT: 1 UN 2 Fht:li PAIL) 5262 SERENO DR FEE DESCRIPTION QUANTITY: LUOA AMOUNT TEMP CA 917803058 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5388-010-050 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H4 LOCALITY- TEMPLE CITY, C 47 WATER HEATER(S) 1 00 WTH 16 20 • TOTAL FEES '43 95 ISSUED ON PROCESSED BY PLAN BY 11/29/04 JK 05/28/05 OWNER. FINAL DATE WONG JACKSON K,MONICA H (626) 823-1032- 5262 SERENO DR Y TEMP 917803058 DESCRIPTION--0 WUXK WATER HEATER CHANGE OUT APPLICANT: --TEL -0- TEKAWA (310) 515-1311- 17111 B. BROADWAY , SPECIAL CONDITIONS- GARDENA CONTRACTOR DATE INSPECTOR SIGW709- ACTION CONTRACTORS (310) 515-1311- 17111 SOUTH BROADWAY LIC NO UNDER SLAB WORK GARDENA, CA 90248 6525358036 WOLTER SERVICE ARCHITECT OR ENGINEER TEL NO - PLASTIC Y/M METAL Y/N LIC NO GAS PIPING GAS VENT HEATER FIXTURES LAWN SPRINKLERS GAS TEST CWV GRAT WATER SYSTEM REPORT ID' DPR263 ROUTE TO: OS0508 '