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Home My Public Portal About5017 SERENO DR_Plumbing__ T.A«TAIa; aTAPTPLICATION FOR PLUMBING PERMIT BUILDING AND SAFEEW DIVISION �.�+p�+�,y� T� FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING SO17 SERII4D 111\. NUMBER FIXTUREOR ITE O FEE WATER CLOSET LOCALITY BATHTUB NEAREST CROSSST SHOWER J, OWNER AIAIORREP ROSA LAVATORY MAIL ADDRESS SME SINK CITY rrryTEL NO 986�401-2 DISHWASHER CONTRACTOR 1rIRANE HCC CLOTHES WASHER ADDRESS 2034 N. PECK RD. SWIMMING POOL RECEPTOR CITY S EL TEL NO - 82 LAWN SPRINKLER SYSTEM STATE LIC WATER HEATER LICENSE NO 265 CLASS 1 GAS SYSTEM E 1 OUTLET � DISTRICT NO -G�R^OUP �ZOyNE PROCESSED BY 50 PERSYSTEMR f s INDUSTRIAL SOLY J� Ets WASTE APPROVAL Goa INSPECTION RECORD T—"0 G - Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE LO 00 Plan check applicant Nome APPROVALS DATE INSPECTOR S SIDNATURE UNDER SLAB WORK Address ROUGH PLUMBING Coy Tel No GHS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AMLIUTNIN AMD STATE GAS VENT THAT THE ABOVE 15 CORRECT AND ACME TO COMPLY W"ALL COUNTYND OINANCES AND STATE LAWS IIEGULATING PLUEIeING HOT WATER HEATER I HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AMD/M MERMO M PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OP IFMNIA M THAT I W THE GAS TESZ` LEGAL OWNER OF AMD INTEND TO RESIDE IM M DE [SED RESNIENTIAL PROPERTY UTILITYCO NOTIFIED • 3t /j FSIGNATURE Al • • • OFPRRIA RER FINAL 2/ PLAN CHECK VALIDATION CK No u w PERMIT VALID,f IEZp O • � mo cASH co O O Ut :t- CH CFI 76A667 CEA 117 6-65 ✓O p ^, It"'"-1�"\ I f7 \1 �_� , APPLICATION FOR PLUMBINGOERMIT7--'� COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FAUDDIM.JOHN A LAMBIE COUNTY ENGINEERCOLEMAN W JENKINS SUPT OF BUILDING Y -T-c- MFOR APPLICANT TO PIIS IN TNUMBlR PIxTURE OR ITCH lACX P[! YWATER CLOSET BITSBATH TOS 173 So 111 NO BNOWE[ 173 b e.l TEL NO �T 6�b1Z LAVATORY 175 CONTRACTOR" {VRCkrkel BINE 175 ADDRI'JBB 6920 CSR, IBD DISHWASHER 175 -CRY Tlc- ( Y TEL Notr)b LAUNDRY TOB 175 STATE LIC LICENSE NO LI 1898 CLASS CLOTHES WASHES 173 DI ST3{GT El0 OR ep ;gill[ 27m OV WATER HEATER 1 iP o :7 , C/�7 till/ OAS SYSTEM OUTLETS I w HNDUSTRtAL WASTE APPROVAL O OUTLETS OVER S PER SYSTEM 5E INSPECTION RECORD u a N Z APPROVALS DATE INSPECTOR&SIGNATURE PERMIT S 21 OO UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HKMBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IB CORI6CT AND AORDE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING I HE My CERTRY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LIC[NSEO AS REQUIRED BY LOS ANGELES C)RUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWN[ OF AND INTEND TO RESIDE IN THE ABO VS DESCRIBED BESIDE IA P Rry UTILITY CO NOTIFIED SIGNATURE �e \ a OF PERMITTE! VW�+ FINAL V)UMATION CK M O CASH =� LAC03 0 118 JLN23 5 D 3.50- p I 1 Dthat I e" a certificate SOTION DECUsent t/ 7 °P^r5r� APPLICATION FOR PLUMBING PERMIT trot 1 hew a cenllicate of caneent to elf Insure or Of Worker's Compensation Insurance, or a certified wpy 3800 Lab C) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV Policy No Company ❑ Certified Copy is hereby furnished! FOR APPI.ICAHT TO FILL IN(PRINT OR TYPE) ABUILDING DDRESS O �7 C ❑ Cwacopy b filed with the coumy,building Inspectiondepmtmtrnent NUMBER F0cTU11E OR RDI O FEE LOCALITY Data Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WOPoKERSCROSS ST COMPENSATION INSURANCE BATN 7UB MASSESSOR AP PARE PARCEL (This sectiom n need not be completed If the work Involved by the SHOWER O permit Is for orra hundred doth re($100)or Isle I OWNER 1 certify that In the Performance of the work for which this permit LAVATORY 0 r is issued I shall not employ any person in any manner so a to ADDRESS 88 L become sublect to the Workers Compensation Laws - aSWASNER c 9 Date ApplicantCLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT 11tafter making this Certificate of Exemption you should become subject to the Workers Compensation SWIIAMINO POOL RECEPTOR provisions of the Labor Code you must forthwith comply with such ADDRESS provisions or this permit Mall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NO I hereby affirm that I em licensed under provisions of Chapter 5 WATER HEATER (commencing With Section 7000)of Division 3 of the Business and STATE LIC Professions Cada and my license Is In full force and effect OAS SYSTEM OUTLETS LICENSE NO CLASS OUTLETS OVER DL4TRICT NO ESSED BY a PER SYSTEM O License Number Uc Claes ALIDATION Contractor Date W DATE N ❑ I am exempt under Sec BFINAL Z B aP C for Ude reason a Data Plan check fee , 9fpnatum PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE SINGLE FAMILY Plan Chock apPlicam 5 NOME OWNER-BUILDER DECLARATION Name Miof ACCT.i I hereby all m irm that I sm exempt frothe Contractor•License Lew for the following reason (Section 7031 s Business and Professions Address7 CA 3307 35.5] Code) S 1 ITEtf� ❑ Tel No I es r ct owneInastrstructuregerty will do the wort and the structure Is not Intended or offered for sets (Section 7044 Business TOTAL 35 - 50 and Professions Code) , MCK-� 35.50 CONSTRUCTION LENDING AGENCY /4nG I hereby affirm that there Is a wristructlon lending agency Ise the owe Performance of the wok for which this permit Is Issued(Sec 3087 Civ C) �� G000-1 11 1/ I.wl :,tI der.NseM 4915 1 AM 3:41 LencWs Addres I cenly that have reed this application • state thaolte abo 100.information Is correct I agree to comply with all County ordinenc es 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