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HomeMy Public PortalAbout5101 - 5107 FARAGO AVE_Plumbing__ 7�, 67�� 817 1REV.6/78) ©S �i�LLLbbb APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AN SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE), BUILDING � jD NUMBER FIXTURE OR ITEM ADDRESS / FEE LOCALITY �i WATER CLOSET NEAREST 1/� BATH TUB CROSS ST. SHOWER OWNER 'DU-j.S-r �'!lG `El- MAIL �' LAVATORY ADDRESS J SINK CIT C�� /7-P TEL.NO `Y�4 DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS 9 SWIMMING POOL RECEPTOR CITY b) �"' TEL.NO. LAWN SPRINKLER SYSTEM STATE (^ CLASS WATER HEATER � � LICENSE NO. J GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT d HOT WATER HEATER O PLUMBING FIXTURES GAS TEST Plan check fee UTILITY CO.NOTIFIED QQ CLQ PLUMBING PERMIT ISSUING FEE$ ! o FINAL 6F' . i TOTAL FEE ! �� �� Plan check applicant PLAN CHECK VALIDATION � Nome6r "�� Address City Tel.No. �` IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES �D � '" - "' �'"r ��'�' �:� C Q O AND STATE LAWS REGULATING PLUMBING. C,PERM �GVjALIQ�F(,�`Tl0 Qq��' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS o/!� ^ al p� � Z O c, i Q O O REOU IR ED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE w LEGAL OWNER OF,AN INTEND TO RESIDE IN THE ABOVE SCRIBED RESIDENTIAL - PROPERTY. ' O O C i Q 0 0 SIGNATURE L+,2 15 7 9 OF PERM ITTE DISTRICT NO. PROCESSED INDUSTRIAL WASTE APPROVAL WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT thereby, 76A66 affirm that I have a certificate of consent to self in- 6 DPW a/87 6A667A sure,ora certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) tertified copy thereof.(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Fj Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING � Certified copy is filed with the county building inspection ADDRESS a/B!'"Dc'S 1/14&A&9 /1A9 department. NUMBER FIXTURE OR ITEM @ FEE n LOCALITY "TL�)a,/.c& Date Applicant (qI�. WATER CLOSET(TOILET) NEAREST v CERTIFICATE OF EXEMPTION FROM WORKER BATH TUB 2"! " CROSS ST. COMPENSATION INSURANCE SHOWER ! OWNER bio (This section need not be completed if the work involved by MAIL � �J7 the permit,is for one hundred dollars ($100)or less.) LAVATORY L4 1ADDRESS �,(�`� ( J &&A.)1) 5 I certify that in the performance of the work for which this per- �fJ SINK mit is issued, I shall not employ any person in any manner so , N CITY �lJ/i TEL. NO.� - ' ! c as to become subject to the Workers'Compensation Laws. 2� DISHWASHER CONTRACTOR g �/ .�/ Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS- SWIMMING DDRESSSWIMMING POOL RECEPTOR zV17 emption, you should become subject to the Workers'Compen- c� CITY -& ,/�_ TEL. NO. - sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM K'L /�- ly with such provisions or this permit shall be deemed revok- STATE LIC. -ed. WATER HEATER ® LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION 1 DISTRICT NO. P CESSED BY I hereby affirm that I am licensed under provisions of Chapter, GAS SYSTEM OUTLETS (� a O 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALI e1ON DAT C License Number Lic. Class U Contractor Date Y O ElI am exempt under Sec. UJ B.&P.C. for this reason poll. g Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ -831.3 A Signature TOTAL FEE # o o o o o 5 SINGLE FAMILY ' HOME OWNER-BUILDER DECLARATION Plan.check applicant I hereby affirm that I am exempt from the Contractor's License Name ( o 1 7 R 5 0 Law for the following reason (Section 7031.5, Business and 78,503. Professions.Code): Address o 0 J9I, as owner of the property, will do the work and•the. City Tel. No. I 1 Ob :87 __1as 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 lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the above,Tentioned property for inspection purposes. Lk4 U Kzke, jA7 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dote WORKERS'COMPENSATION DECLARATION20-0026 APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a-certificate of consent to self in- 76A667A PW 4/87 Lure, or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) �Uf certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING L5/05 ����� Certified copy is filed with the county building inspection ADDRESS —07 depart ent. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant NEAREST �(! WATER CLOSET(TOILET) 6 � CERTIFICATE OF EXEMPTION FROM WORKER BATH TUB O CROSS ST. COMPENSATION INSURANCE 0 0 SHOWER OWNER ,f C— — (This section need not be completed if the work involved by MAIL ` ,ysv�� �/ s� �q the'permit is for one hundred dollar's ($100)or less.) LAVATORY ADDRESS 64917 A-k6*Ln4)b I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so SINK. CITY �� TEL. NO.3S,5 as to become subject to the Workers' Compensation Laws. 7i DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER �� j y > NOTICE TO APPLICANT: If, after making this Certificate of'Ex- ADDRESS ! emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR CITY .�/ TEL. NO.%{ sation provisions'of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM `'/PWSx) 3S� ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. � WATER HEATER /j LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION V DISTRICT Nq PR CESSED B I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS Ui( 9(commencing with Section 7000)of Division 3 of the Business. OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM �o VA ATION fect. DAT FINAL License Number Lic. Class U F Contractor Datev'e, O I am exempt under Sec. V UJ B.&P.C. for this reason Plan check fee g Date: PLUMBING PERMIT ISSUING FEE $ Signature 2831.2 A TOTAL FEE • SINGLE FAMILY plan check applicant # o 0 0 o o 5 HOME OWNER-BUILDER DECLARATION pp I hereby affirm that I am exempt from the Contractor's LicenseName ( 0 1 7 a 5 0 Law for the following reason (Section 7031.5, Business and o 01 7 5 0= Professions Code): Address v �1, as owner of the property, will do the work and the City Tel. No. 1 0 b-B. 7 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 inspection purpose . SEE REVERSE FOR EXPLANATORY LANGUAGE 17If 7 Signature of Permit a Date