HomeMy Public PortalAbout6346 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