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Home My Public Portal About10928 WILDFLOWER RD_Plumbing__ WORKERS'COMPENSATION DECLARATION [� �PPLOCATOON FOR PLUMBING PER"T I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) {`�t or a certified copy thereof(Sec: 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.. Company Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS ® !!QJ I J��1�Certified copy is filed with the county:b inspec- tion department. NUMBER FIXTURE:OR.ITEM @ FEE 521 - LOCALITY Datoppligant WATER Date NEAREST CERTIFICATE OF EXEMPTI WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER . (This section need not be completed if the work involved by the permit Is for one hundred dollars.($100)or less.) LAVATORY MAIL ADDRESS •�./7 'I certify that in the performance of the work for which this , permit is issued, I shall not employ any person in any manner SINK CITY � f TEL. NO. so as.to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR6• s Date Applicant CLOTHES WASHER ADDRESS n 1K NOTICE TO APPLICANT:. if, after.making this Certificate ofr Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL . N Compensation provisions of the Labor Code; you:must forth- � P4 LAWN SPRINKLER SYSTEM with comply with such provisions or this permit:shall,be STATE' LIC. deemed revoked. WATER HEATER LICENSE NO. 4 j ct" CLASS ' LICENSED CONTRACTORS DECLARATION DISTRICT NO. OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Di.vis.ion 3.of the Business OUTLETS OVER ✓ .(f (D and Professions Code;and my license is in.full force and effect: 5 PER SYSTEM FIN s'-? �. .. 20 dv DATAL _ VALUATION 0 License Number Lic. Class FINA1 4 4 4.A09 weContractor Dat O BY # 0000a5 I Al exempt under Sec: 10 .0 � B.BP.C. for this reason 3Q50 Plan check fee Date: 1Q �� > 0 o o 3 Q 5.0�. PLUMBING PERMIT ISSUING FEE$ Signature , `� TOTAL FEE V 01.30-85 Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from.the Contractor's License Address Law for the following reason (Section 7031.5, .Business and Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the structure isnot :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 authori a representatives of this County to enter upon the above- entio roperty'for inspection ses. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date �`!W. RS'COMPENSATION DECLARATION Wz/sA66 A��`�� y� �p ®� I hereby aft m that I have a• certificate of consent to self ce a�z(z-eo) A P P��C 6=A T10 �I FOR PLUMBING P RMI T .insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) . COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No '� CompanY r Cert led copy is hereby furnished. p FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS Certified er i a nen is filed wi4thnount!bu inspection I NUMBER FIXTURE OR ITEM O FEE LOCALITY Date. Applicant WATER CLOSET NEAREST BATH TUB CROSS ST. CERTI KATE OF EXEMP ION FROM WORKERS' ' i ' If COMPENSATION INSURANCE SHOWER OWNER L W (This section need not 'be completed. if the work involved LAVATORY . MAIL ADDRESS QR'R �',�.; } by the permit is for" one hundred dollars ($100) or less.) SINK CITY TEL.NO, d I certify that in the performance of the work for which this I DISHWASHER p�a U permit is issued, I shall not employ any person in any manner I rADD RACTOR - V so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ESS' O " Date Applicant SWIMMING POOL RECEPTOR NOTICE TO APPLICANT: If, after making this Certificate of ®v!A TEL N6.216-3175 '141 Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM 4. STATE LIC Compensation provisions of the Labor Code, you must forth- LIC NSE NO.I' 22 . CLASS C-20 Z with comply with such provisions or .this permit shall be WATER HEATER deemed revoked. DISTRICT N PROCESSED.B GAS SYSTEM OUT LICENSED CONTRACTORS DECLARATION �' OUTLETS OVER r I hereby