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Home My Public Portal About6346 TEMPLE CITY BLVD_Plumbing__ • WOR at I have of consent �ADPW a/09 APPLICATION FOR PLUMBING PERMIT I geraDy aNirm that I have a certificate of consent to self Insure or acertdkete of Worker a Compensation Insurance or a cartefied copy thereof(Sec 3800 Lab C) Policy No Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS r ,t DEPT OF PUBLIC WORKS DIV ' ❑ Canff d copy M hereby hrNahed FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADA ADDRESS 35� 4%11 d ❑ eatM fcopy b 1Jed with&m countycountyhbuilding Inspectioneparanenl NUMBER FIXTURE OR ITEM 9 FEE LOCALITY Dale Applicant 2, WATER CLOSET NEAREST 01 CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST BATH TUB COMPENSATION INSURANCE ASSESSOR PAGE PARCEL (fhb section nand not W eomplNM If the work Mrohad by the 2 SHOWER permit Is for one hundred dollars fill or leu) j, LAVATORY OWNER hit ew— I certify that In the performance of the work for which this permit Is issued I shall not employ any person In any manner so as to SINK MAIL6rsy� Ag become subject to the Workers Compensation Laws ADORESS DOWASHER CITY TEL NO W Data Applicant / CLOTHES WASHER CONTRACTOR cAl.. ` NOTICE TO APPLICANT If,f, after making this Certificate of Exemption you should become sublact 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 LICENSED CONTRACTORS DECLARATION Cm TEL NO } I hereby affirm that I am licensed under provisions of Chapter S WATER HEATER a (commencing with Section 7000)of Division 3 of the Business and STATE LAC Professions Code and my license is in lull force and affect GAS SYSTEM OUTLETS LICENSE NO CLASS OUTLETS OVER DISTRICT NO ��// PROCESSED BY cc 6 PER SYSTEM �1r O (� it �� License Number Lie Gem O l/�G U INAL Contractor Dae OF `�_ Z l-q VALIDATION (Wd ❑ Z I arrh exempt under Sec FINAL By B BP C for w thin reen L9 Date Plan check fee ► Signature PLUMBING PERMIT ISSUING FEE$ o2 tj ❑ TOTAL FEE XJ r tiffQ SINGLE FAMILY Plan check appllca rt HOME OWNER BUILDER DECLARATION Name I hereby affirm that I ern exempt from the Contractor a License Lew (,l-T,i for me following reason (Section 7031 8 Business,and Prolemlons Address lcode end the structurelGay 330 u I as owner of the property will eb the work Tel No is "I intended or offered for sale (Section 7044 Business and Profession Code) , TOTAL i?4 _ 80 CONSTRUCTION LENDING AGENCY l'ECK I hereby affirm that there Is a construction lending agency for the HAf�,jE r ,CID performance of the work for which this permit Is, Issued (Sec 3087 CIV C) Lender•Name h111311-1'O01 7/ 7 "`__' Lender a Address I certifythat I here read tree application end elate that the above information , lormafion u correct I spree to comply with all County ordinances ipgff lu zt y t enteroeenSEE REVERSE FOR EXPLANATORY LANGUAGE tee WORKER aCOMPENSATION DECLARATION �" a/� APPLICATION FOR PLUMBING PERMIT I heyeby aflirmethat I have a certificate of consent to self Insure , of a Ortfflaate of Worker•Compensation Insurance or a certified copy thereof(Sac 3800 Lab C) Policy NonCS1440.6—ccempany RRPEIBT_T1' TBMFMNITCOUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV ❑ Cemfietl .py to hereby fumnihad FOR APPLICANT TO RLL IN(PRINT OR TYPEI ADDRESS6346 N. TEMPLE CITY BLVD. ® Certified copy m filed with the court building department NUMBER FIXTURE OR REM O FEE LOCALITY Date 7/30/92 APP11 WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERRSCROSS ST COMPENSATION INSURANCE BATHTUB ABOOR BOOK PAGE PARCEL (This aectlon need not be completed If the work Involved by the SHOWER MAP permit Is for one hundred dollen($100)or Is") LAVATORY OWNER I candy that In the performance of the work for which this permit JOHN KABLER is issued I shall not employ any person in any manner so as toMAIL SIWcES66346 N. TEMPLE CITY BLVD. become subject to the Workers Compensation Laws DISWASHEn CTTYTEMPLE CITY TEL W818-285-0729 Dale ApplkantN/ CLOTHES WASHER NOTICE TO APPLICANT II after making A this Certificate of CO"TRAOTO"IRVINEWEST HTG. S A/C Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code you must forthwith comply With such AODRESS636 SOUTHERN AVE. provisions or this permit shall be deemed revoked LAWN SPRIMO.ER SYSTEM LICENSED CONTRACTORS DECLARATION crrYORANGE TEL Nd714-921-0 00 } I hereby affirm that I am licensed under provmlons of Chapter B WATER NEATER IL (commencing with Section 7000)o1 Division 3 of the Business and 1 GAS SYSTEM OUTLETS 14. 