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Home My Public Portal About5034 SERENO DR_Plumbing__ 176A667 CE317 12/59 C / APPLIgCA ION FOR UMBING PERMIT DEPAR ■8F/ Ca■OaUnNaTaYTG{�� GINELES m B LAM91E.�RCOUNTY CNgrim �Rr WILLIAM A JENBHN, BGP T GP BAt�, LD1xD LOCALITY FOR APPLICANT TO F= IN NEAR= CSOBB ST NUMBER FIXTURHORITEM OWNER WATER CLOSET NIU, ADDRESS HATS TUB CRT TEL NO 880WER LavaroaY CONTRACTOR SDR ADDRESS DISHWASHER CRT Ecoulm LAUNDRY TDB REGISTRATIONNO CLOTHES WAR® DISTRICT GROUP NE "BED 13 WATER HEATER A GAR EYE= DIP08TRULL WARTE APPROVAL HISPECTION RECORD &. O C U MI .3 $DGS s APPROVALS DATE INSPECTOR 991GNATURE PERMIT S Y GO UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING OAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAV11 READ THIS APPLICATION OA8 VENT AND STATE THAT THE ABOVE IE CORRECT AND AGREE TO COMPLY VITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED ANWOR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAB TEST OR THAT 1 AN THE LQ OWNER OF THE ABOVE DESCRIBED RESIDENTIAL P PEBTT UTILITY C0 NOTIFIED SIGNATURE OF PHRMITFE FINAL mr OVALIDATION ROBERT A WOOD. C[ ■ 0 CA® SUPERVISING MECHANICAL ENO R LAC09852S DEC 15 5 D 3.00 7SlY1S/�EBIY a-SB Or�1�y7 i� �� APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGDIEES BUILDING AND SAFETY DIVISION DD7G ttoeNA. LAlmIR Cemt� LUnDCABBATT D GRIFFIN, 8- 1 of Bmldtoq FOR APPLICANT TO FILL IN NZoe� NUMBER FIXTURE OR ITEM OWITEH WATER CLOBRT � HATH TOB ADDRESS SHOWERCRS TEL NO. • LAVATORY CONTRACTOR SRT[ ADDRESS DISHWASHER CITY NO. — CONTRACTOR LAUNDRY TUB REGISTRATION NO ZZ � COONTS CLOTS WARREN DISTRICT NO I GROUP I EBBED 13Y WATER HUM GAB SYSTEM UTDDeTmn WASTE APPROVAL arePEcnoN RECORD ' G ' d• c 1 0 51w $ EO r VALE T8 INSP CTOR S SIGNATURE PERMIT f Y 00 UNDER SLAB WORK !090 TOTAL FEE J9 44) ROUGH PLUMBING GAB PIPING I HEREBY ACKNOWLEDGE THAT 1 HAYR READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOYE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER 1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS RKOUIRED BY LOS ANG B COUNTY AND RATE OF GAB TEST CALIFORNIA OR THAT AN THE AL OWNER OF THE VE DESCRIBED RKSIDKMTI PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMI FINAL m• /'fAMATION ROBERT A WOOD. a j/ N 0 G® SUPERVISING MHCHANICAL ENG*R LP',,o7005 � �LP -27 5 0 y,LIV 4 C WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I h4 um that I hope o certificate of consent to self in 776 667A 4/B7 ti sure,or certificate pf Workers'Compensation Insurance or a CE 817(REV 8/86) , combed Copy thereof(Sac 3800, Lab C ) � - COUNTY OF LOS ANGELES DEPT .OF�PUBLIC WORKS Policy No Company I .A Certified copy is hereby furnished s FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING p S �,V d9,e�v Certified copy is filed with the county building ADDRESS department NUMBER FIXTURE OR I7HA @ . FEE LOCALITY 04 Date Applicant WATER CLOSET(TOILET) NEAREST T CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS Si G COMPENSATION INSURANCE SHOWER OWNER C f /I64— (This section need net be completed If the work Involved by MAIL the permit Is for one hundred dollars($100)or less ) , LAVATORY ADDRESS - y,ri..f r Z I certify that in the performance of the work for which this per SINK CITY TEL NO mit is issued I shall not employ any person in any manner so as to become subject to the Workers Co pensabo Laws DISHWASHER CONTRACTOR C Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making th Ce ficate o Ex ADDRESS emphon you should become subject to the Workers Compen SWIMMING POOL RECEPTOR CIU TEL NO sohon provisions of the Labor Code you must forthwith comp- LAWN SPRWKLER SYSTEM ly with such provisions or this permit shall be deemed revok STATE / LIC ed WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS I o U 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER ° 0 fed Professions Code and my license is in full force and of 5 PER SYSTEM FINAL VA ATION 1 DATE 0 License Number_L.c Class V FINAL j= Contractor Date BY O r n H ❑ I am exempt under Sec B 8P C for this reason Plan check fee , t ( % D 1` z Date PLUMBING PERMIT ISSUING FEE 1 Signature _ TOTAL FEE SINGLE FAMILY L HOME OWNER-BUILDER DECLARATION Plan check applicant i5a I hereby affirm that I am exempt from the Contractor s License Name Low for the following reason (Section 7031 5 Business and 'n' Professions Code) Address S c+7v O �sQy(/Tr I as owner of the property will do the work and the City C+�Z' Tel No _2�S structure is not intended or offered for sole(Section 70", �� Business and Professions Code) CONSTRUCTION LENDING AGENCY # I hereby affirm that there is a construction lending agency for c • • ° j the performance of the work for which this permit is issued • ) ° @4050 (Sec 3097, Civ C ), ° e ° 40505 Lender s Name 0309-88 Lender it 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 Stott laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the abov -mgnnone prop for inspec In purposes /6SEE REVERSE FOR EXPLANATORY LANGUAGE MLet Sign tore o Irte Date