affirm that I am licensed under'proVisions of Chapter I 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3"of the Busi- FINAL VALIDATION ness and Professions Code, and my license is in'full,force and DATE effect, FINAL License Numb Lic.Class gY Contractor — t Date I am exempt from the licensing requirements as I am a Pian check fee licensed architect.or a registered professional engineer PLUMBING PERMIT ISSUING.FEE$ /•,��j' acting in my professional capacity (Section 7,05'1, Bus- (, iness and Professions Code). l TOTAL FEE :Lic,or Reg.No. Date Plan check applicant i HOME OWNER-BUILDER DECLARATION Name .. I Hereby affirm that I am exempt from the Contractor's lAddress / License 'Law for the following reason (Section.7031..5, Busi- City Tel.No. 9nV( ness and Professions Code): I, as owner of the property, am exclusively contracting. with licensed contractors to construct the project 2 0.2 2'6 A (Section 7044,Business and Professions Code). # a000:.a5 . CONSTRUCTION LENDING AGENCY I. hereby affirm that there is a construction lending agency 2 " 10.00 for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). .0 C C 1'Q 0'0=5 Lender's Name • 0'7.0.7—$ 1 . 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 SEE REVERSE FOR EXPLANATORY LANGUAGE drdinances and State laws regulating Plumbing, and hereby authorize representativ of this County to enter upon the ab tione r ' r inspection pur oses. qq nature of Frerdlinde ate _Ip 768-66 APPLICATION FOR PSL UMB-ING PERMIT - 6;7 B_ .1 BUMDING AND SAFETY DIVISION Deportment of County Engineer County of Los Angeles BU.ILD)NG JOHN A.LAMBIE,COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN,SUPT OF BUILDING. LOCALITY Af FORLICANT TO FILL IN NEAREST in cRoss sT. t OWNER DISTRICT NO. GROUP ZONE READY FOR INSPECTION MAIL ! ADDRESS INDUSTRIAL CITY rf. TEL.NO. WASTE APPROVAL key ! . t i Xi;q►?_i 1, %O r PLUMBER I INSPECiTION RECORD • " % _ 9V E 4OOfl ll. !. ADDRESS • .CII) O 5-129 CITY TEL.NO. 160847 LICENSE NO. - NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00. $. BATH TUB @ .$1.00 SHOWER @ $-1.00 LAVATORY (WASHBASIN) @ $1.00 KITCHEN SINK @ $1.00. .. DISHWASHER @ .$1.00. LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @. $1.00 WATER HEATER @ $1.00 GAS SYSTEM @ $1.00 APPROVALS DATE INSPECTORS SIGNATURE UNDER'8LAB WORK �YY �,'1 (!-fJ, �,,iL✓,� PERMIT $ 1100 ROUGH PLUMBING GAS PIPING TOTAL FEE X6 GAS VENT y I HEREBY ACKNOWLEDGE. THAT I HAVE READ THI APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER t� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES ✓� ,p I I HEREBY CERTIFY THAT I-AM PROPERLY REGISTERED AND/OR GAS TEST L)CENSED AS REQUIREDBY OS ANG ES COUNTY AND STATE OF CALIFORNIA OR THAT 1 THE L AL OWNER OF THE AB VE 'UTILITY CO.NOTIFIED DESCRIBED RESIDENTIA OPERTY SIGNATURE OF FERMITTL ROBERT A.WOOD, JOHN A.LAMBIE OUNTY ENGINEER ATION SUPERVISING MECHANICAL ENG'R � CR. M.0. CASH Ly&3 5 1 1 OCT 18 3 1 0.0 0 a 6 � COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0201160008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: GAL D• FEES PAID TR: 23949 LT: 11 10928 WILDFLOWER RD FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803511 ASSESSOR INOR NUMBER: NEAREST CROSS STREET: SANTA ANITA 8573-034-011 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: TOTAL FEES 43.95 ISSUED 0 : PROCESSED S . 01/16/02 JK 07/15/02 . OWNER: TEL. O: FINAL DAT smal UN BY: CODE: CHAN• TAKCHI (626) 810-8602- 10928 WILDFLOWER RD UR Hr.rl TEMP 917803511 SCR INSTALL SHOWER IN EXISTING BATH APPLICANT: E 0: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO UNDER SLAB WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT0 G TEL. NO: ROUGH PLUMBING LIC. NO: GAS PIPING 5 VENT HEATERHOT WATER FIXTURESPLUMBING LAWN-SPRINKLERS GAS TEST P 0 D C GRAY WATER REPORT ID: DPR263 ROUTE TO: BS0508