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Home My Public Portal About5755 RIO HONDO AVE_Plumbing__ 7SA667-CE617 12/59 — 57v PM A1P1Z9Al#_w o- APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUII.DII Ca�AND ,SAFETY MSION BUII.D'NGL JOHN MBI COUNTY NGINEER ADDRESSOJI WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSETL BATH TUB ADDRESS CITY TEL NO. SHOWER LAVATORY CO TOS SINS ADDRESS DISHWASHER C TEL NO. �'Aj%V CO OR'S STATE LAUNDRY TUB REGIS TION N COUNTY ❑ CLOTHES WASHER DISTRlqj NO =SED BY WATER HEATER V GAS SYSTEM. INDUSTRM WASTE APPROVAL INSPECTION RECORD O V 09 O H ' V W a m ORFPER ITEM ZTT RE $ I / /J�� APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2100 UNDER SLAB.WORK TOTAL FEE I� 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 1 HEREBY CERTIFY TH I AN PROPERLY REGISTERED AND/OR PLUMBING FUCCURES LICENSED AS REQUIRED LOS NOBLES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THA A 7 LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENT LMLITY CO.NOTIFIED SIGNATURE OF PERMITT FINAL I98 VA IdOBERT A.WOOD, .0. ' CS. m.o. CASH SUPERVISING MECHANICAL ENG'R LK0 8 9 6 6,o .�i�v 5 0 3.00 �vORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby;pffIr n that I have a terti;icate'of consent to self 76A667A 'i�sufe,-ora certificate of*orkers'Compensation Insurance, CE 817(REV. 10/81) dr a"certllfed copy thereof(Sec. 3800, Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished.❑ BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspec- NUMBER FIXTURE OR ITEM tion department. @ FEE LOCALIT Date Appl igant WATER CLOSET NEAREST ' CERTIFICATE OF EXEMPTION FROM WORKERS' t52 BATH TUB no CROSS ST. COMPENSATION INSURANCE (This section need not be completed If the work Involved by SHOWER z Q OWNER the permit is for one hundred dollars($100)or less.) l LAVATORYIL D V ADDRESSO I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO�Q� so as to become subject to the Workers'Compensation Laws. DISHWASHER aa��cc��rr++ CONTRACTOR DateQk6AK Applican CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, afW making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT No. PROCESSED RW I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force an effect. 5 PER SYSTEM DATE C — VALIDATIOD 0 License Number Lic. Class 11 FIAO Contractor Date B Z., ❑ au W I am exempt under Sec. in B.BP.C. for this reason Plan check fee Z Date: PLUMBING PERMIT ISSUING FEE$ Q Q , :2 0 9 8.2 A Signature # 0 0 0 0 0 5 TOTAL FEE SINGLE FAMILY Plan check applicant o - 5250 HOME OWNER-BUILDER DECLARATION Name I hereby affirm.that I am exempt from the Contractor's License Address o 52505 Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. I (130-84 Er, 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 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 ��Id- D 2 gnature of Permittee Date f WQRKERS'COMPENSATION DECLAMATION APPLICATION FOR PLUMBING PERMIT ,•� I dl%reby a'firrrl*that I have a certifitate o consent to self 76A667A insure;-or a certificate of Warkers'Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. /y ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS 0 f;J Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Appli4ant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. 14C_ COMPENSATION INSURANCE SHOWER OWNER 7 (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESSrr A / 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/��j 4_� TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER TOR 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- LAWN SPRINKLER SYSTEM CITY TEL. NO. with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PRO SSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ^( 61 (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 ea. i DATE VALID . ON 0 License Number Lic. Class �r Z C9 FINAL Contractor Date BY 6tJ I am exempt under Sec. 1 G �.0 A B.BP.C. for this reason Plan check fee Date: S $} 0 0 0 0 0 5 PLUMBING PERMIT ISSUING FEE$ o Signature TOTAL FEE I a al 650 SINGLE FAMILY Plan check applicant o o o 1 6,5 0 5 HOME OWNER-BUILDER DECLARATION Name o 1,2 5—8 5 I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. 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). ;I 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-mentioned. roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 5i ifure of Permittee Date