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HomeMy Public PortalAbout5336 FARAGO AVE_Plumbing__ 76A667 CE817 B 57 f, APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS 5336 Farago JOHN A LAMBIE COUNTY ENGINEER CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY Temple Cit FOR APPLICANT TO FILL IN NEAREST CROSS ST r (� NUMBER FIXTURE OR ITEM OWNER Larkwood Construction WATER CLOSET MAIL 1 BATH TUB ADDRESS SHOWER CITY TEL NO 7z LAVATORY CONTRACTOR Richard Cavana6gh Plumb. SINK ADDRESS 13354 S Central DISHWASHER CITY Chino TEL NO Na 8-4721 LAUNDRY TUB CONTRACTOR S STATE El REGISTRAT ON NO 155-164 C-36 COUNTY D CLOTHES WASHER DISTRICT NO GR O P ON READY FOR INSPECTION WATER HEATER 'r" 1 GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD Ale) 4; All � /rte l���i.,�- �.�..•..��,, .i�_YQ Y Cs �� C44°i. APPROVALS @ $100 PER ITEM DATE INSPECTOR SIGNATURE 10 OR FIXTURE $ 10.0C UNDER SLAB WORK PERMIT S 1100 ROUGH PLUMBING I GAS PIPING K 't TOTAL FEE 12100 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 1 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 DESCRIBED RESIDENTIAL P OPERT Y SIGNATURE OF PERM ITTEE FINAL ROBERT A WOOD © VALIDATION SUPERVISING MECHANICAL ENG R CK M O CASH UTACo 5 5 9 5 °° OCT 8 5 A 12.0 Q WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I herety affirm that I have a certificate of consent to self 76A667A insure or a certificate of orker Compensation Insurance CE 817(REV 10/81) or a ACO y thereof (Sec 8 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY / Policomp ny Y py is by urn d CCC ❑ FOR APPLICANT F14N(PRINT O YPE) py is e ith e county building inspec ment' NUMBER FIXTURE OR ITEM IryiT t DateAp I WATER CLOSET TE F E MP ION FROM WORKERS BATH TUB lli O PENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less ) LAVATORY MAIL I certify that in the performance of the work for which this ADDRESS permit is issued I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Work e Comperlsation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR Exemption you should become subject to the Workers v CITY TEL NO Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER ! LICENSE NO CLASS G _ LICENSED CONTRACTORS DECLARATION ® DISTg1C0 f PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER —t�7 r >- and Professions Code and my license is in full force and e ect 5 PER SYSTEM FINAL d. 2 Z CDATE VALIDATION License Number Lic Class C9 FINAL O BY Contractor Dat 2 a 8 A I am exempt under Sec H 0 0 0 0 � B &P C for this reason Plan check fee # 0 5► 2t 0 IeB PLUMBING PERMIT ISSUING FEE$ 1650 Signature TOTAL FEE o e o o 16506 Plan check applicant Q 612-85 SINGLE FAMILY HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor s License Address f Law for the following reason (Section 7031 5 Business and ✓� Professions Code) City Tel No ❑ I 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 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 me i n prop f r spection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 1 Signature of Permittee 7 Date