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HomeMy Public PortalAbout5326 FARAGO AVE_Plumbing__ E 817) 5/73 APPLICATION F PLU IT PERMIT IIC71,J7�II1' COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 4j1Z7 (� (� MAKE CHECKS PAYABLE TO "ADDRESS J� 11�11� HARVEY T BRANDT COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST NUMBER FIXTURE OR ITEM @ FEECROSS ST OWNER 4 WATER CLOSET 1 75 MAIL BATH TUB 1 75 ADDRESS s--� 1, A , a SHOWER 1 75 CITY TEL NO LAVATORY 1 75 CONTRACTOR I SINK 1 75 ADDRESS t� DISHWASHER 1 75 CITY TEL NOr I �; CLOTHES WASHER 1 75 STATE ` LIC LICENSE NO O, CLASS SWIMMING POOL RECEPTOR 1 75 DISTRICT NO GROUP f^ A NE OCE$SED BY LAWN SPRINKLER SYSTEM 1 75 -,--) J� - j j WATER HEATER 1 75 INDUSTRIAL •� WASTE APPROVAL pr GAS SYSTEM OUTLETS 1 75INSPECTION RECORD � OUTLETS OVER y�� 5 PER SYSTEM 30 u A 1(�u V w C/) Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR 5 SIGNATURE Plan check a IN,icant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel NO GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREETO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REOU IRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LE L 'R OF I TEND TO RESIDE IN THE ABOV RIB R NT L E T FINAL SIGNATURE OF PER MITTE PERMIT VALIDATION CK M o CASH PLAN CHECK VALIDATION CK M 0 CASH 14 76A667 CE817 8 57 APPLICA PL - PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS 3� JOHN A LAMBIE COUNTY ENGINEER CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY Ir FOR APPLICANT TO FILL IN NEAREST CROSS ST fes. NUMBER FIXTURE OR ITEM OWNER `("!► �lA�„ !. WATER CLOSET BATH TUB ADDRES SHOWER CITY TEL NO �v LAVATORY CONTRACTOR Va1l,§Sr Plu-Mbifig Cd. SINS ADDRESS 442 tVi Fle,4tiva DISHWASHER CITY "OndOM TEL NO ,a LAUNDRY TUB CONTRACTOR S 162QQ� STATE REGISTRATION NO COUNTY CLOTHES WASHER 13M 1 DISTRIC3;, 6 GROUPZ NE READY FOR INSPECTION WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD APPROVALS @ $1 00 PER ITEM DATE INSPECTOR S SIGNATURE OR FIXTURE $ ®� UNDER SLAB WORK PERMIT S 1100 ROUGH PLUMBING GAS PIPING TOTAL FEE O 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 1 ,N PLUMBING 7 .- I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED DESCRIB,D RESIDENTIAL PROPERTY �/A 1 / SIGNATURE OF PERM ITTEE I✓ FINAL ! ROBERT A WOOD © ATION UCK " SUPERVISING MECHANICAL ENG R M O CASH ' LAC0 4 0 6 0t-C) AUG 2 0 5 A 1000 76A667 — CE 817 769 I i r APPLICATION _ FOR, PLUMBING PERMI COUNTY OF LOS ANGELES u DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUP T OF BUILDING LOCALITY /OLLy�T FOR APPLICANT TO FILL IN(PR NT OR TYPE) NEAREST CROSS ST NUMBER FIXTURE OR ITEM EACH FEE WATER CLOSET 1 50 OWNERMAIL �+ BATH TUB 1 50 ADDRESS ✓9,24' �-� J �! SHOWER 1 50 CITY 41= 7 TEL NO // d LAVATORY 1 50 CONTRACTOR SINK 1 50 ADDRESS 9,20 z DISHWASHER 1 50 CITY TEL NO CLOTHES WASHER 1 50 STATE LIC LICENSE NO p{�� CLASS SWIMMING POOL RECEPTOR 1 50 D STRICT N GrI ^NE S BY LAWN SPRINKLER SYSTEM 2 00 WATER HEATER 1 50 INDUSTRIAL O WASTE APPROVAL / GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD u OUTLETS OVER z 5 PER SYSTEM 30 w n. Vf z Plan check fee 25% of above See reverse PLUMBING PERMIT ISSUING FEE 9 2 00 TOTAL FEE �� APPROVALS DATE INSPECTOR 5 SIGNATURE Plan Check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel No HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST �I PLUMBING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PRO V FINAL SIGNATURE I JACK R ALLEN SUPERVISING MECHANICAL ENG R OF PERMITTEE a PERMIT VALIDATIO cK M O CASH PLAN CHECK VALIDATION CK M O CASH N' ► � a901, 1 ',mR 5 5 D 3.50 M a 444% t WORKERS COMPENSATION DECLARATION 75AG67A I hereby affirm that I have a certificate of consent to self CE e17 (z 90) APPLICATION IF OR PLUMBING PERMIT /7 insure or a certificate of Workers Compensation Insurance or ']� a certified copy thereof(Sec 3800 Lab C) COUNTY OF LOS ANGE LES / BUILDING AND SAFETY Policy No Company Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ❑ p Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM O FEE ADDRESS F 7r- 0 /4 I ( department WATER CLOSET LOCALITY 7e fi Date Applicant NEAREST BATH TUB CROSS ST -e CERTIFICATE OF EXEMPTION FROM WORKERS } f COMPENSATION INSURANCE SHOWER OWNER e r e,n IL t-Pi-- T (This section MAIL on need not be completed if the work involved I ADDRESS �3 ;11 �° F� �' (9 , } by the permit is for one hundred dollars ($100) or less) SINK CITY r�+ O I e C i TEL NO y y wa 1 certify that in the performance of the work for which this DISHWASHER / O permit is issued I shall not employ any person in any manner / CONTRACTO so as to bec me sub c) to the W kers Compensation Laws CLOTHES WASHER ! 0 �[ �I/ ADDRESS O Date Jr1 icant SWIMMING POOL RECEPTOR / (~j NOTIC TO APPLICANT If after making this Certi icate of CITYTEL NO LV Exemption you should become subject to the Workers LAWN SPRINKLER SYSTEM STATE LIC Cn Compensation provisions of the Labor Code you must forthLICENSE NO CLASS Z with comply with such provisions or this permit shall be WATER HEATER — deemed revoked GAS SYSTEM OUTLETS DISTRICT ,/ PR ESS_ED B fI LICENSED CONTRACTORS DECLARATION OUTLETS OVER �- d I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi FINAL — VALIDATION ness and Professions Code and my license is in full force and - � DATE // effect np- FINAL License Number Lie Class BY Contractor Date i I am exempt from the licensing requirements as I am a Plan Check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051 Bus iness and Professions Code) TOTAL FEE Lie or Reg No Date Plan check applicant HOME OWNER BUILDER DECLARATION Na-. \7(s r 0 N 'I I hereby affirm that I am exempt from the Contractors Address �j z A lT License Law for the following reason (Section 7031 5 Busi City i til C Tel ness and Professions Code) 21 311,8A I as owner of the property am exclusively contracting ` with licensed contractors to construct the project # o o o'o o 5 (Section 7044 Business and Professions Code) 2 0 0 1 0 0 0 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency o o a 1 Q O Q X for the performance of the work for which this permit is issued(Sec 3097 Civ C) p 928-81 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing and hereby authorize representatives of this County to enter upon the abov me coned property for inspec on p poses d Z S gnature of Permittee Date