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Home My Public Portal About5111 FARAGO AVE_Plumbing__ ION y _ Vm that I'have a certificate of consent to 76A626DPW9/89 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 c 3800 b. .) /� /e i- OUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT: OF PUBLIC WORKS DIV. Policy No/ ompany Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRES �� do- Certified copy is filed with the county building insl5 io Zpartment. U NUMBER FIXTURE OR ITEM Q FEE LOCALITY C Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WO RS' BATH TUB CROSS ST. 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($100)or less.) OWNER ` LAVATORY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as toSINK ADDRESS MAIL ! become subject to the Workers'Compensation Laws. 1� i - DISWASHER CITY Date Applicant CLOTHES WASHER CONTRACTOR / 1 vv NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY - NO. I hereby affirm that I am licensed under provisions of Chapter 9 ! WATER HEATER J d (commencing with Section 7000) of Division 3 of the Business and STATE LIC. o Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. �� CLASS 0 OUTLETS OVER DISTRICT NO. PROCESSED BY (c 5 PER SYSTEM �Q O License Number � Lic.Class ti � f � ?1 � O f' •J FINAL U ��0- DATE J�j f q VALIDATION a Contractor ate CD El I am exempt under Sec. FINAL Z' BY B.&P.C.for this reason & Plan check fee Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE Plan check applicant SINGLE FAMILY 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): F1 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.) "I_ - _ Lender's Name w,1 l - F J. 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 �g2�ffi"o enter upon the above-mentioned property for inspe'�n urp se l SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ure of PermitteDate 4) } WORKER'S COMPENSATION DECLARATION 6DPW9/89 APPLICATION FOR PLUMBING PERMIT 76A66 I hereby affirm that I have a certificate of consent to self insure, 76A667A 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. BUILDING r El ADDRESS APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS I F�,/� O Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY Tem !e Date Applicant WATER CLOSET NEAREST / C_A CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK I PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER I G, �s I certify that in the performance of the work for which this permit LAVATORY doa is issued, I shall not employ any person in any manner so as to MAIL SINK ADDRESS/24-4�YQy�+� `lfl�VG' e Date Applicant become subject to the Workers'Compensation Laws. ^ CLOTHES WASHER CONTRACTOR DISWASHER CITY Bu!/ s,J L 6 J� TEL.N021 „34 7U` c NOTICE TO APPLICANT: If, after making this Certificate of -L0-i'` Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such IADDRESS /Zs �Y�tK C✓f�fld �2 provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM ` 6 / LICENSED CONTRACTORS DECLARATION CITY JUaIA � /1 01_ TEL.1\10213-304_7-0) >_I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER �x 101- (commencing 01(commencing with Section 7000) of Division 3 of the Business and STATE LIC. O Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. N CLASS V/'1Jn U OUTLETS OVER DISTRICT NO. PROCESSED BY Q 5 PER SYSTEM License Number Lic.Class �� " `ate FINAL DATE , —R VALIDATION LL1 d Contractor Date U) ❑ I am exempt under Sec. FINBY Z B.&P.C.for this reason 3303 `= Plan check fee Date: 0. 1 ITEMS Signature PLUMBING PERMIT ISSUING FEE$ TOTAL 41 - 852 ❑ TOTAL FEE � . Plan check applicant CHECK SINGLE FAMILY i-0 HOME OWNER-BUILDER DECLARATION Name ` I hereby affirm that I am exempt from the Contractor's License Law I-[i: for the following reason (Section 7031.5, Business and Professions Address /ZS- dr6c.t e GwbVe Code): City SDu;/t ,{6Ze�e,t�t Tel. NoZl3-3410-7&? li�lli1 if+Jf.1 r:�_: ElI, as owner of the property,will do the work and the structure 0944 1ttl l g 1 i 6 i� is not intended or offered for sale (Section 7044, Business tt 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 I s regulating Plumbing, and hereby authorize representativ s of this County to enter upon the above-mentioned property fort, 1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perettfee Date