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Home My Public Portal About6333 ENCINITA AVE_Plumbing__ � pp i� PLUMBING p pp/� I�2 pp �Vcirm that I have a certificate of corse APPLICATION FOR Ir ILU{,{a BIII G Ir ICRMIT ,J'( firm that I have a <ertif icate of consent to self 20-0(126 DPW 6/87 u IL sou '1u t certificate of Workers' Compensation Insurance, 76AG67A copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Po Company ❑ art, d copy is hereby(urnis'•oed. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ?• �[ Certified copy is filed with the county building inspec- ADDRESS J J`^ tion deportment. NUMBER FIXTURE OR ITEM @ FEE n LOCALITY 7^ Date!T�Applicant WATER CLOSET v NEAREST CERTIFICATE OF EXEMPTION ROM 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 ($100)or less.) LAVATORY D ADDRESS I certify that in the performance of the work for which this - permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. - DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE �� '7 LIC. deemed revoked. WATER HEATER LICENSE NO. 7 CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROC E5S5 DBV I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 5 �f/(V�(L�� (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER _ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM q �= / FINAL 1(/ ' / VALIDATION O License Number—2--t?C )76 Lic. Class DATEU. FBINA Contractor1'4Date 00 ❑ 1 am exempt un4r Sec. U B.BP.C. for this reason Plan check fee D N. Dote: 0 z PLUMBING PERMIT ISSUING FEE$ In Signature TOTAL FEE � . Plan check applicant SINGLE FAMILY' 3307 73.50 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License 1 ITEMS Low for the following reason (Section 7031.5, Business and Address Professions Code): City Tel. No. TOTAL 237 s 10 ❑ I, as owner of the property, will do the work and the CHECK. 289.50 structure is not intended or offered for sale (Section D 7044, Business and Professions Code). CHANGE .00 CONSTRUCTION LENDING AGENCY I hereby affirm that there is o construction lending agency for r�1 the performance of the work for which this permit is issued CIOCIO-CIUO1 8/24/35' (Sec. 3097, Civ. C.). 5300 1 PM 2:44 Lender's Name 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 St 'e laws regulating Plumbing, and hereby autho4ze s n'a'ives of this County to enter upon the - ab property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P rmieee Datrf ' WORKERS'COMPENSATION DECLARATION Ihetiby affirm that I have a certificate of consent to self 76A661q APPLICATION F0 PLUMBING PERMIT - insure, or a certificate of Workers' Compensation Insurance, CE 817 (REV. 10/81) or a certifiedd copy thereof (Sec. 3800,�. C.) •� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. (_ Y_%?� 3Company J 'M Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS YJ G�VC. fir/ tion department. NUMBER NUMBER FIXTURE OR ITEM f 1� EE/� � © LOCALITY DateAppl iSani ^� V�£�--✓SC .��, WATER CLOSET NEAREST , CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. - AfiQJ COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by ,s the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this �7 permit is issued, I shall not employ any person in any manner SINK CITY? I TEL. NGZCOF(O/— so as to become subject to the Workers Compensation Laws. DISHWASHER •7 CONTRACTOR UU 4i Dote Applicant CLOTHES WASHER NOTICE TO APPLICANT: if, after making this Certificate of ADDRESS 85' .�^ Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- - CITY A TEL. NO. I LAWN SPRINKLER SYSTEM .. with comply with such provisions or this permit shall be STATEq LIC. p deemed revoked WATER HEATER LICENSE NO. a 7 / CLASS J LICENSED CONTRACTORS DECLARATION DISTRICT NO. P ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER �• and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION C' DATE Z O License Number 13AI Lic. Class 0-- 36 V ��K •7 �� / FINAL V9 Contractor� P�Hr�tesKs�"'Dare BY �/ 0 ❑ '�I am exempt under Sec � B.BP.C. for this reason H Plan check fee Z Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE /& Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Nome 2 5 6 A I hereby affirm that I am exempt from the Contractor's License Address Low for the fallowing reason (Section 7031.5, Business and e e s e o 5 Professions Code): City Tel. No. t r ❑ I, as owner of the property, will do the work and the 'Z e e 1650 structure is not intended or offered for sale (Section D o e o 1 6 5 U0 x 7044, Business and Professions Code). , CONSTRUCTION LENDING AGENCY R0 6—e 4 1 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 Nome 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 laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-m ntio property for i pe ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee 7 Dote