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Home My Public Portal About5116 FARAGO AVE_Plumbing__ 76A667 CE6}7 6-60 �l G r APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION TADDRESSILDING / JOHN A LAMBIE COUNTY ENGINEER /(d �AQA(TU s WILLIAM A JENSEN SUP T OF BUILDING CALITY C/ t FOR APPLICANT TO FILL IN NEAREST oss 2 i'L NUMBER FIXTURE OR ITEM OWNER �r/ IZCr� i2r9 WATER CLOSET BATH TUB DAD RFSS � �U �/�✓t-/�G�O SHOWER CITY T��P� �� r� TEL No LAVATORY CONTRACTOR SA.��(r► `� y Z�� SINS ADDRESS 'T"7/` `L IJ N � DISHWASHER CITY S ,W�'F� Q t_�'/ TEL No -?-'/'7Y,Y CONTRACTORS STATE [$ LAUNDRY TUB REGISTRATION NO COUNTY CLOTHES WASHER DISTRICT NO GROUP ZONE % SSED BY WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD a O Yw.lz! GC W a yr rA $100 PER ITEM i OR FIXTURE APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2100 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING 1 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 PRO k�tTY UTILITY CO NOTIFIED SIGNATURE�B� V ti i OF PERMITTE �� 111111 FINAL ®P AL0 C ROBERT A WOOD M 0 � SUPERVISING MECHANICAL,ENG R �t -' L� LL � OCT 1 LI 5 D SCJ . .p 4 , 76V67 CE817�12/59 it AP LICATION FOR PLUMBIN PEIRM IT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER cruffigImemp BUILDING AND SAFETY RBnSION BUILDING JOHN A LAMBI COUNTY NGINEER ADDRESS WILLIAM A JENSEN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST ICI U NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL ADDRESS BATH TUB CITY TEL NO SHOWER LAVATORY CONTRACTOR v slNs ADDRESS 13933 So. Crenshaw Blvd CITY Hawthorne TEL NO Os 9-3691 DISHWASHER RACTOR S STATE LAUNDRY TUB REGISTRATION ON NO 168479 C-36 COUNTY CLOTHES WASHER DIICTYO GROUP ZONE PR ESSEDBY WATER HEATER D 4��// 1 J, l7 GAS SYSTEM INDUSTRIAL WASTE APPROVAL ei INSPECTION RECORDP. n /�" / v . L 1e 4/ V �,�.4 veG /l.f 6J/B F ' ::Z U w Q $1 00 PER ITEM I �J OR FIXTURE $ / APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK 'f-Z /,,4J 1l, TOTAL FEE ROUGH PLUMBING d&C .—H GAS PIPING ♦-.07— e " n 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LICATION GAS VENT 1 •( AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ��/ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER A ` "fly, (� 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES t7� � LICENSED AS REQUIRED BY LOS ANGELES CSXNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I M THE LEGAL R OF THE ABOVE DESCRIBED RESIDENTIA OPER UTILITY CO NOTIFIED SIGNATURE r OF PERM--TE FINAL 6 fie- 6 ®r OVALIDATION ROBERT A WOOD cK m O CASH SUPERVISING MECHANICAL ENG R LAAO 3 S 5 0 a JUL ? 5 0 9 co A� r. WORKERS' COMPENSATION DECLARATION 6 DPW 4/87 APPLICATION FOR PLUMBING PERMIT • I hereby, affirm that I have a certificate of.consent to self in- 76A6676A667A sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS 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 NUMBER FIXTURE OR ITEM LOCALITY department. @ FEE �"�GG Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS 5T. le 0,/- COMPENSATION INSURANCE SHOWER OWNER . (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so - CITY TEL. NO. as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If;after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. cation provisions.of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LI . ed. WATER HEATER LICENSE NO. /CLASS LICENSED CONTRACTORS DECLARATION DIST`CTNq..� .� PROCESSED B4 I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETSb 00 ��}}JJe / 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL V LIDATION. fect. DATE License Number' Lic. Class O V FINAL 1'z Contractor Date BY O I am exempt under Sec. V B.&P.C. for this reason Plan check fee, — Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE f SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant. I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and T a i. Profe Bions Code): Address a:7J 7 o•.i I, as owner of the property, will do the work and the City Tel. No. / structure is not intended or offered for sale(Section 7044, i ITEM Business and Professions Code). CONSTRUCTION LENDING AGENCY ► WAL 22 = 50 I hereby affirm that there is a construction lending agency for te 22.50 the.performance of the work for which this permit is issued CHANGE 0011 (5ec..'3097, Civ. C.). Lerider's Name 0001-10 1 11127189 Lender's Address 7008. 1 AM 110 I 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 a horize representatives opi this County to enter upon the ve-me p ert f r inspection urp ses. I, - l �, SEE REVERSE FOR EXPLANATORY LANGUAGE lure of P r 'ttee Date