The URL can be used to link to this page

Home My Public Portal About4937 SERENO DR_Plumbing__ 75A647A 1411, 61701 -4/17 1 ✓�L APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN[PRINT OR TYPEI BUILDING 7 NUMBER FIXTURE OR ITEMFEE ADDRESS .7 WATER CLOSET LOCALITY ` BATH TUB NEAREST CROSS ST SHOWER OWNER IVJ LAVATORY MAIL ADDRESS SINK CITY TEL NO DISHWASHER CONTRACTOR CLOTHES WASHER 1 ADDRESS SWIMMING POOL RECEPTOR j [AWN SPRINKLER SYSTEM Ott TEL STATE LIC WATER HEATER LICENSE NO CLASS Gam' GAS SYSTEM 5- 06 1 P ED BYM� OUTLETS DIS S rGROUP G SPER SYSOV R INDUSTRIAL K. WASTE APPROVAL INSPECTION RECORD CD N PIOn check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE 7 v Plan check opplKant Name APPROVALS DATE INSPECTOR S SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel No GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS"I ATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMELY ATTHI ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CER IF THAT I AM PROPERLY REGISTERED AND/OR LICENSED M PLUMBING FIXTURE$ REQUIRED BY LOS ELES COUNT AND STATE O CALIFORNIA OR THAT I AM THE LEGAL OWNER O INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL GAS TBT 7 / �ERTM UTILITY CO NOTIFIED SIGNATURE f oR PERM FINAL 3�I PLAN VALIDATION M 0 CASH PERMIT VALI TI / cA No cwsH 1 1 1�JAN �5 0 AS , TeAeeEA 1CB*gel I1/7e Y ' APPLICATION FOR'PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE( BUILDING y93 NUMBER FIXTURE OR ITEM 0 - FEE 1 ADDRESS WATER CLOSET LOCALITY ?2F BATH TUB NEAREST CROSSST SHOWER OWNER G6 LAVATORY MAIL ADDRESS • SINK Cltt TEL NO H DISHWASHER CONTRACTOR CLOTHES WASHER r ADDRESS C SWIMMING POOL RECEPTOR ClttC .� TELVNO LAWN SPRINKLER SYSTEM STATE LIC WATER HEATER LICENSE NO CLASS GAS SYSTEM OUTLETS DISTR�ICTTNO GROUP S/ Z E D O L $ R _ cog i 1� UT ET pyo INDUSTRIAL 5 PER SYSTEM WASTE APPROVAL V INSPECTION RECORD m O Plan check fee PLUMBING PERMIT ISSUING FEE E Q TOTAL FEE Plan dxxk applicant DATE INSFWORs swlutuRE 7272 Name UNDEkOM WORK Address ROUGH PLUMBING City Tel No GASPIPING I HEREBY ACKNOWLEDGE THAT I HAYS HEAD THIS A UCATION AND STATE GAS VENT THAT THE ABOVE S CORRECT AND AGREE TO COMPLY WITH ALL C W NTY ORDINANCES AND STATE LAWS MUTING P MBING HOT WATER HEATER I MEREST CE"IFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES MWKIED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL AMMERTY UTIUTYCO NOTIFIED SKINATURE OF PERM TREE FINAL '3 7 PLAN CHECK VALIDATION C51/ M 0 , PERMIT VALIDATION CB No CASH x6 4 2�SEP 7 5 D 1 3-5 0 A!�d U �E WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT eT H•Hb'3j,affirm that I have a certificate of consent a self 78A867A insure or a certificate of Workers Compensation Insurance CE 817(REV 8/88) ` or a certified copy thereof (Sec 3800, Lab C ) ' - COUNTY OF-LOS ANGELES DEPT OF PUBLIC WORKS Policy No Company Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(AUNT OR TYPE) BUILDINGADDRESS 1443 _2eizeA)o Certified copy is filed with the county budding inspec- tion department NUMBER FIXTURE OR ITEM ® FEE LOCAIIi>' Tse, e DoteAppliront WATER CLOSET NEAREST� CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS `�NG a�n � COMPENSATION INSURANCE ` n (This sectton need not be completed If the work Involved blr SHOWER OWNER _ p E� the permit Fs for oee hundred dollon ({108)or toss) IAVA70RY ADDRESS 7c3 J Gr MAIL I certify that in the performance of the work for which this S9Y S permit is issued, I shell not employ any person in any manner SINK CITY TEL NO Z-PS so as to become subject to the Worker'Comports on Lawa DISHWASHER ' p. CONTRACTOR Dote ` Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR Exemption you should become subject to the Workers Compensation provisions of the Labor Code' you must forth- Cm TEL NO with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTFM STATE LIC deemed revoked I WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATIONDISTRICT.NQ�/ By 1 hereby affirm that I am licensed under provisions,of Chapter 9 GAS SYSTEM OUTLETS L (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code and my license is in full force and effect S PER SYSTEM _- FDI AL ' VALID GN 0 ATE License Number Luc Clan Q FI p Contractor Dote BY F ❑ I am exempt under Sec 6 B 8P C for this reason Plan check fee 7 1 hill, i Gate PLUMBING PERMIT ISSUING FEE f Signature TOTAL FEE Plan check applicant T SINGLE FAMILY _ 1 HOME OWNER-BUILDER DECLARATION Name - I hereby affirm that I am exempt from the Contractor's License Address7 11._8 A • Low for the following reason (Section 7031 3, Business and Professions Code) City Tel No # • • • • • 5 ' I, as owner of the property, will do the work and the ( • • 2 255 0 i structure is not Intended w offered far sole (Section 70", Business and Professions Code) -.0'. 22505 CONSTRUCTION LENDING AGENCY - Q 7'2 3 1 8 7 I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097, Cw C ) Lender's Name Lender's Address I certify that I have read this application and state that the . _ ► above information is correct I ogres to comply with all County ordinances and State lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the oboe mentioned property for Inspection purposes EEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pormitfoo pot -