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Home My Public Portal About5237 FARAGO AVE_Plumbing__ ION DEC WORKER'S I have a certificate of cLARATI to 76A666DPW 9/89 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. Polioy 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 department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY 0 Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. �i PACE COMPENSATION INSURANCE ASSEMAP SSOK PAG�O (This section need not be completed if the work involved by the SHOWER permit is for one hundred dollars($100)or less.) OWNER LAVATORY !� I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as toSINK MAIL ell become subject to the Workers'Compensation Laws. ADDRESS _( /C / DISWASHER CITY TEL.NO. /�/yM/�//�Jj/�� Date / Applicant�VIfl J�/`��/ CLOTHES WASHER NOTICE TO APPLICANT: If, aftef making this Certificate of CONTRACTORAZAI d) r Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR �/ provisions of the Labor Code, you must forthwith comply with such ADDRESS + �� provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITYTEL.NO / > I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER V @. (commencing with Section 7000) of Division 3 of the Business and STATE LIC. Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. CLASS (� OUTLETS OVER DISTRICT O. PROCE D BY V;� 7 3 Lic5 PER SYSTEM A (} License Number .Class�� D �. FINAL DATE _ t VaIDATION Contractor/ Date F-1 FINAL. ACC€ 'vs _� I am exempt under Sec. By BAP.C.for this reason Plan check fee , i ITEM Date: Signature PLUMBING PERMIT ISSUING FEE$ �sI I - } ❑ TOTAL FEE y.[.WD SINGLE FAMILY Plan check applicant '-_HF1NGE e 010 , 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 E r( j j f + 193 Code): �1 I00-100 1 Ji t! 7•:r ❑ City Tel. No. 86,15tli a c 1 I, as owner of the property,will do the work and the structure l I 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 representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKER'S COMPENSATION DECLARATION 6DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A66 - I hereby-affirm that I have a certificate of consent to self insure, 76A667A or a certificate of Wgrker's Compensation Insurance, or a cert' 'ed coPy thereof00 Lab.C - r COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No ny ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certifie copy is filed-(tth the county bui g i pection ADDRESS n / 'AMBER FIXTURE OR ITEM @ FEE LOCALITY � Date ApplicantWATER CLOSET NEAREST 6� CROSS ST. CERTIFICATE OF EXEMPTION OM WORKERS' BATH TUB 2C' COMPENSATION INSURANCE ASSESSOR / (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL 4 s� ,pr — permit is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY MAIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS become subject to the Workers'Compensation Laws. �_� DISWASHER ,� CITY TEL.NO. Date Applicant CLOTHES WASHER 9' SJ CONTRACTQRR�//f NOTICE TO APPLICANT: If, after making this Certificate of �s�V Exemption,you should become subject to the Workers' Compensation SWIMMING POOL RECEPTOR �/ provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITYTEL. (:A I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STA E� (commencing with Section 7000) of Division 3 of the Business and ( �`� LICENSE NO. , �CILASS —� Professions Code,and my license is in full force and effect. GAS SYSTEM J OUTLETS J (c OUTLETS OVER DISTRICT NO. q OC SED BYcc � 5 PER SYS T 06 License Numb Lic.Clas - 29 l v vv / FDATEINAL r V I TION CL Contractor/v� Date CO) ❑ FINAL Z I am exempt under Sec. BY B.&P.C.for this reason Plan check fee , Date: Signature PLUMBING PERMIT ISSUING FEE$ 4-q "ZS ❑ TOTAL FEEZ-5-71 5 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 fir•?"'; Code): _ . ... City Tel. No. ElI, 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 pp 1 and state that the above , :. `�:• ,,, iS »� information is correct. agre c ly with all County ordinances and State laws r ul ng mbmg, and hereby authorize represents' s s Cou y o enter up n e abo e-mentioned pr per tion pu o s. 9��,y�/� SEE REVERSE FOR EXPLANATORY LANGUAGE Sign lure of Allifermittee Date