HomeMy Public PortalAbout5023 SULTANA AVE_Plumbing__ '°A'°'' � 17 7-31 1 APPLICATION FOR PERIM
DEPARTMENT OFNG AND SAFETY
COUNTY LOS ANGELES
WILLIAM J.OF
LOS FOX. CHIEF ENDINCER PLUMBING 1
FOR APPLICANT TO FILL IN _ 3/
PLUMB[q \ i'
"Clirfm S. SEAMY FOR DAT[ ISSUED
►IRST INSPECTION
EY
BG
envi TEL No ADDRESS
COUNTYf
NO 4 47 EXPIRES 0 LOCALITY
pp�
�� �n NEAREST nj
PEBJ Fit+re CROSB RT. 1p
NIIMS[R TIT[OI FIKTtIR[OR ITEM FCC OWNER
MAIL
WATER CLOSET(TOILET) @ 050 0 O
MAIL
BATH TUB @ CSO 0 CITY TEL ND
SHOWER @ CBC 1 HEREBY ACKNOWLEDGE THAT I HAV[ READ THIS
LAVATORY (WASH BASIN) @ 050 sv APPLICATION
ANDAGREESTATE ABOVE
TO OCMPLY WITH ALL COUNTYORDINANCES
KITCHEN BINK @ O SO AND STAT[ LAWS REGULATING PLUMBING
I CERTIFY THAT 1 POSSESS THE ABOVE VAUD LOS
LAUNDRY TUB OR TRAY @ CSO Q ANGELES COUNTY LIOENS[. OR 1 AM THE LEGAL OWNER
OF THE R501DENTgA.L PROPERTY D CRIBED ABOVK.
GAS SYBTE UTLETS @ 050 SIGNATURE OF
WATER HEATER @ O 60 Q P[RMITT[ n�
SLOP BINK @ 050 INSPECTION RECORD
FLOOR BINK @ 050
FLOOR DRAIN @ O BO
DISHWASHER @ D SC /
DRINKING FOUNTAIN @ 050
URINAL @ M BC a
HOUSE SEWER @ 050 Z
MISCELLANEOUS
O
APPROVALS
DAT[ 1NlKD ww NAM[
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ ICC CESSPOOL
SEPTIC TANKI REPTIC TANK
DRAIN ( ) PIT ( ) @ Iml I REWER
PERMIT 1 MD awe TEST
TOTAL FEE
UTILITY CO NOTIFIED
R O
FINAL
I
°f W °BE 19 7-61 APPLICATION FOR PERMIT I
DEPARTMENT OFNG ANSAFETY
CODN17 LOS D ANGELES
_ WILLIAM J.OF
LOS FOX, aHlcr cNGIN[ER PLUMBING 1
FOR APPLICANT TO FILL IN _ds �
R ••7 RGDY FOR
fIRRTINBP[OTICN
DUMB S_ C
BUILDING
CITY T /TEL NO ADORERS
Impigz1 B LOCALTrY Gr
PERMIT P8S8 Dwo•R Rr.S�/P.I�
MYMQ[ TIT[or nIRYlO:an ITEM FEE OWNER
+ MAIL
WATER CLOSET( ET'
TOIL ) @ 660 • ADORERS V[
OATH TUB @ 06O CITY [L No "J
SHOWER @ D60 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIR
LAVATORY (WASH BASIN) @ 0.60 APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN RINK @ 050 AND STAT[ LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE LOB
LAUNDRY TUB OR TRAY @ O BO ANO[ [
LEB COUNTY LICNR[,, OR 1 AM TN[ O
L[ AL VAL(OWNER
OAS SYSTEM nRTLiTp @ Opp OF THE RESIDENTIAL PROPERTY D[BOMBm AN
BIONATURE
WATER HEATER @ O 60
SLOP BINK @ 050
FLOOR BINK @ 0.60 3 i�
FLOOR DRAIN @ 0.60
DISNWA•HQi @ 0.60 An Q
Z
DRINKINO FOUNTAIN O coo C Awl i'
RIKAL O b6O 1
Q
Houes RCTY[w @ 0 6G _Z
MISC[LLAMEOUS _0
m
0
APPROVALS
DAT[ IMErEGTDE'E NAM[
ROUGH PLUMBING _
SAB PIPING
OAS VENT
CLBBPOOL @ 1.00 CESSPOOL
SEPTIC TANK( SEPTIC TANK
DRAIN PIT ( ) O I.DO SEWER
PERMIT 1 Do BAS TEST
W4_C UrluTY Q0.MOTFI[D
TOTAL FEE •2
INA
o�..r•, APPLICATION FOR PERMIT
ARTMENT OFF LOS NG AND SAFETY PLUMBING
COII AM . F LOS ANGELES
WILLIAM J. FOX. CHIEF CNOIN[[R
FOAPPLI RVTO FILL IN
PLUMBER READY rOR
R [I BY rIRSTINBPECTIOM FT,/
I -Sti
IF[BS
BUILDING
CITY T[L No ADDRESS
COUNTY LOOALrrY t P T
R
PER FEES %ROBQKARK6T
ROBS R.
