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Home My Public Portal About4833, 4825 AGNES AVE_Plumbing_4/28/1980_ 76A667A w / G r a CE 817(REV 11/78) + f C B si 4 APPLICATION FOR PLUMBING PERMIT 'J COUNTY OF LOSrANGELES r - BUILDING AND SAFETY r ` h FOR APPLICANT TO FILL IN(PRINT OR TYPE)f' BUILDING 9Co ADDRESS 4833NUMBER^ FIXTURE OR ITEM ) ® FEErt r LOCALITY Tem le Cit WATER CLOSETf NEAREST I BATH TUB 00 CROSSST1 SHOWER r 00 OWNER Fairhaven CorpMAIL 2 LAVATORY . 6 00 ADDRESS 1 SINK 00 CITY e TEL NDISHWASHER t a CONTRACTOR Dorsey Plumb r CLOTHES WASHER ADDRESS 800 Palomares SWIMMING POOL RECEPTORiT ; s LAWN SPRINKLER SYSTEM 4 CITY Le Verne TEL NO 0828 WATER HEATER j 3 OO LICENSE NO CLASS ATE LIC r GAS SYS EM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE Q 00 + V OUTLETS OVER UNDER SLAB WORK M ;pk C'i, t , HC 5 PER SYSTEM r ROUGH PLUMBING ?d'^ � vea � O + I GAS PIPING £a f r u, LW GAS VENT y HOT WATER HEATER v • Z t PLUMBING FIXTURES " GAS TEST 4 Plan check fee UTILITYCO NOTIFIED PLUMBING PERMIT ISSUING FEE$ 9 COOI { TOTAL FEE r3? 100 FINAL e .L;1-,/- Plan check applicant PLAN CHECK VALIDATION 1 Name Address r r � City Tel No Ti f 1 y E I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 0 0&9 A THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES 1 AND STATE LAWS REGULATING PLUMBING p A PERMIT VALIDATION i > 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS r l Q O D 0 0 5 REOUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE i LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL R2 - o3700 O3700 PROPERTY SIGNATURE 00037005 OF PERMITTEE y R DISTRICT NO PROCESSED Y a&28-80 INDUSTRIAL A r WASTE APPROVAL r 46 --wsIf affirm t COMPENSATION DECLARATION 78A887A APPLICATION FOR PLUMBING P 1--1 R M I T I hereby affirm that I have a certificate of consent to self CE sig (z eo) insure or a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) COUNTY OF LOS ANGELES T - BUILDING AND SAFETY _ Policy No Company Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING /yy32 ADDRESS 0 Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE department WATER CLOSET LOCALITY L Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST k4 e— COMPENSATION INSURANCE SHOWER OWNER qrl p LAVATORY MAI L (This section need not be completed if the work involved ADDRESS a by the permit is for one hundred dollars ($100) or less) SINK CITY ` TEL NO _U I certify that in the performance of the work for which this DISHWASHER permit is issued I shall not employ any person in any manner CONTRACTOR so as to com s.,ubbjject to the orkers Compensafylo�n Laws CLOTHES WASHER ADDRESS j Date yf' Applicant l^QO U l h TO—S41 SWIMMING POOL RECEPTOR a NOTIC TO APPLICANT If after making this Certificate of CITY TEL NO U) Exemption you should become subject to the Workers LAWN SPRINKLER SYSTEM STATE LIC Z Compensation provisions of the Labor Code you must forth LICENSE N CLASS with comply with such provisions or this permit shall be WATER HEATER deemed revoked GAS SYSTEM OUTLETS DISTRICT NO PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER Q I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi FINAL ( VALIDATION ness and Professions Code and my license is in full force and DATE v effect JBY IN License Number Lic Class Contractor Date F1 I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051 Bus iness and Professions Code) � TOTAL FEE Lic or Reg No Date Plan check applicant HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractors Address License Law for the following reascn (Section 7031 5 Busi City Tel No ness and Professions Code) 2 51 3 3 A I as owner of the property am exclusively contracting with licensed contractors to construct the project # o 010 0 o 5 (Section 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY 1 2 5 0 1 hereby affirm that there is a construction lending agency 0001250F! for the performance of the work for which this permit is _ issued(Sec 3097 Civ C) 0723-82 Lenders Name Lender s Address I ce ify the I have read this application and state that the abo a inform ion is correct I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ord nances n State laws regulating Plumbing and hereby aut rize r pre nt ves of is County to enter upon the abo ment ned op r nspection purposes t Sig natu ermittee Date WORKERS COMPENSATION DECLARATION20 0026 ° APPLICATION FOR PLUMBING PERMIT I herebyaffirm that I have a certificate of consent to self in 76A667 DPW 4/90 76A667A a sure or o cestificule cue`rs rWorkCompensation Insurance or a - n certifiedcopythereof(Sec 3800.La`b C ) lul Policy Ne'`�i L 3$00%10 ompanyC-'Ou�at� 0P.-Lo— COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Certified copy is hereby furnished BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS Jif R 2S14 "157department NUMBER FIXTURE OR ITEM @ ., FEE ^ ~ (�^ W (� WATER CLOSET(TOILET) LOCALITY ` o to QAC Cl Ddte Applicant a++'�+ +� NEAREST r CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB y CROSS ST t, atq O,Ll q JF:_ s COMPENSATION INSURANCE SHOWER OWNER Gp2 AV-5 - (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less) LAVATORY ADDRESS E S I certify that in the performance of the work for which this per SINK — mit is issued I shall not employ any person in any manner so CITY I _M 110 E TEL NO 0"7154a as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR JkA t 1ejr— V,%6Ac3K17 f>L7*46 Date Applicant CLOTHES WASHER ADDRESS &�JfOS W JfiPF��-Boll NOTICE TO APPLICANT If after making this Certificate of Ex SWIMMING POOL RECEPTOR emption you should become subject to the Workers Compen CITY i`, C r T T AO sation provisions of the Labor Code you must forthwith comp LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok STATE LIC ed WATER HEATER 0 LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS, a 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER O 0Z4'e0e5e--' and Professions Code and my license is in full force and of 5 PER SYSTEM FINAL VALIDATION fect HOSE BIB DATE *-Z d License Number 399 �"l o Lic Class C � O FINAL V Contractor L�M� 1"1 �' Date ^�g� �� BY I= ❑ I am exempt under Sec a 0O V B 8P C for this reason W Plan check fee y Date PLUMBING PERMIT ISSUING FEE$ Q Z Signature TOTAL FEE ZJA SINGLE FAMILY HOME OWNER BUILDER DECLARATION Plan check applicant 9 I hereby affirm that I am exempt from the Contractor s License Name �t�'f g Low for the following reason (Section 7031 5 Business and Professions Code) Address 3303 43 tO ❑ 1 as owner of the property will do the work and the City Tel No 1 ITEMS structure is not intended or offered for sale(Section 7044 Business and Professions Code) TIIT,L 43 .40 CONSTRUCTION LENDING AGENCY ® Cr ECK 43 40 1 hereby affirm that there is a construction lending agency for „r ("GE Dr the performance of the work for which this permit is issued (Sec 3097 Civ C ) Lender s Name 0000-0001 b/183 r OLc Lender s Address + 6973 1 An 10 3.L 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 jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the above mentioned property for inspection purposes 0 r '10 , L-16 7,k SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee NDate