0 STATE Nd468609 CC20 Professions Cade and my license m in full force and affect OUTLETS OVER DISTRICT NO PROCESSED BY -.44-PI 0 LceneeNumber468609 U, class 6 PER SYSTEM C20 G� 7/30/92 FINAL 1-71 VALIDATION n. ❑ I ern exempt under sec N BFY AL Z B 8P C Icr tide reason Data Plan check fee ► c Signature N/A PLUMBING PERMIT ISSUING FEE$ 24. 75 ❑ TOTAL FEE 39. 5 ACCT.= SINGLE FAMILY Plan CIIBck aPDllcant ��07 39.25 HOME OWNER-BUILDER DECLARATION Name 1 ITEMS I hereby affirm that 1 am exempt from the Contractors License Law for ethe following reason (Section 7031 6 Business and Professions Address, TOTAL 39 . 25 Codcity Tel No ❑ MCK 39.25 I as,Owner the property well do the work and the structure Is not Intended or offered for sale(Section 7044 Business C � .1.313 and Professions Code) , OOOO- I CONSTRUCTION LENDING AGENCY ODS-GOD 1 8/17/9-"I hereby affirm that there is a construction lending agency for the performance of the Work for which this permit is Issued(Seo 3087 Akf 't Civ C) JVT9 1 AMIO:. Lender a Nemo Lender a Address I cenlfy that I have read this application and state that the above , information is caned 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 pr pony la Pett n purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Ignature of'Phrihifte WORKERS'COMPENSATION DECLARATION nunw ^ 1 hprcbf ef= that I have a certificate of consent to self paai„r-ae) APPLICATION FOR PLUMBING PERMIT i JI1 insure, o�e cerdficete of Workers'Compensate Insuranc or a cernfiat�a�y thereof(Sec 3800,Lab C) COUNTY OF LOS ANGEL BUILDING AND SAFETY Po11cy 'N/"I/�yA9-Company /f c O Certified copy u hereby furnished Co i�a FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING �JN Cern Rad copy Is filed with the county building Inspection Nl1MBER R FIXTURE OR EM • FEE ADDRESS 1-�WT6/0 department WATER CLOSET LOCALITY Date Applicant NEAREST BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE SHOWER OWNER (Thu section need not be completed If the work tmolved LAVATORY MAIL ADDRESS by the permit u for one hundred dljBan ($I00) or leis) SINK CITU TEL NO O I certify that in the performance of the work for which thisDISHWASHER CONTRACTOR / permit n issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws CLOTHES WASHER g ADDRESS J Data Applicant SWIMMING POOL RECEPTOR e y W NOTICE TO APPLICANT If, after making this Certificate of CITY Q TEL NO O 11 Exemption you should become subject to the Workers LAWN SPRINKLER SYSTEM �j 'IN y Compensation provisions of the Labor Code you must forth WATER HEATER STATE NO./J�� 7"7 LI .�)<Z Q� Z with comply with such provisions or this permit shall be deemed revoked GAS SYSTEM OUTLETS D SS�T�,lGT NO RO ED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER �� r O� I hereby affirm that I am licensed under provisions of Chapter 6 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Bun FINAL VALIDATIO nese and Professions Code, and my license a in full force and ✓ DATE P effect ¢ License Numb 3 c Class q� FINAL 4� BY x Contrecto ata lam exempt fro a licensing r4. em nH as I em a Plan Check file licensed architect or a registered professional engineer u PLUMBING PERMIT ISSUING FEE$ / acting m my proCode capacity (Section 7051 Bus ineand Professions Code) TOTAL FEE Lic or Reg No Date Plan cheek applicant �j 1 HOME OWNER BUILDER DECLARATION Name 1 hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 7031 5, Busl Iciry Tot No V :90 0 1 Q A i nese and Professions Code) El1, as owner of the property, am exclusively contracting /� �� # • • • • • 5 with licensed contractors to construct the project (Section 7044, Business and Professions Code) C�` b v , 2 • - 1300 CONSTRUCTION LENDING AGENCY • • • ) 3006 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 0 619-81 issued(Sec 3097,Civ C) Lender's Name Lender's Address 1 certify that I have read this application and state that the _ above information is correct 1 epee to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authonz epresentatives f this County to enter upon the me oned prope f ns on purposep� T! gnture o ermittee Date