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Home My Public Portal About4942 FIESTA AVE_Plumbing__ 76A6E.z-C_817,X2/59 APPLICATION FOR PLUMBING PERMIT 9 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 7BULDNGJOHN A. LAMBIE. CouNTYNGINEER %�/,r� CtWILLIAM A. JENSEN. SuP'7 OF BUILDING _FOR APPLICANT TO FILL IN r.�a ci/NUMBER FIXTURE OR ITEMl� rWATER CLOSET , BATH TUB CITY TEL. NO. SHOWER LAVATORY CONTRACTOR SINK ADDRESS ti DISHWASHER CITY O! N CONTRACTOR'S STATE ❑ LAUNDRY TUB REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT NO. GROUP ZONE PJR�OCE EDD BY WATER HEATER Q I `/ l✓� '<�lJ� GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD w U , � a 0 F U W a z $ ORF TUBE $ APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK TOTAL FEEH ROUGH PLUMBING GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT 1 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 PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE /.- FINAL OF VALIDATIO ROBERT A/ WOOD, CK. M.0. casx SUPERVISING MECHANICAL ENG'R L ? 5 1 0 :0' {AY 141. 5 0 3 .5 0 76A667 (CE-817) — 1/75 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: ADDRESS- HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY enL. FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM @ FEE , OWNER WATER CLOSET 2�� MAIL BATH TUB 2.00 ADDRESS � SHOWER � ) CITY f� �. Ai TEL. NO. � e LAVATORY 6.1151 CONTRACTOR �� SINK 2.00 ADDRESS �6?2 6u v� DISHWASHER 2.00 CITY /. !�' TEL. N0.� Z/ � 73 CLOTHES WASHER 2.00 STATE �^7 e // CLIC LASS SWIMMING POOL RECEPTOR 2.00 / LICENSE NO. v DISTRICT NO.GRO1 :rUP ZONE PROCESS D BY LAWN SPRINKLER SYSTEM 2.00 c 0 a� CJ5 � WATER HEATER 2.00 INDUSTRIAL WASTE APPROVAL O GAS SYSTEM OUTLETS '2'0'0 INSPECTION RECORD � OUTLETS OVER O 5 PER SYSTEM .30 U O V W CL f/! Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEES v TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING . ' Address GAS PIPING City Tel. No. GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST � ,,� G' ✓ -� I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REOUI RED BY LOS ANGEA�COY AND STATE OF CALIFORNIA OR THAT I AM THE L L , AND INTEND TO RESIDE IN THE ABOVE DESCRIBE�D0'PERTY. FINAL SIGNATU RE ' OF PERMITTEE PERMIT VALIDATION CK. O: CASH PLAN CHECK VALIDATION CK. M.0 CASH 7 1 .3 i` l:q > 5 5 U 11 6.5 76A607-CE817 10 60 APPLICATION FOR PLUMBING PERMIT ) COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIMION BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS WILLIAM A JENSEN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM OWNER WATER CLOSET BATH TUB ADDBESS SHOWER TE CITY L NO 44 LAVATORY CONTRACTOR SINS ADDRESS DISHWASHER CITY TEL NO 1/41 CONTRACTOR S STATE ❑ LAUNDRY TUB REGISTRATION NO COUNTY CLOTHES WASHER DISTRICT NO GROUP ZONE SSED BY { WATER HEATER a J ` a GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD 0 U GO LLI a to $1 00 PER ITEM OR FIXTURE $ aJ APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2100 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING l �� GAS PIPINGIHE / I PPLICATION AND STATE THAT THE EBY EABOVE DGE HISTCORRECT AI HAVE ND AGREED THIS TOCOMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES /I LICENSED A9 REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST �� /► �/r CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED "'a`� �`�-"- SIGNATURE / OF PERMITTE FINAL ® 3 ALIDATION ROBERT A(WOOD cK M o CASH SUPERVISING MECHANICAL ENG R 2 0 9 1% &L24 5 D 4.75— a WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT affirm I hereby arm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company 01-lia uL Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �' ' Certified copy is filed with the county building inspec- ADDRESS '-/ Z �� /, tion epartment. NUMBER FIXTURE OR ITEM n FEE .�. L+ �2 II "�DI`? 144421— WATER CLOSET LOCALITY Date Applicant NEAREST I � CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. (J L(/G A u SA COMPENSATION INSURANCE SHOWER OWNER � � (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. BI—, so as to become subject to the Workers'Compensation Laws. DISHWASHER �� CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR , CITY e� Compensation provisions of the Labor Code, you must forth- TEL. NO.!2 with comply with such provisions or this LAWN SPRINKLER SYSTEM /'7 p y p permit shall be STATE LIC. 4� - CLASS deemed revoked. WATER HEATER LICENSE NO./ LICENSED CONTRACTORS DECLARATION O DISTRIC�. ROCESSED BY 1 hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS /{ (commencing with Section 7000 of Division 3 of the Business ( 9 ) OUTLETS OVER � and Professions.Code,and my license is in full force and effect. 5 PER SYSTEM L�-y '- / FINALDATE V DATION License Number r / 2 L-4 Lic. Classes � ,� ��, FIN Contractor k1&St2_M i`(pate s BY ❑ I am exempt under Sec. B.BP.C. for this reason Plan check fee g Date: PLUMBING PERMIT ISSUING FEE$ Q Signature '.S� � 1 9 Q 5 A Plan check applicant TOTAL FEE #.000005 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address 0 0 2250 Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. o o 0 22506- 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ® 0 Q 2 2 e$5 7044, Business and Professions Code). 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, 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-me boned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE `'icd� h Signature 0;06n ittee Date