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Home My Public Portal About5551 PERSIMMON AVE_Plumbing__ 78A667Ax--- ?, , CE 817(REV.6/78) �r APPLICATION F R PLU MB ING PE RM IT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING, NUMBER FIXTURE OR ITEM ® FEE ADDRESS �`1✓ LOCALITY _ C. WATER CLOSET NEAREST BATH TUB CROSS ST. SHOWER OWNER bw, a MAIL G. LAVATORY ADDRESS o SINK CITY —r C , TEL.NO. DISHWASHER CONTRACTOR s CLOTHES WASHER -ADDRESS ' C SWIMMING POOL RECEPTOR p CITY C� ��1 � � TEL.NO. � 0 LAWN SPRINKLER SYSTEM STATE. WATER HEATER LICENSE NO. , 5 CLASS GAS SYSTEM OUTLETS APPROVALS 9ATINSPECTqf'SPIGNATURE OUTLETS OVER UNDER.-SLAB WORK 5 PER SYSTEM16 ROUGH PLUMBING /' /,';'=� ;^+;";�'• f i•f,"1 GAS.PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES GAS TEST ub Plan check fee UTILITY CO.NOTIFIED � PLUMBING PERMIT ISSUING FEE.$ ilm TOTAL FEE. FINAL Plan check applicant PLAN CHECK VALIDATION Name �" C s Address W,b� yv/ .,e* City '. Tel.No. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AAD STATE. 126 9 S 7 A THAT THE ABOVE IS CORRECT AND AGREE TO COMP Y WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION # O o O o O 5 I HEREBY CERTIFY THAT' AM PROPER E IS ED AND/OR LICENSED AS C REQUIRED BY LOS ANGE ESC TY AND 5 O C L FORNIA OR THAT I AM THE 2 - o 25 O O LEGAL OWNER OF.AND I TEN RESIDE E B V DESCRIBED RESIDENTIAL PROPERTY. + ' YD002�000 SIGNATU OFPERMITT (101 -79 DISZNO. PROCESSED B, J , b INDUSTRIAL WASTE APPROVAL / WORKW C"OAPENSATION DECLARATION APPLICATION. FOR PLUMBING PERMIT 1 hereby affirm that I have a certificate of consent to self 76A667A insure, or-a certificate.of Workers'Compensation Insurance, CE 817(REV. 10/81) or artified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES �/ BUILDING AND SAFETY Policy No'. Company I ❑ Certified copy is hereby furnished. - FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspec- ADDRESS e tion department. NUMBER FIXTURE (� FEE r.. LOCALITY � � f f Date Appligant WATER CLOSET NEAREST r CERTIFICATE OF EXEMPTION FROM WORKERS' / BATH TUB CROSS ST. COMPENSATION INSURANCE , OWNER (This section need not be completed If the work Involved by SHOWER , the permit Is for one hundred dollars($100)or less.) LAVATORYMAIL ' I certify that in the performance of the work for which this ADDRESS perrrii.t is issued, I shall not employ'any personin any manner SINK CITY TEL.NO.. so as to become-subject to the Workers'Compensation Laws. DISHWASHER 'CONTRACTOR- 1911 NTRACTOR 14' CA CO- Date ApplicantCLOTHES WASHER • ADDRESS. /r TO. APPLICANT: If, after making this Certificate of. r �lle"A AR Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY 0 �� TEL'NO. Q+ f with comply with .such rovisons or this permit shall be LAWN SPRINKLERSY$TFJ1A P Y R ' P STATE_ LIC. deemed revoked. WATER HEATER LICENSE NO.. CLASS LICENSED CONTRACTORS DECLARATION I - DISTRICT NO. ` PROCESSED BY I hereby affirm that I.am licensed.under provisions of Chapter 9 GAS SYSTEM OUTLETS d„/ '+ (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER L and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL } DATE Gr—+ �^ VALIDATION W License Number ?j .330 Lic.-Class t c.(� r`'�L 68►1- Cv FINAL h.. i} ,.v.. O ' Contractor e� Date BY ❑ I am exempt under Sec. B.BP.C. for this reason Plan Check fee Date: ` PLUMBING.PERMIT ISSUING FEE$ Signatureo�4 5 7 A TOTAL FEE i 0 0 p 0 0 5 SING E FAMILY Plan-check applicant • HOME OWNER-BUILDER DECLARATION Name 2 o - 4650 ' I hereby affirm that I am exempt(Section o from the Contractors License Add Law for the followingreason Section 7031.5, Business and Fu o 4 5 fl Professions Code): City Tel. No. 092 1 -83 ❑, I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section , I 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 (See. 3097;Civ. C.). Lender's Name Lend'er'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 l1-11471A AIJMP- 'Sigriatur-e.of Permitte Date WORKERS'COMPENSATION DECLARATION 1 APPLICATION FOR PLUMBING PERMIT I hereby affirm 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 f e c BUILDING AND SAFETY .Policy No. Company Certified copy is hereby furnished. BUILDING. �7p ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) gDDRESS6! G A�eS•[I1'1M0 nI Certified copy is filed with the county building Inspec- tion department. NUMBER FIXTURE OR ITEM ® FEE. �,I LOCALITY / •� � WATER CLOSET r'�PIC Date Appligant NEAREST ` CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. %51fW . yamYaw. [✓c oxx COMPENSATION INSURANCE OWNER EtV,� E. (This section need not be completed if the work involved by SHOWER MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS �A• �� I certify that in the performance of the work for which this q permit is issued, I shall not employ any person in any manner SINK CITY _� t[FjJ TEL.NO: 9l�OS.? -so as.to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR /Date Applicant I CLOTHES WASHER ADDRESS 0 NOTICE TO APPLI ANT: •If; after making this Certificate of �� y Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAW N'SPRINKLERSYSTEMI CITY TEL.� t`' TEL'NO.q�a 'T •o with comply with such'provisions or this permit :shall be STATE: LIC. deemed revoked.. WATER HEATER LICENSE NO. 157CLASS COO-7 LICENSED CONTRACTORS DECLARATION DISTRICT NO. OCES8ED B, I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS !O ,�/ (commencing'with Section 7000)'of Division 3 of the Business OUTLETS OVER Q and Professions Code,and my license is in full force and effect. 5 PER SYSTEM' FINAL cf DATE �!-"s , '" VALIDATION 0 License Number `DS Lic: Class�0��W BG FINAL ContractorDate ; BY ❑ Ise I am exempt under Sec. L 464 B.BP.C, for this reason Plan check fee i G 1 9 A Date: PLUMBING PERMIT ISSUING.FEE'$ 0 0 0 0 Signature TOTAL FEE i� 2 o o 1 c 5 D Plan check applicant SINGLE FAMILY ";° ° Q:s HOME OWNER-BUILDER DECLARATION Name ) j L _ v I hereby affirm that lam exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ 1, as owner of the property, will do the work and the structure is.:nof intended or offered for sale (Section ®, 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 Rabo 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 TSignature of Permittee Date