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HomeMy Public PortalAbout5120 FARAGO AVE_Plumbing__ 7SM67 55 s APPLICATION FOR PLUMBING PERMIT DBS+}.'DIVISION OF BUILDING AND SAFETY Deportment of County Engmeer County of Los Angeles BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY FOR APPLICANT TO ML IN NEAREST CROSS ST OWNER DISTRICT NO GROUP ZONE READY FOR INSPECTION MAIL ,, — I ADDRESS �' V Vi/ I INDUSTRIAL CITY EL NO WASTE APPROVAL PLUMBER / 9--` INSPECTION RECORD ADDRES 6 3 Q CITY �JALQ TEL NO Z LICENSE NO �J 6 --./ f , NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1 00 ly 6i•,�itGt - BATH TUB @ $1 00 r SHOWER @ $100 LAVATORY (WASH BASIN) @ $100 D KITCHEN SINK @ $1 00 DISHWASHER @ $1 00 c LAUNDRY TUB OR TRAY @ $1 00 CLOTHES WASHER @ $1 00 WATER HEATER @ $1 00 d GAS SYSTEM @ $100 APPROVALS G„-mg=v DATE INSPECTOR S SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUMBING GAS PIPING TOTAL FEE C' GAS VENT 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMING PLUMBING FIXTURES D 1 B / I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST L LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTI PRO ERTY SIGNATURE OF PERMITTEE �' =�1L� �J "'I FINAL �J JOHN A LAMBIE COUNTY EIGI EER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR CK M G CASH y 0025OR JM 2 3 A 1000 �' a 76A667 CE617 8 57 • APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER FNEAREST BUILDING AND SAFETY DIVISION JOHN A LAMBIE COUNTY ENGINEER /� el CASSATT D GRIFFIN SUP T OF BUILDING (.C. FOR APPLICANT TO FILL IN r NUMBER FIXTURE OR ITEML%� OWNER WATER CLOSET BATH TUB ADDRESS d2 SHOWER CITY TEL NO 62, le LAVATORY CONTRACTOR 1 SINK ADDRESS DISHWASHER CITY TEL NO LAUNDRYTUB CONTRACTORS STATE REGISTRATION NO COUNTY ❑ CLOTHES WASHER DISTRICT NQ GROUP ZONE READY FOR INSPECTION WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD y ' Or APPROVALS @ $100 PER ITEM DATE INSPECTOR S SIGNATURE OR FIXTURE $ UNDER SLAB WORK ROUGH PLUMBING PERMIT S 1 00 GAS PIPING TOTAL FEE GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST S LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF r CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED / DESCRIBED RESIDENTIAL PROPERTY SIGNATURE FINAL v OF PERMITTEE y 7�� ROBERT A WOOD © TION---, SUPERVISING MECHANICAL ENG R CK M D ASH ' LACO2926OR APR15 3 A 300 M L/ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 1 hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90 76A667A sure,gr a certificate of Workers'Compensation Insurance,or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS-ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS � 09-,9 D department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Ddte Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE / SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS FARM 6 I certify that in the performance of the work for which this per- Q / SINK mit is issued,.l shall not employ any person in any manner so CITU TEL. NO.O� as to become subject to the Workers Compensation Laws. DISHWASHER CONTRACTOR Date Applicant �/ `• �/�� CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS tion,you should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR em p y I P CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER ,J,196P and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB DATE License.Number Lic. Class O FINAL s Contractor Date BY �_t` ea• I am exempt under Sec. 1 B.BP.C. for this reason Plan check fee ► I A -- — Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY tV.(� f3 eft 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 ��S e'• G,/ ri_It13 E—s)0;f 1 .j/y_411`51 Professions Code): Address beAl I, as owner of the property, will do the work and the City .� G� Tel. No. 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 7 C- 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 t is County to enter upon the above-me t' ned propert oc i spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature ot Permittee Date