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Home My Public Portal About5746 ENCINITA AVE_Plumbing__ APPLICATION FOR PLUMBING PERMIT 1 OB.S-1]._17 IO-59 DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles + BUILDING j JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN. SUP-TO F BUILDING ♦' LOCALITY FOR APPLICANT TO FILL IN NEAREST _ CROSS ST. OWNER e [WASTEAPPROVAL ST IC NO. GROUP ZONE READY FOR IN51ECTIOM MAIL ADDRESS I V YYY STRIAL CITY TEL. NO. PLUMBER INSPECTION RECORD ADDRESS CITY TEk4. 7 G LICENSE NO. D49 NUMBER TYPE OF eIXTUREPR ITEM FEE WATER CLOSET (TOILET @ 51.00 $ BATH TUB @ $1.00 SHOWER @ S1.00 LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ 51.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ S1.00 O WATER HEATER @ $1.00 GAS SYSTEM @ 51.00 APPROVALS DATE INSPECTORS SIGNATURE UNDER SLAB WORK PERMIT $ 1 OO ROUGH PLUMBING / 2 GAS PIPING TOTAL FEE GAS VENT I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - GAS TEST `. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE gBOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIAL PROPERTY„ sN7� SIGNATURE /�� .N OF PERMITTEE/ FINAL JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR <K. IS.0. CASH f 0281NSR17 3 2.00 m WORKERS"COMPENSATION DECLARATION APPLICATION FOR PL AL1A I�IIaAr14 PERRA67 I hereby affirm thatrl 'have a certificate of consent to self 76A667A - FOR PLUMBING��1`L� u I�N'IOHC insure, ar a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY 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- tion department. NUMBER FIXTURE OR ITEM -FEE LOCALITY Date ` Date ��Z VApplicaaI �j�-f-��`^'"1� WATER CLOSET 0 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL � the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS -'/ t 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER 7 Q/ CONTRACTOR Dote J l Z 94 Applicant CLOTHES WASHER ' NOTICE TO APPLICANT: If, after mating This Certificate of ADDRESS7 Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. 9 / with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM b p y p p STATE "Y/ Z CLASS deemed revoked. WATER HEATER LICENSE NO. -Z 9 LICENSED CONTRACTORS DECLARATION DISTRICT NO. E SED BY I hereby offiim that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �` (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER ✓ (� } and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VA ATION 6 AT 0 License Number � ZUc. Class /,f Z V FIN � Contractor Date J Z 6 Y BY O N V �y I am exempt under Sec W0. B.BP.C. for this reason N DatePlan check fee > ? Signature—_ l / pLUM81NG PERMIT ISSUING FEE$ ;E 4 2 1.4 A —� TOTAL FEE SV # o o a o 0.5 Plan check applicant ( o 0 2 8 5 O SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name o a o 213500 I hereby affirm that I am exempt from the Coi -ca 's License Address Law for the following reason (Section 7031.5, Business and 0 3 1 2-8 6 Professions Code): City Tel. No. ❑ 1, 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 Thai 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 ame Lender's Address I certify that I have read this application and state that the D above information is correct. I agree to comply with all County ordinances and State lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- ion d pro ty for coon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date