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Home My Public Portal About5947 AGNES AVE_Plumbing__ 76A667 CEtt817 4 64 /{� L l -7 APPLICA IO FOR P MBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION 7DDRE � 4/ 17 A, JOHN A LAMBIE COUNTY ENGINEER ! / N/L WILLIAM A JENSEN SUP T OF BUILDING FOR APPLICANT TO FILL IN CROSIt NUMBER FIXTURE OR ITEM EACH FEWATER CLOSET it25 DATH TUB 1 125 SHOWER 125 CITY I L NO;Fy, 7 LAVATORY 125 CONTRAC R SIN% 1 25 ADDRESS DISHWASHER 125 CITY d / TEL NO [� LAUNDRY TUB 1 25 REGISTRATION NO !�CONTRACTOYS STATE COUNTY CLOTHES WASHER 125 DISTRICT NO GROUP ZONE P OCE 5 D Y WATER HEATER 150 O GAS SYSTEM OUTLETS I SO INDUSTRIAL off. WASTE APPROVAL Q OUTLETS OVER 5 PER SYSTEM 90 INSPECTION RECORD V FO V W a Z APPROVALS DATE INSPECTOR S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE O GAS PIPING IH ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY OS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM HE EGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DE IBE RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE FINAL VALIDROBERT A WOOD 0 CK M o CASH SUPERVISING MECHANICAL ENG R LACO2949'�-oo JUN21 5 D 350- Arvka-fl-d �j, ,'.VKURKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT Is�ereby affirm that I have a certificate of consent to self 76A667A insurR or a certificate.of Workers Compensation Insurance CE 817(REV 10/81) or a certified copy thereof (Sec 3800 lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company I Certified copy is hereby furnished F-1Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �` r�f ` ' ' `� Certified copy is filed with the county building inspec ADDRESS WATER CLOSET �v '6 tion department � NUMBER FIXTURE OR ITEM Q FEE LOCALITY �o s Date Applicant ✓ NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER ,JU a r. (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less ) LAVATORY { ADDRESS I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner SINK CITY TEL NO 2(35.5 1 so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR Dote Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR Exemption you should become subject to the Workers CITY TEL NO Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER y LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO P 0CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS � /► (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER `U and Professions Code and my license is in full force and effect 5 PER SYSTEM FINALVALID ION DATE7 .e-- License Number Lic Class ` V FIN Oe: Contractor Date BY ❑ I am exempt under Sec W O. 1A B 8P C for this reason Plan check fee poll. Z Date Signature PLUMBING PERMIT ISSUING FEE$ 0 �a :21 7 2 5 A TOTAL FEE o o e o 0 5 SINGLE FAMILY i Plan check applicant U e o HOME OWNER BUILDER DECLARATION Name 0 0 0 I hereby affirm that I am exempt from the Contractor s License 03,2 �2 1 �8 5 Law for the following reason (Section 7031 5 Business and Address 1te Professions Code) City No I as owner of the property will do the work and the structureis not 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 ) f Lenders Name Lenders 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 pr erty for inspection purposes t SEE REVERSE FOR EXPLANATORY LANGUAGE ature of Per a Do e • WORKERS' COMPENSATION D�ECLARATTON 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, 76A667A or a certified copy thereof (Sec. 3800, Lob. C.)/r� G,� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS . Policy No. co-Company V/L - Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS /►/L-� tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET Date —� Applicant NEAREST CERTIFICATE OF EXEMPTION FROM W ERS' BATH TUB CROSS ST. �l COMPENSATION INSURANCE SHOWER OWNER 01CZ6a ' A4M G (This section need not be completed if the work involved by MAIL �Q��L'� the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 7 r 1��v I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY (.e TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR 1f C Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of a . Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR -� CITY TEL. NO./� a Gp Compensation provisions of the Labor Code, you must forth- SCS ` 0 a 0 33 LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. S CLASS l Z d LICENSED CONTRACTORS DECLARATION DISTRICT NO. �l PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS � y�x C? (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER IJ!/ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION r —`Zy DATE _ O, License Number Lic. Class FINAL / 0, Contractor � Date `� BY ,vim/ ®, 1.7 I am exempt u r Sec. 40 �} 1 I T Ell'13, B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature CHECK 4101. TOTAL FEE 4Q CHANGErl # Plan check applicant .0 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License 01300-110111 5.1"24,193' Law for the following reason (Section 7031.5, Business and Address �` -, r� Professions Code): x=93 1 Hri1`I23 ) 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 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 authorize representatives of this County to enter upon the abo -mentioned'p perty for inspection purposes. ` SEE REVERSE FOR EXPLANATORY LANGUAGE S��-C(3 Signature of P mittee Date