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Home My Public Portal About9902 WOODRUFF AVE_Plumbing__ ` WORKERS'COMPENSATION DECLARATION 7GA867A 1 I hereby affirm that I have a' certificate of consent to self ce a17(z-ae) APPLICATION P®R PLUMBING PERMIT 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 i F1 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING { ADDRESS Gr N E] Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ® FEE tgt321� J/ department. WATER CLOSET LOCALITY -7� C Date Applicant NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM.WORKERS' ! Cap 'O'WNER COMPENSATION INSURANCE SHOWER a tGQVYI'' f �c:u:r LAVATORY MAIL (This section need not be completed if the work involved LAADDRESS by the permit is for one hundred dollars ($100) or less.) SINK } CITY TEL.NO. I certify that in the performance of the work for which this DISHWASHER V CONTRACTOR permit is issued, I shall not employ.any person in any manner so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER 0 ADDRESS O Date Applicant SWIMMING POOL RECEPTOR V NOTICE TO APPLICANT: If, after making this Certificate of• CITY TEL.NO. LLI Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM d Compensation provisions of the Labor Code,you must forth- STATE LIC. rn with comply with such provisions or this permit shall be WATER HEATER LICENSE NO. CLASS Z deemed revoked. DISTRICT NO. XCE GAS SYSTEM OUTLETS SSED BY LICENSED CONTRACTORS DECLArpRATION OUTLETS OVER `,t I hereby affirm, FI that I am licensed under provisions of Chapter 5 PER SYSTEM i 9 (commencing with Section 7000)of Division 3 of the Busi- NAL 4-p VALIDATION ness and Professions Code,and my license is in full force and DATE (® Q effect. �^-- FINAL License Number Lie.Class BY Contractor Date I am exempt from the licensing requirements as I am a Plan check fee Y licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ ,acting in my professional capacity (Section 7051, Bus lness and Professions Code). TOTAL FEE 1Z ItiEnc Lie.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's .Address License Law for the following reason (Section.7031.5, Busi- Tel.No. ness and Professions Code): ' I, as owner of the property, am exclusively contracting I with licensed contractors to construct the project j (Section 7044,Business and Professions Code). I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency - 3$ 3 A for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). # 0 0 0 0 0 5 Lender's Name Lender's Address 2 ° ° 1 250 I certify that I have read this,application and state that the. 1 o 0 o 1 250' above information is correct.I agree to comply with all CountySEE REVERSE FOR EXPLANATORY LANGUAGE l 06,04-82 ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the i above-mentioned properW for inspection purposes.. Signatur o ermittee Dite WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers' Compensation Insurance, 76AG67A or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES DEPT, OF PUBLIC WORKS Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspec- FIXTURE OR ITEM ADDRESS tion department. NUMBER @ FEE LOCALITY �` '� Dote Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. C IL COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY ?EL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be ISTATE LIC. deemed revoked. WATER HEATER I LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. j PR(JCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM r; OUTLETS31— ., (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM _ FINAL VALIDATION i DATE — O License Number Lic. Class U FINAL Contractor Date BY O ❑ ~ I am exempt under Sec. u B.BP.C. for this reason –1 _ ; CL Plan check fee ► i , Z .Date' PLUMBING PERMIT ISSUING FEE$ Signature _ TOTAL FEE 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 a?essions 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 offirm 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-mentioned property for inspection purpose/s.. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ture of Permittee pate COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0111190035 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL S: TR: 6561• LT: 48 UN: .002 9902 WOODRUFF AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801729 ASSESSORNEAREST CROSS STREET: AGNES 8587-031-022 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 T5NANT: 11 CLOTHESWASHER(S) 1.00 FIX 16.20 ISSUED ON: PROCESSEDL P N: 21 HOSE BIBB(S) 2.00 FIX 32.40 11/19/01 JK 05/18/02 25 LAVATORIES/SINKS 1.00 FIX 16.20 OWNER: TE O: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 FINAL DATE FINAL Y: CODE: TRAN, BIEN HAI - TOTAL FEES 124.95 9902 WOODRUFF AV `�� TEMP 917801729 DESCRIPTION OF WORK PLUMBING FOR ADDITION APPLICANT: HONG A. MIU (626) 281-3881- 1809 S. MONTEREY ST _ SPECIAL CONDITIONS: ALHAMBRA 91807 CONTRACTOR: TEL. NO: APPROVALS DTE INSPECTOR SIGNATURE HONG A MIU (626) 281-3881- v. 1809 MONTEREY ST. LIC. NO ALHAMBRA CA 91801 755456 8 �� t DE Lv. R 4'�G - ATTER SERVICE C C 0 G R: L. 0: - �y; , C� r ?� JJ�- ` ',,� PLASTIC Y/N METAL Y/N LIC.-N GAS PIPING - — --- - --- --- ---- --- --- ---- GAS VENT - —-- _ - -- -- — —= - -- -- HEA791- PLEMBING FIXTURES Of. GAS TEST UTILITY COMP NTW67rFrED CWv irvic GRAY WATER SYSTEM REPORT ID: DPR20 ROUTE TO: BS0508