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Home My Public Portal About5023 FARAGO AVE_Plumbing__ 76A667 CE617 12159 TEEtl1l%nr"-*h Em CITY APPLICATION FOR PLUMBING PERMIT � COUNTY OF LOS ANGELES DEPARTMENT ONG F COUNTY ENGINEER BJOLHN DIAGLAMBIE GFOEUNTY ETY NG NE�ERN ADDRESS O WILLIAM A JENSEN SUPT OF BUILDING LOC FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL TUB ADDRESS RATH / NO � oZ SHOWER CONTRA OR LAVATORY SINK ADDRESS DISHWASHER CITY NO CONTRACTOR S STATE ❑ LAUNDRY TUB REGISTRATION X0 COUNTY ❑ CLOTHES WASHER DISTRI/yCT NO GROUP ZONE OCESSED BY WATER HEATER L/ GAS SYSTNI INDUSTRIAL WASTE APPROVAL INSPECTION RECORD V r P4 0 F U W a N z 0 11 OR DOPER ITUBE $ ( ` APPROVALS DATE INSPECTOR S SIGNATURE PERMIT 2 00 UNDER SLAB WORK /® TOTAL FEE ROUGH PLUMBING GAS PIPING 1 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 PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERM ITTE FINAL ®r VALIDATIOkl,---,,ROBERT A WOOD Cs M O ( CASH SUPERVISING MECHANICAL ENG R L,(,o4956- DEC 20 5 D 300 76A60 CE817 12/59 APPLICATION FOR PL BING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGMEER RmLDzrrG B oIHDNIIAiG MBIE�cnTiTYYNG ISdeOERr ADDRESS X03 QvQ O WILLIAM A JENSEN SUPT OF BUILDING LOCALITY Q/ FOR APPLICANT TO FIM IN CR T NUMBER FIXTURE OR ITEM OWNER Q `r WATER CLOSET NAL RATS TUB ADDRESS CITY TEL NO SHOWER LAVATORY CONTRACTOR / Snm ADDRESS 13933 So Crenshaw Blvd , DISHWASHER CITY dawt ao me TEL NO Os 9-3691 CONTRACTOR S ATE LAUNDRY TUR REGISTRATION NO 193617 C-36 COUNTY ❑ CLOTHES WASHER DISTR�It� GRO ZONE ED B r WATER HEATER C! r / GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPE TION RECORD w ! 0 s 04-f �,t'�'A o �, 0 al Imo. . � a ul ii 51 W PER ITEMI A OR FI=RE ; / APPROVALS DAVE / INSPECTOR S SIGNATURE PERMIT S 2100 UNDER SLAB WORK O 011g16� ,,/,I TOTAL FEE ROUGH PLUMBING1-1 GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THi8 PLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE iO CONPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER gg I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES -111AVIZ, LICENSED SREQUIRED BY LCOUNTY AND CALIFORNIA ORTHAT I AMTHE LEqkL LEL OWNER OF THE AABOVE GAS TEST DESCRIBED RESIDENTIAL PROPS Jf UTILITY CO NOTIFIED Al SIGNATURE ol OF PERMITTE FINAL ®F VALMATION ROBERTA' WOOD M 0 crsx SUPERVISING MECHANICAL ENG R WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 1 hereby affirm that I have a certificate of consent to self 76A667A insure or a certificate of Workers Compensation Insurance CE 817(REV 10/81) or a certified copy thereofSec 3800a C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy NoCompany Certified copy is hereby furnished BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspe ADDRESS tion department NUMBER FIXTURE OR ITEM (off FEE LOCALITY Date Applican WATER CLOSET � NEAREST ERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER Are the permit is for one hundred dollars($100)or less) MAIL LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner SINK CITY TEL N f so as to become subject to the Workers Compensation Laws DISHWASHER CONTRA Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If after making this Certificate of ADDRESS Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM CITY TEL NO with comply with such provisions or this permit shall be STALE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PRO E BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS I- - 't with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL d ( VALIDA ON � DATE[ V License Numbeic A/ ad Fl Q Contractor Date e B V ❑ W I am exempt under Sec y B 8P C for this reason ► Z Plan check fee /�� D PLUMBING PERMIT ISSUING FEE$ Signatuo �s o'er —. — 6" —1�K) TOTAL FEE 6 Plan check applicant SINGLE FAMILY HOME OWNER BUILDER DECLARATION Name R 3 7 0 0 A I hereby affirm that I am exempt from the Contractor s License Address Law for the following reason (Section 7031 5 Business and # s o 0 0 0 5 Professions Code) City Tel No ' 0 0 5 0 ❑ I as owner of the property will do the work and the structure is not intended or offered for sale (Section , 0 0 01 65070- 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY 0 1 09-86 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 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 jaws regulating Plumbing and hereby authorize representatives of this ounty to enter upon the above menti rop or spection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date