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Home My Public Portal About4901 FIESTA AVE_Plumbing__ 76A667-CES17 3-59 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ~� BUILDING AND SAFETY DIVISION BUILDING' / JOHN A. LAMBIE, County Engineer ADDRESS G CASSATT D. GRIFFIN, Supt of Building LOCALITY FOR APPLICANT TO FILL IN NEAREST '" CROSS ST. env 1-41411 NUMBER FIXTURE OR ITEM OWNER � WATER CLOSET MAIL BATH TUB ADDRESS CITY TEL NO. SHOWER LAVATORY CONTRA OR SINS ADDRESS _ DISHWASHER CITY TEL. NO CONTRA R'S STATE LAUNDRY TUB REGISTRNTION NO. �� COUNTY ❑ CLOTHES WASHER DISTRICT NO. GROUP ZONE PR CESSED BY n WATER HEATER ��- GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD @ $1.00 PER ITEM OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 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 s; 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ` GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE AB VE DESCRIBED RESIDENTIA P PERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMIT. FINAL ®e VAUDATIO ROBERT A. WOOD. Cg. M.o. CAsx SUPERVISING MECHANICAL ENG'R 8 5 4 3 ' EC 7 5 A WOthat 1, v.e a ceSATION DECLARATIONtto 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT - 76A667A I hereby affinri that I•fiave a certificate'of consent to self insure, or&--certificate,of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 fib. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant � WATER CLOSET NEAREST ' CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. COMPENSATION INSURANCE BATH TUB ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGEOj PARCELpp�1,2 permit is for one hundred dollars($100)or less.) LAVATORY v OWNER `jV{`/ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to SINK MAIL become subject to the Workers'Compensation Laws. ADDRESS ,0 DISWASHER CITY TEL.NO. 1PNfie�pDate Applicant , CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR tjyWW CAN 10 Exemption,you should become subject to the Workers' Compensation SWIMMING POOL RECEPTORV17nWi provisions of the Labor Code, you must forthwith comply with such ADDRESS 0 ►1 N ` v Q provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM '^l LICENSED CONTRACTORS DECLARATION CITY TEL.NO. 2f 1) d I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER l• 4! (commencing with Section 7000)of Division 3 of the Business and STATE LIC. 0 Professions Code,and my license is in full force and effect. I GAS SYSTEM OUTLETS LICENSE NO. 1 CLASS 0 OUTLETS OVER DISTRICT NO. PROCESSED BY EE; 5 PER SYSTEM p License Number CO Lic.Class —12— O q ( ,� FINAL VALIDATION W l�itkt, �1L1�id �� 4� DATE 7-3 fl Contractor Date CO ElFINAL Z I am exempt under Sec. BY B.&P.C.for this reason e-0 7 3 Plan check fee Date: ► Lam, PLUMBING PERMIT ISSUING FEE$ Signature ` ❑ TOTAL FEE 6 SINGLE FAMILY Plan check applicant 5 ,r HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License LawH4,�.T.a for the following reason (Section 7031.5, Business and Professions Address Code ❑ City Tel. No. 3307 175.65 I,as owner of the property,will do the work and the structure 1 ;TEMP- is not intended or offered for sale (Section 7044, Business and Professions Code). , TOT T AL 175. 65 CONSTRUCTION LENDING AGENCY !_t�E!_K i r_I■6:C I hereby affirm that there is a construction lending agency for the CHANGE performance of the work for which this permit is issued (Sec. 3097, CHANGE ,[!S I Civ.C.) Lender's Name 1 Lender's Address 8253 1 PM,,U d 111 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 Signature of Permittee Date WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9189 APPLICATION FOR PLUMBING PERMIT 76A667A "d I herp.by'affirn�i that I.have a certificate of consent to self insure, or Tcertificate 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 is hereby furnished. F-1Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant 1 WATER CLOSET �`� b� caossSST. 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($100)or less.) LAVATORY OWNER Epm + I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to ' SINK MAIL ADDRESS , + s become subject to the Workers'Compensation Laws. DISWASHER CITY � + TEL.N 7✓ Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of b Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS i J provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM C ¢ LICENSED CONTRACTORS DECLARATION CITY TEL.N Z/ f' �� - I hereby affirm that I am licensed under provisions of Chapter 9 / WATER HEATER / d0 (commencingwith Section 7000 of Division 3 of the Business and a. STATE LIC. ) GAS SYSTEM OUTLETS LICENSE NO. y CLASS Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NPROCESSED BY O • 5 PER SYSTEM License Number f� Lic.Class U FINAL VALIDATION W DATE � �..� Contractor Lk&nw Date 0 ,Z _ fA ❑ FINAL Z I am exempt under Sec. O BY B.&P.C.for this reason Date: 3 A3 0 Plan check fee , - �-1 PLUMBING PERMIT ISSUING FEE$ S Signature _Iry� c El TOTAL FEE e�j a Plan check applicant ADJ.s SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 3307 . �"I,F.�= I hereby affirm that I am exempt from the Contractor's License Law T C for the following reason (Section 7031.5, Business and Professions Address 1 1 I Gt 3 t Code): _: .. .. _ c EJ 1, Tel.No. I(IT AL e` 0 m 6 I,as owner of the property,will do the work and the structure c tl e is not intended or offered for sale (Section 7044, Business !:HELY. f�• and Professions Code). CHANGE aleft 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, r; Civ.C.) I _ t IJi 3/330/93 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 Signature of Permittee Date