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Home My Public Portal About5022 SULTANA AVE_Plumbing__ saes n rw ® APPLICATION FOR PERMIT DEPARTMENT OFDING AND SAM COUNTY OFF LOS ANGELES WILLIAM J FOX CHIEF ENGINEER ,I PLUMBING FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE, F; S � PLUMBS TJJRH LVED BY READY FOR DATE ISSUEDr FIRST INSPECTION ADDRESS / BUILDING CITY TEL NO ADDRESS kS COUNTY LOCALITY LICENSE NO EXPIRES NEAREST PERM FEES CROSS BT Numilzu TY"01 FISTURR OR MM FEE DWNER let. le MAIL WATER CLOSET TOILET O SO ADDRESS BATH TUB a O 30 L.,ro Clry T L NO SHOWER @ O EO 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY IWAGH BASIN O SO APPLICATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN BINK O SO STATE LAWS REGULATING PLUMBING 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOG LAUNDRY TUB R AY O SO ANGELES COUNTY LICENSE OR 1 M THE LEGAL OWNER OF THE RESIDE IAL ROPERTY D RI D ABOVE OAG SYSTEM zlo,OUTLETS O EO SIGNATURE OF WATER HEATER 0 O SO PERMITTER SLOPSINK a 050 INSPECTION RECORD PLAORSINK a O SO fY0 ,.✓ �f1r . _ BOOR DRAIN a O SO r DISHWASHER 050 DRINKING FOUNTAIN 050 C; URINAL O SO C 0AWA/ „J HOUSESEWHR O SO Q e�J _Z M.I.SCIELLANEOUS _ 0 O ZG APPROVALS DATE Iwv[ R• KAMR ROUGH PLUMBING OAS PIPING GAS VENT CEGSPOOL a 100 CESSPOOL SEPTIC TANK SEPTIC TANK DRAIN ( ) PIT ( ) ® tool OmSR PERMIT 1 OO GAB TEST TOTAL FEE UTILITY CO NOTIFIED G ,/ I DO FINAL v i vuee-i tv n-+. APPLICATION FOR PERMIT ! DEPARTMENT OFAND SAFETY PLUMBING �� ' COUNTY LOS LOS ANGELES WILLIAM J.. FF FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRlr-T /_ /J / PLUMBER RGDY FOR ` PERMIT(Q 7 RECEIVE (F, READYPECTION DAT[ /1 [D ADDRESS l n BUILDING S k . CITY TEL No ADDRESS COUNTY LOCALITY LICKMax No PEXPIRER EST PERMIT FEES CROSS SST NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER WA \ tX MAIL �� A WATER CLOSET(TOILET) ® 050 B MAILADDRESS A AI BATH TUB O 50r CITY O TEL o` ♦+ SHOWER 060 1 HEREBY ACKNOWLEDGE THATJI HAVE READ THIS LAVATORY (WASH BASIN) O 6O APPLICATION AND STATE THAT TH ASOVC IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN BINK O 50 AND STATE LAWS REGULATING PLUMBING 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOB LAUNDRY TUB OR TRAY 050 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. a" SYSTEM- -uTLETS ! O SO (� 1 SIGNATURE OF WATER HEATER ® 030 PERMITTE SLOP SINK (m 050 INSPECTION RECORD FLOORSINK ?ng FLOOR GRAIN ® O SO DISHWASHER ® Deal DRINKING FOUNTAIN 05a URINAL ® O SO J a 140USE SEWER ® O 60 Z MISCELLANEOUS m I APPROVALS DATE INEPEDTOR•e Itl1ME ROUGH PLUMBING GAG PIPING GAB VENT CESSPOOL IO0 CESSPOOL A I SEPTIC TANK SEPTIC TANK !! DRAIN ( ) PIT ( ) ® l 00 ISEWER I PERMIT 1 Do a" TEST TOTAL FEE UTILITY CO NGTIFIED ! '/j u I' FINAL r a9 rb WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 204018 DPW 8/87 insure or a certificate of Workers Compensation Imurance, 76A667A , 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 ' 1 ❑ PORAPPLICANT TO FILL IN(PRINT OR TYPE) a BUILDING — �• lik Certified copy fled with the county budding rnspec- ADDRESS 0 ZZ J � 7 /VA non department NUMBER FIXTURE OR nEM ® FEE LOCALITY Date Appligant WATER CLOSET zau NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER �.T(^/ O (This stolon need not un creel kitteddolga M The workilnvolred 6T MAIL r0 Z _ S ISE L�ie}�/ the jsermM k for terse hundred Boilers($100)or; LAVATORY J I certify that d the performance of the work for which this SINK CITY L `ry- .P TEL N024 Z.