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Home My Public Portal About5526 ENCINITA AVE_Plumbing__ 76A6¢7A 1 CE 817(RRVt6/78) t - APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) (ADDRESS 5526 EN INI TA NUMBER FIXTURE OR ITEM FEE LOCALITY TEMPLE CITY WATER CLOSET NEAREST BATH TUB CROSS ST SHOWER OWNER FRANS MAIL LAVATORY ADDRESS 55961 ENCINITA AVE- SINK CITY TEMPLE CITY TEL No285-1881 DISHWASHER CONTRACTOR WALNUT POOLS CLOTHES WASHER ADDRESS 21450 GOLDEN SPRINGS DR. SWIMMING POOL RECEPTOR 3 CITYWALNUT TEL N09 i 2- LAWN SPRINKLER SYSTEM TATE LIC WATER HEATER LICENSE NO 319 018 CLASS C-53 GAS SYSTEM OUTLETS _3 APPROVALS DATE INSPECTOR S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING 114-� -l-� 0 GAS VENT u 123 HOT WATER HEATER PLUMBING FIXTURES 9 GAS TEST �Q �- -e IIA Plan Check fee UTILILY CO NOTIFIED PLUMBING PERMIT ISSUING FEE$ TOTAL FEE71 FINALa Plan check applicant PLAN CHECK VALIDATION v Name WALNUT POOLS ' � 12Q6A Address 21450_ GOLDEN SPRINGS DR. 0 0 0 0 0 5 City ALNUT Tel No 912'-1 41 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Z a O 1 300 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION o o o 1 3,0 0 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELESCOUN AND STATE OF CALIF IA OR THAT I AM THE I 1.0 7—78 LEGAL OWNER OF AND INTEND RESIDE IN THE ABO SCRIBED RESIDENTIAL I ,I PROPERTY SIGNATURE OF PERM` EE DISTRI NO JOROCESSED BY So Of INDUSTRIAL WASTE APPROVAL 6WQRKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT _ YQ offir�n that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/811) or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY_ acy No Company Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING S 2— r C�fvtT/� V Certified copy is filed with the county building inspec- ADDRESS ry tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY T'{-.��L �T'J—Y Date Applicant WATER CLOSET 16 10 NEAREST `►�'QC j CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB , b O CROSS ST COMPENSATION INSURANCE OWNER .�'A y{}N r -r�--�, (This section need not be completed if the work involved by rh SHOWER the permit is for one hundred dollars ($100)or less ) LAVATORY MAIL ADDRESS 4-- I certify that in the performarice of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Workers'Compensation Laws �— DISHWASHER CONTRACTOR � Date r pphcant - CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making is ertificate of Exemption you should become subject to the Workers' SWIMMING POOL RECEPTOR CITYTEL NO Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be I STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PRXEEDBY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS !► (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER j/ and Professions Code,and my license is in full force and effect 5 PER SYSTEM 0. DATEL �� 6 VALIDAT N p License Number Lic Class V FIN % = Contractor Date B O F— ❑ LJ I am exempt under Sec C B&P C for this reason H Date Plan check fee 10.PLUMBING PERMIT ISSUING FEE$ U Signature TOTAL FEE Aa 5 Plan check applicant SINGLE FAMILY 22 1 9.7 A HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License # 0 0 0 0 0 5 Law for the following reason (Section 7031 5, Business and Address Professions Code) City Tel No 10 0 4 Q 5 0 qI, as owner of the property, will do the work and the 0 n v structure is not intended or offered for sale Section , 1d 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 1 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-mentionedprop ty fdr inspection purposes ¢ SEE REVERSE FOR EXPLANATORY LANGUAGE U , Signature of Permittee Date