HomeMy Public PortalAbout4949 FIESTA AVE_Plumbing__ 78A667 APPLICATION
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DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN,SUPT OF BUILDING O J .
LOCALITY
FOR APPLIC T,TO FILL IN NEAREST
CROSS ST. f
OWNER~_ / y DISTRICT NO. GROUP ZONE READY FOR INSPECTION
MAIL
ADDRESS �• �/ d-
o INDUSTRIAL
CITY TEL. NO. WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESSy:(.._ts'�[.�,.�
CITY ( TEL. NO y Q :E
LICENSE NO,
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00 -
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
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APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ I 00 ROUGH PLUMBING 2526 oy R_�4a
GAS PIPING
TOTAL FEE CR 1661, GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION IHOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ;h
PLUMBING. PLUMBING FIXTURES
1 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 RESIDEN .A1 PROPERTY.
SIGNATURE 1
OF PERMITTEE v FINAL '�'"C� ar�: res�" tet_; r'"
JOHN A. LAMBIE, COQ/NTY ENGINEER VALIDATIO ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. M.O. GASH
'T04 2 8 5
R20 3 2.00
WORKfaRS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87
insure, or a certificate of Workers' Compensation Insurance, 76A667A
or a certified copy thereof (Sec. 3800, Lab C. C ,,/ COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No. /�v �//Company ' '�inv
❑ Certified copy is hereby furnished. �/
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING C-7 § r S
Certified copy is filed with the c ildi n pec- ADDRESS
tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY e
�J ,� e I
Date ✓ Applicant C WATER CLOSET �� NEAREST / �
CERTIFICATE OF EXEMPTION FROM WORKERS' r BATH TUB CROSS ST. G- OSS
COMPENSATION INSURANCE P SHOWER OWNER 1 dy,
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars ($100)or le'ss.), LAVATORY ADDRESS
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO.
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY W h a- TEL. NO.
LAWN SPRINKLER SYSTEM O
with comply with such provisions or this permit shall be STATE / �+( LIC.
deemed revoked. WATER HEATER 3_ LICENSE NO.�/ / ) CLASS /
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION
License N er 5 Lic. Class—
FINAL^ / DATE 7—elf 9y O.
62.
U /� A FINAL
Contractor Date �j BY
❑ I am exempt under Sec. �f
B.&P.C. for this reason
Plan check fee
Date:
PLUMBING PERMIT ISSUING FEE$ :.�;.:•.•- .• �'
f:•;»•;
Signature TOTAL FEE
Plan check applicant -• .
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name ;•E; ,_y _
I hereby affirm that I am exempt from the Contractor's License ``' w- t6m•-?
Law for the following reason (Section 7031.5, Business and Address CJ HECK
Professions Code): City Tel. No.
i=a
❑ I, as owner of the property, will do the work and the -
structure is not intended or offered for sale (Section
7044, Business and Professions Code). "
CONSTRUCTION LENDING AGENCY ''3''
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
%rdinances and State laws regulating Plumbing, and hereby
orize repr sentatives of this County to enter upon the
v -ment' dyp operty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Lature of Permittee Date