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Home My Public Portal About5750 OAK AVE_Plumbing__ 78A9B7-CS817�117/ 1` APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTIMENT OF COUNTY ENGffa= BUILDING AND SAFETY DIVISION BUILDING CADI�DGotm R TYRIFFIN 'of O� LOCAlm FOR APPLICANT TO FILL IN ICROSSNE _ NUMBER FIXTURE OR ITEM 14 WATER CLOSE! OWNER 19— BATH TUB IADRESS VQ►• SHOWER CITY TSL.NO SrL LAVATORY CONTRACTOR � Sm ADDRESS , VAQ DISHWASHER CTTY TEL NO k-r-C.7.Ca CONTBACTOB LAUNDRY!OB t A REGISTRATION NO { COgNTY CLOTHES WASHER DISTRI NO LASVOUPIZONE READY FOR IMSPRCTIGM WATER HEATER GAS SYSTEM nwuSTRm WASTE APPROVAL O INSPECTION RECORD APPROVALS 0 co R PIXTUNE ; I / DATE INSPECTOR S SIGNATURE UNDER SLAB WORK PERMIT $ 00 ROUGH PLUMBING TOTAL FEEGAS PIPING 1 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 1 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 TH ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTIAL PROPERTY SIGNATURE OFPERMITTEF ` ■ r FINAL iJAM ROBERTA WOOD ®� VALIDATION SUPERVISING MECHANICAL ENG R R 0 CASH • + y 03 �` El 4 5 A 3.00 IPL WORKER S COMPENSATION DECLARATION 7 D 9189 APPLICATION FOR PLUMBING PERMIT 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) 7��/'� CL Poli No CompanyCOUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV Policy ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) DR ADIESS �J v ®�/� ❑ Certified copy is fled with the county bud /�� ding inspection _ department NUMBER FIXTURE OR ITEM G FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATHTUB CROSS ST L'd 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($100)or lees) OWNER �v I certify that in the performance of the work for which this permit LAVATORY �JLGLV C��G� is issued 1 shall not employ any person in any manner so as to SINK MAIL become subfect to the Workers Compensation Laws ADDRESS S / DISWASHER CITY r TEL N �!!/ Date l'J / Applicant CLOTHES WASHER NOTICE TO APPLICANT If afte aking this Certificate of CO mNTRACTOR Exemption you should become subject to the Workers Compensation with such SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code you must forthwith complywith such provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY EAT /��K/ TEL NO I hereby affirm that I am licensed under provisions of Chapter 9 ---WATER HER � �/¢ (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS CENSE N04�STATE �� CLASS C�jG� Professions Code and my license is in full force and effect OUTLETS OVER DISTRICT NO PROCESSED BY / 5 PER SYSTEM - License Number V tg` of Lic Class I v - F- Contractor Date�l/(' / oL VALIDATION d 11FINL;U AL Z Is exempt under Sec gy �� INSPECTION Date B dP C for this reason Plan check fee Signature PLUMBING PERMIT ISSUING FEE$ a p _ w ❑ TOTAL FEE 1?-0 rvulJ► q SINGLE FAMILY Plan check applicant _ F f�r�•f I� •ttTt HOME OWNER BUILDER DECLARATION Name WV� TY I hereby affirm that I am exempt from the Contractors License Law 1 for the following reason(Section 7031 5 Business and Professions Address TOTAL T:3.40 Code) ❑ City Tel No tea owner of the property will do the work and the structure is not intended or offered for sale(Section 7044 Business _ GECK 43.40 and Professions Code) , CONSTRUCTION LENDING AGENCY MIwL� I hereby affirm that there is a construction lending agency for the CWNE .00 performance of the work for which this permit is issued(Sec 3097 Civ C) Lender s Name000D-=1 O/e'17,/eC 7, i Lenders Address I certify that I have read this application and state that the above 4:43 information is correct I agree to comply with all County ordinances 1 i PM, and State laws regulating Plumbing and hereby authorize representatives of this County to enter upon the above me tioned property for inspection u poses �l/ / � SEE REVERSE FOR EXPLANATORY LANGUAGE —