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Home My Public Portal About5113 FARAGO AVE_Plumbing__ ION DECLARATI fNm 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(Sec.3800 Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / Certified copy is filed with the county building inspection ADDRESS Sl13 O e- ❑ department. NUMBER FIXTURE OR ITEM © FEE LOCALITY Te Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. 44- ASSESSOR COMPENSATION INSURANCE MAP BOOK PAGE PARCEL ,(This section need not be completed if the work involved by the SHOWER permit is for one hundred dollars($100)or less.) OWNER *' 14 LAVATORY ON'rdj Nt7 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as toMAIL //� y become subject to the Workers' Compensation Laws. SINK ADDRESS J2� PrA" e. `� �Ve . e— DISWASHER CITYu / fQ�Eaa- TEL.NOeq y�Z Date Applicant CLOTHES WASHER A (• NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR 67W Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 2S' i' ,-Od2 Afy 0- provisions or this permit shall be deemed revoked. a LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. �- I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER �Ou� ��' -Y �j �7d1 (commencing with Section 7000 of Division 3 of the Business and STATE i� LIC. ( 9 ) LICENSE NO. T/ CLASS Q Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS OUTLETS OVER DISTRICT NO. [B PROCESSED BY cc 5 PER SYSTEM 'C/�f �/ _� License Number Lic.Class G-mG�� FINAL DATE ' VALIDATION CL. Contractor Date r co EJFINAL r•r Z I am exempt under Sec. BY ; �•i ° B.&P.C.for this reason Plan check fee "��'°• Date: ' I r-¢i= -; Signature PLUMBING PERMIT ISSUING FEE$ 0 U; i- � �� ❑ TOTAL FEE AL A%- - Plan check applicant CHECK Y 1.=° -' SINGLE FAMILY /I t HOME OWNER-BUILDER DECLARATION Name Thom- 5 kO a i•YIi�NGE °(11 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address/ZS� ��•,; �jv�t/�' Code): 1 R—_7 r- ❑ city Sp J"q SRieq 2. Tel. No.2 t 3 o/L �jif :-s E l 7 i l.�6 9 I,as owner of the property,will do the work and the structure AM! °, . is not intended or offered for sale (Section 7044, Business 13943 1 i:.EM!I fl_) and Professions Code). , CONSTRUCTION LENDING AGENCY 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 representat es of this County to enter upon the above-mentioned property fo inspection purposes. z SEE REVERSE FOR EXPLANATORY LANGUAGE X 7/Z� Signature of Pe tee Date ION WbFLKER'SCOMPENSATate 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 thereoXS3 Policy No. La �OUNTY 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 `` .7 (,_�t'/I Certified copy is filed with the county building inspe n ADDRESS f` p rtment. ~- NU ER FIXTURE OR ITEM @ FEE LOCALITY t Date plican WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKER � BATH TUB GROSS ST. ASSESSOR COMPENSATION INSURANCE (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) r OWNER I certify that in the performance of the work for which this permit LAVATORY71 1'JAZ 9 is issued, I shall not employ any person in any manner so as to SINK MAIL become subject to the Workers' Compensation Laws. �u11 ADDRESS DISWASHER �+ CITY %'� / L. t t Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, of making this Certificate of I 'Exemption,you should becom ject to the Workers'Compensation SWIMMING POOL RECEPTOR c �.- provisions of the Labor C e, you must forthwith comply with such ADDRESS provisions or this per shall be deemed revoked. LAWN SPRINKLER SYSTEM LIC ED CONTRACTORS DECLARATION CITY N >• WATER HEATER IL I hereby affirm hat I am licensed under provisions of Chapter 9 STATE (commencing with Section of Division 3 of the Business and GAS SYSTEM ,'''OUTLETS LICENSE NO. / CLASS Professions Code, and my license is in full force and effect. � OUTLETS OVER DISTRICT NO. PROCESSED BY 5 PER SYSTEM License Number r Lic.Class FINAL VALIDATION u�1 Contractor M � co a DATE �si r. A•_ /l'�` � ❑ 1 am exempt under Sec. BYINAL B.&P.C.for this reason Plan check fee , ® PLUMBING PERMIT ISSUING FEE$ Signature ❑ TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Lawq. for the following reason (Section 7031.5, Business and Professions Addressi•'. ;,.., Jl - t3'i Code): ❑ M, ,. _» I,as owner of the property,will do the work and the structure City Tel. No. �� is not intended or offered for sale (Section 7044, Business and Professions Code). , CONSTRUCTION LENDING AGENCY 'I`' ''mo '••`»' -• + c••' I hereby affirm that there is a construction lending agency for the i 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 tt is C y to nter upon the above-mentioned propertyfor ipEfiort urpq SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of Permit I tab Date