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HomeMy Public PortalAbout4823 FIESTA AVE_Plumbing__ 76A667A , ? -� CE 817(REV.11/78) �/ LLLSSS APPLICATION �U PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE( BUILDING ADDRESS s NUMBER FIXTURE OR ITEM @ FEE LOCALITY ' WATER CLOSET NEAREST BATH TUB CROSS ST. SHOWER OWNER LAVATORY MAIL A ADDRESS SINK CITYG� TEL.NO4a�/7� �� DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS 45,--�'Ab ?mtnA as �i SWIMMING POOL RECEPTOR CITY Q. TEL.NO. LAWN SPRINKLER SYSTEM STATE C. WATER HEATER LICENSE NO. 3 LASS GAS SYSTEM OUTLETS APPROVALS DATE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING d C>` ® GAS PIPING 0 GAS VENT 129 HOT WATER HEATER PLUMBING FIXTURES i GAS TEST Plan check fee UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ TOTAL FEE FINAL —$ Plan check applicant PL CHIC VALI ATION Name `% C/�� Address City Tel.No. 0 3 1.2 A I HEREBY ACKNOWL GE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH AM COUNTY ORDINANCES O O O'a O 5 AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 0 0 1 0,00 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 O O O 1 O.O O�'I PROPERTY. SIGNATURE 05 13-8 0 OF PERMITTE �TRICLNO P CESSED BY �� r INDUSTRIAL f WASTE APPROVAL I WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I, affirm that I have a certificate of consent to self 20-0026 DPW 6/87 in) ;)6 a certificate of Workers' Compensation Insurance, 76A667A or�, (ified copy thereoft-ny- . 3800, Lob. C. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS pclicy No. (L'""J, Certified copy is hereby furnished. BUILDING I, FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Z 4P X0,01-� l Certified copy is filed th the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY j tll 7-Y Date 9 Applicant '"� WATER CLOSET �`— NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER , the permit is for one hundred dollars($100)or less.) LAVATORY MAIL I.certify that in the performance of the work for which this ADDRESS ES permit is issued, I shall not employ any person in any manner SINK CITY f� " CITY TEL. NO.�g�-� gP so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTORyN1tJE 77' Date Applicant CLOTHES WASHER ADDRESS / NOTICE TO 'APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. d JT O with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM v STATE LIC. deemed revoked. WATER HEATER LICENSE N19 CLASS / LICENSED CONTRACTORS DECLARATION D TRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 / GAS SYSTEM OUTLETSIl/01 (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL DATE VALIDATION p�„Y License Number Lic. Class f3 —1 O. I r� FINALy6lods Contractor �9te�� — BY Ix /N 1 Q ❑ I am exempt under Sec. f/�,,�V�Fi B.BP.C. for this reason "�'' h3 Plan check fee Date: O PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE . SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name c 1 hereby affirm that I am exempt from the Contractor's License Address ACCToQ Law for the following reason (Section 7031.5, Business and �y-p Professions Code): City Tel. No. J30 16.50 ❑ I, as owner of the property, will do the work and the 1 I'T'EM' structure is not intended or offered for sale (Section 7044, Business and Professions Code). ® TOTAL 4S © 50 CONSTRUCTION LENDING AGENCY CHECK' 16.50 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CHANGE .00 (Sec. 3097, Civ. C.). Lender's Name � n QOC� 0C 1 9/ 8789 Lender's Address I certify that I have read this application and state that the .5-597 1 AMII-009 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 9-& nature of Permitte Date