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Home My Public Portal About5423 ENCINITA AVE_Plumbing__ r 76A667 CE#817 2 62 cr VI� APPLICATION FOR PLUMBING PERM COUNTY OF LOS ANGELES ; DEPARTMENT OFCOUNTY ENGINEER BUILDING BUILDING ANDD SAFETY DIVISION ADDRESS / JOHN A LAMBIE COUNTY ENGINEER WILLIAM A JENSEN SUP T of BUILDING LOCALITY rvj J'J t FOR APPLICANT TO FILL IN ROSS ST Ldi4 NUMBER FIXTURE OR ITEM EACH FEE OWNER 4 WATER CLOSET $1 25 (�3 �_ (IC1,A/ MAIL � 7- ` r '-ADDRESS�T BATH TUB 1 25 / cJ i CITY TEL NO SHOWER 1 25 LAVATORY 125 O CONTRACTOR ec:5 6 Q 4A4 � / SINK 1 25 ADDRESS XZ 10 v S a , DISHWASHER 125 CITY (,/N�y TEL NOD Q r .CONTRACTOR'S �? `' // / STATE LAUNDRY fUB 1 25 REGISTRATION NO oS V b to Ip COUNTY ❑ CLOTHES WASHER 125 DISTRICT NO G Z R BY WATER HEATER 150 ` Q GAS SYSTEM OUTLETS 1so O INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM 30 /INSPECTION RECORD d APPROVALSj' DATE INSPECTOR,5 SIGNATURE P_ERMIT $ 2 CC UNDER SLAB WORK ROUGH PLUMBING MIT If A7 I f;7j✓ 4, TOTAL FEE 3 GAS PIPING 75— I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATE42—_ PLUMBING /ml,1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBYNG FIXTURES 'V I /'/�l LICEN SED AS ETOHATED BY II AM HES LEGALES OWNERNTY AND STATE OF AND INTEND TOO GAS TEST i1 X` IqN/I f} CALIFORNIA ORti RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPER T UTILITY CO NOTIFIED SIGNATURE OF PERM ITTE ��---[[[��--^ FINAL Vw,l /11 1,) /AAJIL)L VALIDATION R d BERT A W[1,OOD_ v CK M o CASH SUPERVISING KlECHANICAL ENG R Lilo 8 U 9 b w DEC 7 5 0 1 3.75— WORKER'S COMPENSATION DECLARATION 26DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A6 I hereby affirm that I have a certificate of consent to self insure, 76A667A or a certificate of Worker's Compensation Insurance, or a certified copy there�foffec.3800 Lab. C.) Policy No.' qS 110A0Company D� Fs 1. 4 r�)�OUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑ Certified copy is hereby furnished. [f n �+ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGADDRESS department. 3 Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM Q FEE f LOCALITY Date Zd 1 Appliran - �t- WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. v COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) LAVATORY lA.OWNER J 1 n f_ t 0Lt_1,_ „ X- I certify that in the performance of the work for which this permit MAIL1 is issued, I shall not employ any person in any manner so as to SINK ADDRESS C-- � become subject to the Workers' Compensation Laws. n DISWASHER CITY'�f AIR �i TEL.NO. ze& -013 Date Applicant CLOTHES WASHER CONTRAtCfT�O`R A NOTICE TO APPLICANT: If, after making this Certificate of V�(.c V f� e,ilu 'r-7 Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM `-/- LICENSED CONTRACTORS DECLARATION _ CITY Niue(iue( ,Ck TEL.NO.^�i3(Fi^1tL(DS WATER HEATER l�L D 'yam I hereby affirm that I am licensed under provisions of Chapter 9 �+ _'_"F_• Yw=_� CLASS STATE 2 C)L� 2 (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. I l� �J�..�,.., (� Professions Code,and my license is in full force and effect. - OUTLETS OVER DISTRICT NO. �p�APsROOCCESSSSED BY' 5 PER SYSTEM License Number J 9 I Lic.Class C 6(p JJl ' ( MFINALVAtIC�DATE ' ;..{ bTION�>•> CO> Contractor(_'�lt "'I V l tl�r r` u Date ❑ FINAL I am exempt under Sec. BY B.&P.C.for this reasonI'_I; Plan check fee - - �t �? Date: , _==}_ 1 ri€ 9� d. Signature Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address Code): City Tel. No. 1 ElI, 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 above-mentioned property for insion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �_t�.s�.e�Q Signature of Permittee Date