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Home My Public Portal About5853 SULTANA AVE_Plumbing__ .� %^iIyORKER$'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I�herel�ji affirm that I have a certificate of consent to self 76A667A . .irtsuee;'vr a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a.certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company— Certified ompany 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 � n LocALaTY Date Applicant CE .WATER CLOSET 0" NEAREST RTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB b 00 CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed if the work Involved by SHOWER MAIL the permit is for one hundred dollars($100)OF less.) LAVATORY �� ADDRESS i� a I certify that,in the performance of the work for which this CITY- permit is issued, I shall not employ any person in any manner � SINK. 6rogo CIT �.' TEL.NO P10. so as to become subject to the Workers'Compensation Laws. i DISHWASHER CONTR:ACfORAe Ir Date Applicant f CLOTHES WAS e/ ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you, should become subject to the Workers' CITY TEL.N. wdza Compensation;provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit' shall be STATE LIC:: , deemed revoked. WATER HEATER ®� LICENSE NO. .: CWSS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS d .�C'`s f� 0 9 (commencing with.Section 7000)of Division 3 of the Business OUTLETS OVER `J and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL /�� / VA ATION V DATE ( C8' License Number Lic. Class 06 FINAL O Contractor Date BY ❑ I am-exempt under Sec. y B.BP.C. for this reason Poo check fee Date: -PLUMBING PERMIT ISSUING FEE$ 0-281L38- Signature #'o 0 0 0 0 TAL FEE �� " Plan check applicant TO :Ito a5a5O- SINGLE FAMILY x HOME.OWNER-BUILDER DECLARATION Name p Q I hereby affirm that I am exempt from the Contractor's License 'Address Law for.the following reason (Section 7031.5, Business arid: Professions 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 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 ntioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �. Signatur aAmittee Dat WOR�CERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I�ere6�i affirm that I have a certificate of consent to self 76A667A inn'sure or ,certificate of Workers'Com ensation Insurance, �. P CE.817(REV. 10/81) or a certified copy}hereof(Sec..38 Lail. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.C1176' pan5U{,%� ❑, Certified copy is hereby furnished. BUILDING FOR,APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspec go tiondepartment. NUMBER FIXTURE OR ITEM @ FEE yr LOCALITY l ��-� WATER CLOSET 00 Date Appli4ant - '� to /.)- O NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' / BATH TUB 0 CROSS;ST. COMPENSATION INSURANCE OWNER (This section need not be completed If'the work Involved by SHOWER 0,0 the permit Is for•one hundred dollars($100)or less:) pd MAIL L. LAVATORY ADDRESS I certify;that in the performance of the work for which this permit Is.issued, I shall not employ any person'in any manner SINK CITY TEL, O: so as to become subject to the Workers'Compensation Laws. DISHWASHER A •S CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS , NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR y Compensation provisions of the Labor Code, you must forth-. CITY TEL. N. d%F-2' C6d) with com I. with such rovisions or this LAWN SPRINKLER SYSTEM. p y. p permit .shall be STATE LIC. �r deemed revoked. WATER HEATER LICENSE NO. CLASS c.r .LICENSED CONTRACTORS DECLARATION ' ' D DISTRICT NO. BROCESSED BY I hereby affirm.that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS r (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER• y, and.Professions Code,and my license is in full forces andel effect. 