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Home My Public Portal About5107 FARAGO AVE_Plumbing__ ION that I have a certificate of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT • • 76A667A I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(S 00 ab. C.) / �OUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Polim cy No/ Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING r® I, r#' Certified copy is filed with the county buildd'p ec ADDRESS U Ioit 4dart ent#ATE NUMBER FIXTURE OR ITEM © FEE LOCALITY ") f Dateplicant WATER CLOSET NEAREST CERTIFI EXEMPTION FROM WORKER j'� CROSS ST. I BATH TUB COMPENSATION INSURANCE / • /0 ASSESSOR (This section need not be completed if the work involved by the ISHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER LAVATORY v I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to SINK MAIL become subject to the Workers'Compensation Laws. , ADDRESS DISWASHER CITY �f4Lrn0� Date Applicant CLOTHES WASHER r CONTRACTOR vv JJ NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION `I' CITY TEL.N > I hereby'affirm that I am licensed under provisions of Chapter 9 WATER HEATER /4- 0. (commencing with Section 7000) of Division 3 of the Business and STATE LIC. 0 Professions Code,and Section license is in full force and effect. GAS SYSTEM OUTLETS ` LICENSE NO. l CLASS OUTLETS OVER DISTRICT NO. PROCESSED BY X r �✓//_ 5 PER SYSTEM? ) �D f! License Number Lic.Class FINAL r DATE g3 VALIDATION Q� � Contractor ate CO) FINAL I am exempt under Sec. BY B.&P.C.for this reason Plan check fee , Date: SignatuPLUMBING PERMIT ISSUING FEE$ LWZ re _ ❑ TOTAL FEE r SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address Code): El 1, Tel. No. I,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 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 M Y 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 QIthi n to enter upon the above-mentioned property for i n pur os /�/ SEE REVERSE FOR EXPLANATORY LANGUAGE i nature 0 f-Per ee Date ION " WORKER'S I have a certificate of consent to 76A666IPW 9/89 APPLICATION FOR PLUMBING PERMIT 11 76A667A I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab. C.) Policy No. Company COUNTY OF LOS ANGELES DEPT.'OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING El5 J{ ®� u r Y� Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM Qo FEE LOCALITY DateApplicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. Vyd Av,44- COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER �rn CA— I [`t I certify that in the performance of the work for which this permit LAVATMAIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS 1 ZS rGH �Y ve �/�, become subject to the Workers'Compensation Laws. ,�J DISWASHER CITY $Otrl /G SQ� .0 TEL.NO.26_ 5� —7vl Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRES &e - LICENSED or this permit shall be deemed revoked. 2 LAWN SPRINKLER SYSTEM /S`25• Or N C7Y�Wa Iry LICENSED CONTRACTORS DECLARATION CITYS 1 TEL.NO. 1 hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER �7 �JC s.JG�1� 21 '3 � Q (commencing with Section 7000) of Division 3 of the Business and STATE LIC. Q� , O Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. q lA CLASS 1Z OUTLETS OVER DISTRICT NO. PROCESSED BY a: 5 PER SYSTEM O P 0 License Number Lic.Class V FINAL l® `/` AFALIDATION a DATE Contractor Date s ❑ FINAL fit'i co I am exempt under Sec. BYC B.&P.C.for this reason 3 .i Date: Plan check fee , 1 I 4 EIM3 Signature PLUMBING PERMIT ISSUING FEE$ -/0 Ii_ITAL 57 ® 30 ❑ TOTAL FEE Lf�zl CHECK K r7 SINGLE FAMILY Plan check applicant �k vv�G✓S oa.Vl CHANGE HOME OWNER-BUILDER DECLARATION Name - - I hereby affirm that I am exempt from the Contractor's License Law q for the following reason (Section 7031.5, Business and Professions Address1zs gr4, 6 66 ie Ave✓ 0rill 0--0001 Code): ❑ City SJW44104 4deti 4- Tel.No.213-344-7,017 094'6 1 AM 411;1 I, 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 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 represe atives of this County to enter upon the above-mentioned propert for inspection pur osq es. SEE REVERSE FOR EXPLANATORY LANGUAGE 7 ZGL-71 ignature of rmittee ate