"u— M[Or", UR[OR REM FCC OWNER
I
MAIL
WATER
CLOSET(TOILET) a Goo B rG ADOREBB
BATH TU
B a ago CITY TEL No oV
SHOWER a 0.60
I HSR[ON AND STATE
T THAT I HAVE READ THIS
LAVATORY (WASH BASIN) a 0313 APPLICATION AND STAT[ THAT THE ABOVE IR CORRECT
AND ABR[[ TO COMPLY N ALL COUNTY ORDINANDES
KITCHEN BINK a O BO AND STAT[ LAWS14 REGULATING POSBE PLUMBING
t CERTIFY THAT I POSSESS THE ABOVE VALID LOB
LAUNDRY TUB OR TRAY a ago ANGELES COUNTY LIC[NS[. OR 1 A TH[ L[BAL ER
BAB BYBTEM 3 nUTL[TB a O 6O `(`� GI THE RESIDENT R CBIBED ABw
SIGNATURE O►
WATER HEATER a ago P[RMI
BLOP RINK a Dan INSPECTIO
rLOOR BINK a ago q ��
rLOOR DRAIN a ago
{ DISHWASHER a ago
DRINKING ►OUWrAIN a 0.60
URINAL a 0.00 a
HOUSE BEWER a ago G���/�J� / _Z
MISC[LLANEOUR J
C
O
APPROVAL
ISAW HAMS
R UGH NpL"bK?BINLCf X10
BAB PIPING
OAS VENT
CESSPOOL a 1.00 CESSPOOL
SEPTIC TANKI SEPTIC TANK
DRAIN ( ) PIT ( ) a 1 W SEWER
PERMIT 1 DD BAB
TOTAL FEE TEST
UTILITY CO NOTIr1ED
B � -
FINAL
to _l�
WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
,I hereby offum that I have a cernconsent fi�ote of coent to self 200028 DPW 8/87
insure or a certificate of Workers Compensation Insurance 78A887A
or a certified copy thereof (Sec 3800, Lob C ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
Policy No Company ,
Certified copy is hereby furnished ` Q h
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BADDRRESS 5�%s 5 UL7AAJ Q A.V
Certified copy is filed with the county budding inspec
non department NUMBER FIXTURE OR ITEM ® FEE P
LOCALITYDate AppliSoni WATER CLOSET 10 ZY-1FF.4RE �nT T
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST Mr9 f�'�1 C#J D
COMPENSATION INSURANCE SHOWER OWNER p`�•'-� +jQ�J,�
(Thio section need not be consplefed R the work Imrolved by f S
the pernitt Is For one hundred dollars($100)or less ) LAVATORY MAILSS * _
I certify that in the performance of the work for which this ADDR
permit Is issued I shall not employ any person in any manner SINK Cm' TEL NO
so as to become subject to the Workers'Compensation Laws DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT If, after mating this the WADDRESS
SWIMMING POOL RECEPTOR
of r
Exemption you should become subject to the Workers CITY TEL NO
provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC
deemed revoked WATER HEATER LIQ NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS n P
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is In full force and affect 3 PER SYSTEM FINAL VALIDATION R
8 License Number L¢ Ctaw DATE =t
FI
Contractor Date FBy
I Pf CT.s
❑ I am exempt under Sec
B 8P C for this reason Plan check fee 1 ITEI'I_•
Date PLUMBING PERMIT ISSUING FEE$ �[ I i l'AL 68 . 4101 ?
0 0�7 S
SI nature TOTAL FEE S, CHEK 6S,Itci
SINGLE FAMILY Plan check applicant (MANGE .till
HOME OWNER-BUILDER DECLARATION Name
I hereby offum that I am exempt from the Contractor's License Address
Low for the following reason (Section 7031 3, Bua)ness and
PrItCode) City Tel No I rF:19L
LJ I, m owner of the property will do the work and the
structure is not Intended or offered for sale (Section
7044, Busmesa'and Professions Code)
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued
(Sec 3097, Civ C )
Lender's Name
Lender s Address
I certify that 1 have read this application and state that the
above information is correct I agree to comply with all County
ordinances and State lows regulating Plumbing and hereby s
authorize re stent 14es of this County to enter upon the -
a - e p ry for inspection pulopo
SEF REVERSE FOR EXPLANATORY LANGUAGE
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