5 PER SYSTEM PATE L --AA. VAL ATION License Number`L�� Lic. Class s2 ;0 /Q� i FIN Contractorej'�� ®&'a'o""pate BY ❑ I am,exempt under Sec. ILP B..BP,C. for this reason Plan check fee "Date: PLUMBING PERMIT ISSUING FEE,$ �J Signature •' ' TOTAL.FEE 7® O A Plan.check applicant 8 -{� SINGLE FAMILY ° -i HOME OWNER-BUILDER DECLARATION Name �. I hereby affirm that I am exempt from the Contractor's License Address Q Law for the following reason (Section 7031.5, Business and U _ Professions Code): City Tel. No. ° Q ❑ I, as owner of the property, will do the.work and the structure is not intended or offered for.sale (Section , 0 a05"85 7044, Business and Professions Code): CONSTRUCTION LENDING AGENCY I hereby affirm-that:there'is a construction lending agency for 22 8 5 7 A the performance of the work for which this permit is issued # 0 0 0 0 0 5. (See.3097, Civ. C.). I ° ° 7050 Lender's Name ° ° ° 7Q505 Lender's Address. I certify that 1'.have read this application and state that the 0 a 0 5`8 5 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 property for inspection purposes. c �p SEE REVERSE FOR EXPLANATORY LANGUAGE �"O']" Signature of.�PermitteL�! ��_Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0202250004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 • PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILDING ADDRSS: TR: 5905 LT: 110 0055 Ste¢ FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801841 ASSESSOR FO ION NUMBER: NEAREST CROSS STREET: ROSEMEAD 5387-014-007 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 25 LAVATORIES/SINKS 2.00 FIX 32.40 ISSUED ON: PROCESS BY: EXPIRES ON: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 02/25/02 JK 08/24/02 TOTAL FEES 92.55 OWNER: TEL. N0: FINAL DATE FINAL BY: CODE: WALKER WILLIAM R;MARTHA J - 9044 HERMOSA DR TEMP 917801841ESCRI 031 OF WORK ADD BATH AND EXTEND BEDRM L. NO: WILLIAM LEONG (562) 698-0571- 11713 E WASHINGTON SPECIAL CONDITIONS: WHITTIER 90606 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATOR HAMMERFORD CONSTRUCTION (562) 698-0571- 11713 E WHINGTON BLVD LIC. NO DUNDER SLAB WOR WHITTIERCA195413 WATER SERVIC PLASTIC Y/N METAL Y/N ARCHITECT R ENGINEER: . LIC. N0: ROUGH PL BING GAS PIPING GAS VVENT HOT WATER HEATER PLUMBING F X UR S LAWNSRNLES GAS TEST UTILITYCOMPANY NOTIFIED CW GRAY WATER SYSTEM (REPORT ID: DPR263 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0911160003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: I ITR: 5905 IT; 110 I 5853 SULTANA AV I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801841 ASSESSOR INFORMATION NUMBER: [ I NEAREST CROSS STREET: 15387-014-00701 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl I '151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 TENANT: I TOTAL FEES 43.95 JISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 11/16/09 SR 11/16/10 IOWNER: TEL. NO: IFINAL $71 FINAL BY: CODE: WALKER WILLIAM (626) 291-2652- [ 15853 SULTANA AVE. � TEMP 917801841 IDESCRIPTION OF WORK I IGAS LINE FOR FOR NEW HVAC APPLICANT: TEL. NO: I COMFORT ZONE INC. - I 1144 B VALENCIA ISPECIAL CONDITIONS: IGLENDORA CA 91740 [ CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE COMFORT ZONE INC. (626) 963-8383- I [ 1144 B VALENCIA LIC. NO I [UNDER SLAB WORK I I IGLENDORA, CA 91740 760955 C20 I I I I IWATER SERVICE I IPLASTIC YIN METAL YIN ARCHITECT OR ENGINEER: TEL. N0: - IROUGH PLUMBING I I I LIC. NO: I I GAS PIPING I I IGAS VENT I I IHOT WATER HEATER I I [ I I I I I I I [ [PLUMBING FIXTURES I [ I [ [LAWN SPRINKLERS I I I I [ I [ [ I I I IGAS TEST [ [ [ [ I I [ I [ I [UTILITY COMPANY NOTIFIED[ I [ [ I [CWV [ [ [ I I IGRAY WATER SYSTEM [ I [ I I [ I I I I [ [ I I I I [ I I i I I I I I I I [ [ [ j[REPORT ID: DPR263 ROUTE TO: BS0508 I I [ i