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Home My Public Portal About4933 FIESTA AVE_Plumbing__ 76A667A(CF 8 17 19)- 11/76 Yp APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVIS FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 7Z4� NUMBER FIXTURE OR ITEM @ FEE ADDRESS WATER CLOSET LOCALITYNEAREST oo BATH TUB CROSS ST. /�t: SHOWER OWNER 0 LAVATORY MAI L ADDRESS SINK CITY TEL.NO. DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS Gi f. Jn SWIMMING POOL RECEPTOR CITY ,.� TEL. LAWN SPRINKLER SYSTEM STATE � [ ..Y c'^ � LIC. WATER HEATER LICENSE NO. �S' CLASS GAS SYSTEM OUTLETS G 14 DISTRICT NO. GROUP ZONE PROCESSED BY OUTLETS OVER 5 PER SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD 129 2� No Y n- g Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING CityLAN Tel.No. GAS PIPING I HEROWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ARRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LATING PLUMBING. HOT WATER HEATER I HERIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BE OUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWND INTEN TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIEDgSIGNATURE OF PERMbr/� F -"� —7 J PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M,O. CASH 8 3 9 r,APR 21 5 g 7.5 Q ev3 0s 76A667f817-8-58 APPLICATION FOR PLUMBING PERMIT � 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTLE!!gineer EER BUILDING AND SAFETYN BUILDING JOHN A. LAMBIE, County ADDRESS CASSATT D. GRIFFIN,Suptg LOCALITY FOR APPLICANT TO FILL IN NEAREST ' CROSS ST. 13a� NUMBER FIXTURE OR ITEM OWNER L WATER CLOSET MAIL BATH TUB ADDRESS CITY ^EL. NO. SHOWER LAVATORY CONTRACTOR (� ------ SINS ADDRESS "52 DISHWASHER CITY TEL. NO. CONTRACTOR'S STATE ❑ LAUNDRY TUB REGISTRATION NO. COUNTY ❑ / CLOTHES WASHER DISTRICT NO. GROUP ZONEI PR CESSED BY WATER HEATER / GAS SYSTEM INDUSTRIAL WASTE APPROVAL, INSPECTION RECORD APPROVALS 1Q @ OR FIXTURE $ I �J ' DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 2100 " ROUGH PLUMBING t. �• 1 TOTAL FEE GAS PIPING .� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I 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 PROPERTY. SIGNATURE ` OF PERMITTEE r FINAL ✓ /I/ /� (1„ ROBERT A.WOOD. OF VALIDATION UPERVISING MECHANICAL ENG'R CK. M.O. CASH ,(' 6 8 3 0 - NOV 2 5 A 8.0 0 76A667-CE817 12/59 APPLICATION OR PLl➢ RING PE'RMI'T'. COUNTY OF LOS ANGELES DEPARTMENT OF tTOFILL NGINEER BUILDING AND TVISION aulLDnaG 2 JOHN A. LAMBIENGINEER ADDRESS WILLIAM A. JENSEUILDING ' LOCALITY i FOR APPLICAIN NEAREST CROSS ST.NUMBER ITEM OWNER WATER CMAIL ' ¢ BATH TUB ADDRESS CITYp/ TEL. NO. SHOWER LAVATORY CONTRACTOR SINK ADDRESS DISHWASHER CITY TEL. NO. CONTRACTOR'S STATE ❑ LAUNDRY TUB REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT YNO. I GROUP ZONE P ED BY WATER HEATER , GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD P. O U M O F U W a In z @ $1.00 PER ITEM $ I r OR FIXTURE / APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 OO UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING '/ GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PR�OPEEyRTY. A UTILITY CO.NOTIFIED {� SIGNATURE OF PERMTTEE- amu✓' .��/A /C.� FINAL �✓ '/ �12 � I OF VALIDATION ROBERT A. WOOD, CK. M.0. CASH SUPERVISING MECHANICAL ENG'R WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 20-0026 DPW 4/90 I hereb y+,-affirm tf+at l have a certificate of consent to self in- 76A667A 'sure, or a certificate of Workers'Compensation Insurance,or a n certified copy thereof (Sec. 3800, Lab..C.) U Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING : Certified copy is filed with the county building inspectionADDRESS department. NUMBER FIXTURE-OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 4/1640.jjob. CROSS ST. CL COMPENSATION INSURANCE OWNER v` (This section need not be completed if the work involved by MAIL the permit is for one'hundred dollars ($100)or less.) LAVATORY ADDRESS Jj t I certify that in the performance of the work for.which this per- mit is issued, I shall not employ any person in any manner so SINK TEL. NO. CITY `Z } as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date. Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR empfion,you should become subject to the Workers'Com pen.- CITY TEL. NO. , sation provisions of the Lab-C-ar e, you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or'this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT'NO. PR SED BY I hereby affirm that I am licensed under provisions of.Chapter GAS SYSTEM OUTLETS _J- 9 ,-0 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �J and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALI TION fect. HOSE BIB DATE License Number Lic. Class f3 FINAL O Contractor Date BY A/I "� U fly+ a cc 1 am exempt under Sec. Cf iii t e-i V B.&P.C. for this reason LU Pian check fee t i ITEMS.Date: PON.PLUMBING PERMIT ISSUING FEE$ 02 0 TOT�i. t 110'x`o 413;103 Signature TOTAL FEE SINGLE FAMILY plan check applicant CHECK ioe.sfl HOME OWNER-BUILDER DECLARATION pp �� .00I hereby affirm that I am exempt from the Contractors License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address 00_ 0 6I11.E6 I, as owner of the property, will.do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044; 6$ 7 1 ver Business and Professions Code). CONSTRUCTION LENDINGAGENCY 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date