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Home My Public Portal About4844 FIESTA AVE_Plumbing__ 76A667 CE98171067 Tew /` C,-;,/�/ APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS COLEMAN W JENKINS SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST CROSS ST NUMBER FIXTURE OR ITEM EACH FEE WATER CLOSET 1 50 OWNER MAIL BATH TUB 1 50 ADDRES SHOWER 150 CITY TEL O LAVATORY 1 50 CONTRACTO SINK 150 ADDRESS DISHWASHER 150 C TEL NO CLOTHES WASHER 1 50 STATE / LIC LICENSE NO S^ CLASS SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GROUP ZONE PROCESSED BY LAWN SPRINKLER SYSTEM 2 00 �O �/ CL O WATER HEATER 1 5040 INDUSTRIAL V WASTE APPROVAL GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD C~) OUTLETS OVER , Lu 5 PER SYSTEM 30 /, C G�f�/ L,y Ci Ree- �*� G- N Z Plan check fee 25% of above See reverse PLUMBING PERMIT ISSUING FEE S 2 00 TOTAL FEE S APPROVALS DATE INSPECTOR%SICPATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING X Address GAS PIPING GAS VENT city lel No HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO 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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER AND INTEND TO RESIDE IN THE ABOVE GCRIBED RESIDENTIA PER TY FINAL SIGNATURE JACK R ALLEN SUPERVISING MECHANICAL ENG R OF PERMITTE PERMIT VALIDATION CK M O CASH PLAN CHECK VALIDATIO CK o CASH L&ob 4 4 2� JULY, 2 5 D 3,50- 14 I VA667 CE'4817 10 67 7emfp1e. G�It-y APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING P JOHN A LAMBIE COUNTY ENGINEER ADDRESS COLEMAN W JENKINS SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST r O y CROSS ST !-1IV .L NUMBER FIXTURE OR ITEM EACH FEE NER OW �+ WATER CLOSET 150 a MAIL /^- BATH TUB 1 SO ADDRESS l� SHOWER 1 50 CITY TEL NO LAVATORY 1 50 _50CONTRACTOR V SINK 1 50 ADDRESS DISHWASHER 150 CI TEL NO 'O / CLOTHES WASHER 1 50 Q STATE LIC �j� CLASS LICENSE NO JJ SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GRQIIR ZONE P SED BY LAWN SPRINKLER SYSTEM 2 00 i p U / WATER HEATER 1 50 �0 INDUSTRIAL WASTE APPROVAL _ p GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD V OUTLETS OVER d 5 PER SYSTEM 30 T 6 i>144, 6E AtCisT c,,,r& To 0*9 7& - R01✓ 0NdFr2 4j)b i Ti D W/ Plan check fee 25% of above See reverse PLUMBING PERMIT ISSUING FETE $ 2 00 IOTAL FEL / OO APPROVALS AT / INSP TOR S S N URE Plan check applicant UNDER SLAB WORK - a Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel No - HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO 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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF - - CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO fI RESIDE IN THE ABOVE DEW IBED RESIDENTIAL ROPERTY FINAL ' SIGNATURE JACK R ALLEN SUPERVISING MECHANIC ENG OF PERM ITT E PERMIT VALIDATION CK M o CASH PLAN CHECK VALIDATION M o CA ; - LAW � � � �� ,��11 - 5 a 1 r1.i:� 0 N-� - DECLARATI 20 0026 WORKER I have COMPENSATION ate of consent to 76A667 DPW 9/89 APPLICATION FOR PLUMBING PERMIT LI 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 Policy No Company Certified copy os hereby furnished ILDING p r_1FOR APPLICANT TO FILL IN(PRINT OR TYPE) DDRESS p Certified copy is filed with the county budding inspection department NUMBER FIXTURE OR ITEM ® FEE LOCALITY v Date Applicant WATER CLOSET NEAREST - CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the - SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars 1($100)or less) t OWNER I certify that in the performance of the work for which this permit LAVATORY is issued I shall not employ any person in any manner so as to SINK MAIL become subject to the Worker Compensation Laws ADDRESS �. DISWASHER CI TEL N t� lrC7 A h , 7 // Date pp - CLOTHES WASHER NOTICE TO APPLICANT If after making this Certificate of ONTRACTOR ` Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code you must forthwith comply,with such ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NO I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER �u CL ,(commencing with Section 7000) of Division 3 of the Business and STATE LIC0 Professions Code and my license is in full force and effect GAS SYSTEM- OUTLETS �� LICENSE NO ��3(� CLASS (2 C) 0 OUTLETS OVER DISTRICT NO PROCESSED BY O ' 1 O 5 PER SYSTEM O ` � /Ic ense Number �3��3� Lic Class ci d F_ / 6 FINAL DATE t VALIDATION I� d Contractor U0eA ElI am exempt under Sec BY AL Z B&P C for this reason c Plan check fee , ACtT■s Date _ f Signature PLUMBING PERMIT ISSUING FEE$ t� /a J "�7 ,i" LI} TOTAL FEE O - yl 1 ITEM L Plan check applicant —. --+ SINGLE FAMILY T�I 3 1 AL 9 .30 HOME OWNER BUILDER DECLARATION Name t�ry7 -.,7 -, I hereby affirm that I am exempt from the Contractors License Law r r.r7Ct.t� J7■.Jl I for the following reason (Section 7031 5 Business and Professions Address _ Code) f HMGE .I)17 EJClty Tel No i I as owner of the property will do the work and the structure is not intended or offered for sale (Section 7044 Business tits ,r t1 and Professions Code) , UV rt1�— �V1 1 /25/7- CONSTRUCTION LENDING AGENCY ! -7i�/ 1� AM104."C I hereby affirm that there is a construction lending agency for the ' performance of the work for which this permit is issued (Sec 3097 t Civ C) f f - r 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 A, �0 1 ?-Z_S-�� Signature of Permittee 'Date