HomeMy Public PortalAbout5066 1/2 SERENO DR_Plumbing__ 63
TBAeeT,CCBeif "APPLICATION MB N FOR P ERMIT"
LU I�
COUNTY OF LOS ANGELES �
DEPARTMENT OF COUNTY
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JOFNLyE HTCI �D�
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
FOB APPLICANT TO FILL IN NET
NUMBER FIXTURE OR ITEM EACH FEE
OSS ST
OWNER
WATER CLOSET 8125 NAD.
I MATH TUB 125 ADDRESS
1 SHOWER 1 S CRY TEL NO b
LAVATORY 1}S ,CONTRACTOR
am 1 n , ADDRESS
DISHWASHER Iib CRY eV TEL No o O,
LAUNDRY TDR 145 CONTRACTORS ® STATE
REGISTRATION NO v COUNTY
CLOTHES WASHER I4S DISTRICT NO GROUP ZONE P C D BY
WATER HEATER ISO .�
a
-GAS SYSTEM OUTf.ETB 1 WULL
ASTEAPPROVAL ~ 0
OUTLETS OVER S PER SYSTEM m INSPECTION RECORD
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2
GfF ,Isr I a;t z
APPROVALS DATE, INSPE�OR a SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING N
TOTAL FEE / 00
GAS PIPING
1 HEREDY ACKNOWLEOG[ THAT I HAVE READ THI[ APPLICATION GAS VENT
AND RAT[ THAT THE ABOVE 1/ CORRECT AND AGRQ TO COMPLY 1
WITH ALL COUNTY OADIMANW AND "AM LAWS REGULATING
PLUMBING HOT WATER HEATER 5 ioT' A
I HERESY CERTI FY THAT 1 AM PROPERLY REGISTERED AND/GR PLUMBING FIXTURES C
LICENSED AS R[OUIR[D BY LOB ANGELED COUNTY AND STATE OP GAS TEST `
CALIFORNIA OR THAT 1 AM THE L[OAL OWNER OF AND INTEND TO
RESIDE IM THE A&OjZ RUIDENTIAL• KIRY
UTILITY CO NOTIFIED
SIGNATURE ,{ nL
OF PERMITTEE FINAL /va/.9
/VALIDATION ROBERT A OOD
M o cAfH SUPERVISING MECHANICAL ENG R
L1io4 6 9 2�-6 JPA 21 5 D 1 5.00~ v
WORKERS'COMPENSATION DECLARATION 76AGVA
[ hereby affirm that I have a certificate ofconsertt to self es0„1"o) APPLICATION FOR PLUMBING PERMIT
insure or a certificate of Workers'Compensation Insurance or
a certified copy thereof(Sec 3800,Lab C) 7
p COUNTY OF LOS ANGELES/ / � BUILDING AND SAFETY
PoifW�7 cPy Flo Q51A 9 9 Company VQmnnt
❑ Certified copy a hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
Certified copy n filed with the county budding inspection NUMBER FIXTURE OR ITEM FEE ADDRESS
It me WATER CLOSET LOCALITY Temple, City
DateApphcanl Kamor Alr COR(1 NEARE T
BATH TUB CROSS ST
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE SHOWER OWNER
MAIL
(This section need not be completed if the work involved LAVATORY ADDREss; 50605 Sereno Dr. >-
by the permit s for One hundred dollars ($100) or less) SINK CITY TEL NO IL
Templt-
1 certify that in the performance of the work for which this DISHWASHER CONTRACTO 28 43 C�1
permit o Issued. I shell not employ any person in any manner cc
so as to become subject to the Workers'Compensation laws CLOTHES WASHER O
ADDRESS Ur
Date Applicant SWIMMING POOL RECEPTOR
60 N- Ann r�ahrif-1 Rlurl -
NOTICE TO APPLICANT If, after making this Certificate of CITY Pasadena TEL NO79575
1
Exemption, you should become subject to the Workers LAWN SPRINKLER SYSTEM U)Compensation provisions of the Labor Code, you must forth- STATE LIC Z
sbith comply with such Provisions or this permit shall be
WATER HEATER LICENSE NO CLASS —
deemed revoked 1 GAS SYSTEM OUTLETS DIB�T NO PR CESSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER 6 00
I hereby affirm that 1 am licensed under provisions of Chapter 6 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Bust FINAL _� _�,S VALIDATION
ness and Professions Code, and my license s in full force and DATE t� f,F
effect
License Number 165064 Lic Class C-70 BY
FINAL (7
Contractor Kamor Air Dale 9/16/83Vf sem•.
I am exempt from the licensing requirements as I am a Plan Check fee �-/ ��
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ '
acting in my professional capacity (Section 7051, But
mese and Professions Code) TOTAL FEE 16 50
Lic or Reg No Date Plan check applicant 5.3 9 9 A
HOME OWNER BUILDER DECLARATION Name
I hereby affirm that 1 am exempt from the Contractor's Address
License Law for the following reason (Section 7031 5, Bust- City Tel No 2 i • 1 650
ness and Professions Coda) • • • 16506
El1, as owner of the property, am exclusively contracting
with licensed contractors to construct the project 0.9,2 0—8 3
(Section 7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCY ,
I hereby affirm that there is e construction lending agency
for the performance of the work for which this permit s
Issued(Sec 3097,Civ C) ,
Lenders Name
Larder's Address
I certify that I have read this application and state that'the
above Information is correct 1 agree to comply with all County , SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing and hereby '
euth nze representatives of this County to enter upon the
a e e ioned pro tn ,Iy spection purposes '
J�/ n �i ,LJ
gn tur ear ItteeDate