-75 permit is issued, shall not employ any porion in any manner a so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR • Date '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- CITY TEL NO with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC deemed revoked WATER HEATER LICENSE NO St,^oCCLLAS-S - LICENSED CONTRACTORS DECLARATION DISTRICT bp D BY ` I hereby affvm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS � C (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER yy and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION O. License Number Lic Class10 1*0 27 D DATE 1I^ _1 / O FINALfY Contractor Date BY &ZC7rs ❑ I am exempt under Sec Q ItO��jj7 B dP C for this reason Plan check fee , Z Date PLUMBING PERMIT ISSUING FEES Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Nome A�C r.t I hereby affirm that I or;exempt from the Contractor s Licerue Address _oU7 s.YIJ Law for the following reason (Section 7031 5, Business and - - Professions Cade) City Tel No 1 I T EM_ u} 1, as owner of the property will do the work and thec 35 structure is not intended or offered for sale (Section 101 AL 35 . 90 7044, Business and Professions Code) , LASH 71•9c• CONSTRUCTION LENDING AGENCY ' ' •I hereby affirm that there is a construction lending agency for i-HhN1 ,iJIJ the performance of the work for which this permit is issued (Sec 3097, Civ C ) r Lender's Nome C(CI(Ilf-13G111 SL/ 7/91 baY§ Lender s Address I AM 3.57 I certify that I have read this application and state that the above information is correct I agree to comply with all County Poo ordinances and State lows regulating Plumbing and hereby authorize reprelentatives of this County to enter upon the above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE u� c '' �7! / Signature of PermiLlse W Date VYORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I Tiareby affirm that I hove o cenficate of consent to self 20 a026 DPW 6/87 insure or a cerhhcate of Workers Compensation Insurance, 76A667A or%certified copy thereof(Sec 3BD0, Lob C ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS P❑olfcy No - Company r Certified copy ,s hereby furnished ^� ❑ f-0R APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county bwldmq impec ADDRESS non department NUMBER FIXTURE OR ITEM LOCALITY G Dote Appllgant = WATER CLOSET7. - NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER c, (This section need not be completed R the work Involved by MAIL the permit Is for one hundred dollars ($100)or Ins) LAVATORY I ADDRESS 6 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 CITYligvtw TEL NO so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER _2if ADDRESS � NOTICE TO APPLICANT If offer making this Certificate of • Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR CITY TEL NO Compensation provisions of the Labor Code you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER - LICENSE NO CIPSS LICENSED CONTRACTORS DECLARATION DSTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS O (commenting with Section 70of Division 3 of the Business OUTLETS OVER v' 'rD a yy and Professiom Code,and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION p: License Number L is ClossDATE r_ -qJp FINAL U Contractor Date BY lQ� ❑ I am exempt under Sec B BP C for this reason Plan check fee Dote PLUMBING PERMIT ISSUING FEE E s!`OPilo z z Signature TOTAL FEE .rrD Plan check applicant y SINGLE FAMILY r�_t.� .♦ HOME OWNER BUILDER DECLARATION Name 37,07 JD7 cl7 ry`j I hereby affirm that I am exempt from the Contractor's License Address Low for the following reason (Section 7031 5, Business and 1 ITEMS Pr esaons Code) City Tel No ITOTAL 57 -50 IL/[x'IJI\ , as owner,of the property, will do the work and itis structure is not intended or offered for sale (Section ► 70" Business and Professions Code) (HECK 711.7,13 CONSTRUCTION LENDING AGENCY C 041 .[QI I hereby off Inn that there is a construction lending agency for the performance of the work for which this permit is issued t (Sec 3D97 Civ C ) Lender s Name 70>31 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 ordinance Ad State lows, egulating Plumbs and hereby authorize %lent ves f this County to titer on the e-me o Oper fa fnspechon par s C% SEE REVERSE FOR EXPLANATORY LANGUAGE 1 Sigrw ur mee Do ' ,