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Home My Public Portal About4518 FIESTA AVE_Plumbing__ F � 76A607-CE817 10 60 i APPLICATION F R PLU INC P RMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 7ADDRESS JOHN A LAMBIE COUNTY ENGINEER WILLIAM A JENSEN SUP T OF BUILDING 01 FOR APPLICANT TO FILL IN NUMBER FIXTURE OR ITEM 3 2, WATER CLOSET BATH TUB TEL NO SHOWER il 4 LAVATORY CONTRACTOR Uj r / SINK ADDRESS l J DISHWASHER CITY/�C !� NOCONTRACTORS STATE LAUNDRY TUB REGISTRATION NO I x 7 COUNTY CLOTHES WASHER DISTRICT NO G` Rel ZONE PR CESBED BY i WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL rs� INSPECTION(BECOBD'-,,f ,dye A 1 2 h; di I T/A"f/lam r $100 PER ITEM OR FIXTURE T/ APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 1 2100 1 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 PLUMBING HOT WATER HEATER 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES CE LICENSED AS REQUIREDBY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE / { DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE A1, A M14 mi OF PERMITTEE-. FINAL �l 0 k I WIPW VALIDATION ROBERT AvW OD� I /) M O CASH SUPERVISING MECHANICAL�JENG R 3 � ? o SEi � 2 5J � 1tJ li DECLARATI 20 WORKER I have COMPENSATION ate of consent to 76A666DPW9/69 APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self insure 76A667A f or a certificate of Worker s Compensation Insurance or a certified ' copy thereof(Sec 3800 Lab C) - I t COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV Policy No Company 1 r Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ' BUILDING _/-I—/o2 �fJ � f Certified copy is filed with the county budding inspection ADDRESS `J , �{/ department NUMBER FIXTURE OR ITEM ® FEE LOCALITY �y �t w1 1, I p Date Applicant WATER CLOSET NEAREST Ip "[ CERTIFICATE OF EXEMPTION FROM WORKERS CROSS ST C -2 COMPENSATION INSURANCE BATH TUB ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less) LAVATORY OWNER IL� t +A,�a I certify that in the performance of the work for which this permit V is issued I shall not employ any person in any manner somas to SINK bMAIL SSbecome subject to the Workers Compensation LawsDISWASHER fly r2 (T TEL NO -513 Date Applicant CLOTHES WASHER Y"l�l� L CONTRACTOR NOTICE TO APPLICANT If after making this Certificate of Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR prov+s+oris of the Labor Code you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION J CITY 1 TEL NO } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE LIC IZ (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO CLASS V Professions Code and my license is in full force and effect ' OUTLETS OVER DISTRICT NO PROCESSED BY Q 5 PER SYSTEM License Number Lic Class FINAL DATE _ /3 VALIDATION LU CL Contractor Date ! O ❑ I am exempt under Sec FINAL Z dy B&P C for this reason Plan check fee Date Signature PLUMBING PERMIT ISSUING FEE$ a! t TOTAL FEE 9 D ❑ Plan check applicant SINGLE FAMILY nil HOME OWNER BUILDER DECLARATION Name W ACCT.0 I hereby affirm that I am exempt from the Contractors License Law c for the following reason (Section 7031 5 Business and Professions Address :307 Code) City Tel No - 1 ITEMS I as owner of the property will do the work and the structure _ A _ is not intended or offered for sale (Section 7044 Business TOTAL 39 ® 30 and Professions Code) _ f CONSTRUCTION LENDING AGENCY - - _ � `��"rj l I hereby affirm that there is a construction lending agency for the CHAWK 00 performance of the work for which this permit is issued (Sec 3097 - Cry C) Lender s Name Lender s Address bW J 1 M 10 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 prop" for inspecti purposesmw v a 7 SEE REVERSE FOR EXPLANATORY LANGUAGE lgnature of Permittee Date