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Home My Public Portal About5074 SULTANA AVE_Plumbing__ ,► ''�'. TewesT B®1, tl-ED APPLICATION FOR PERMIT DEPARTMENT COUN T OF II OS A G AND SAFETY PLUMBING CODNTY . F LOS ANGELES WILLIAM .1. FOX. OHI[F [NGIN[[q FOR APPLICANT TO FILL,�II(N�� PLUMBER RECE D BY READY FOR DAT[ IOBUED FIRST INSPECTION ADDRESS C O♦ I CITY TEL ESS No J j��j ADDR COUNTY A �d ` LOCALITY LICENSE No !r r NEAREST PERMIT FEES CROSS BY NUMBER TYPE OF FIKTURE OR ITEM FEE OWNER �7 MAIL WATER CLOSET(TOILET) a MSG B ADDRESB BATH TUB U50 CITY TEL, NB SHOWER B O 6D I HQR[BY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) @ 050 APPUCATION AND lrr^TX THAT THE I'3RRRO I IN" AND AGRQ TDO COMPLY WH ALl QO R IE EB KITCHEN BINK O 050 / AND STAT[ LAWS q[GU D PMB IN4 LAUNDRY TUB OR TRAY 050 / ANO[OLES 0'Up, THA IOENP8SS D OS AM TSw[ AL D ER OAS SYSTEM UTLETB @ O 6O OF THE REBID IAL E D[BC D AS BIONATUR[ • '— WATER HEATER O 60 PERMI BLDP SINK O O 6D INSPECTION RECO FLOOR BINK 0 DSO FLOOR DRAIN Q 4BD II DISHWASHER @ 0.60 AI S�8 L DRINKING FOUNTAIN O O.SO Lt0—iS �7 URINAL ® O 60 'a .SAN J a HDuge BeweR im 050 p AC 6 _Z MISCELLANEOUS NO S�..iG ♦AJST a � APPROVALS DAT[ 1 •e NAME ROUGH PLUMBING OAS PIPING OAS VENT CeBSPOOL ! ton CESSPOOL SEPTIC TANK. SEPTIC TANK DRAIN ( ) PIT ( ) @ 1 OD I SEWER PERMIT , GAB TEST IO/S/Yj UINALTILITY DO NOTIFIED O �-� TTAL FEE B 0 I 715 � DBB IT 11 APPLICATION FOR PERMIT DEPARTMENT COUN OFF LOS NG AND SAFETY PLUMBING C ILLIAM . F LOS ANGELES WILLIAM J. FOX, aHl[r ENGINEER . 1rmmmlg mu. FOR APPLICANT TO FILL IN -c6r l PLUMBER /r R[O[IY[D BY FIRREADY FOR ST IN Ml t"DAT[ IWU[D ADDRESS _ /o X23�S ADDRESS G' OITY TEL.No ADDRWB COUNTY f LOCALITY LICEMBE NO FXPIRrA PERMIT FEES DRaBaHr NUMBER TYR OF FIKTIItt OR ITEM F[[ OWNER MAIL WATER CLOSET(TOILET) @ O Bo B ADDR[HB BATH TUB @ O.SO CITY T[L No BNOWER @ 000 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIR LAVATORY (WASH BASIN) @ 1350 APPLICATION AND STAT[ THAT THE ABOVE IB CORRECT AND AGREE TO COMPLYCWITH ALL COUNTY GRDINANO[S KITCHEN BINK @ 0.50 - AND STAT[ LAWS REGULATING PLUMBING 1 CERTIFY THAT'1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.60 ANGELES COUNTY.LIC[MBE, OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVL GAB BYSTICM OUTLETS @ n5O �) BIGII NATR[ OF / WATER HEATER @ Ow PERMITTEIC SLOP BINK @ DSO INSPECTION RECORD FLOOR BINK @ 0.50 _ n FLOOR DRAIN @ 050 DISHWASHER @ 050 1 Tey TS DRINKING FOUNTAIN @ O BO URINAL @ 050 Q HOUBE SEWER @ 050 ^ - Z MIBDCLLAN[OUB 1 C i Q^ APPROVALS ' DAT[ IN we NAMt ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL ' @ ICO 0 CESSPOOL SEPTIC TANK SEPTIC TANK DRAIN ( ) PIT ( ) @ Ion SEWER PERMIT I.00 G'A'S TEST UTILITY 06 NOTIFIED,-• �- '�_ .�^ TOTAL FEE B FINAL T = WOR ereby, affirm Kthat t have COMPENSATIONDECLARATIONfconsent self m �AM APPLICATION FOR PLUMBING PERMIT sure,or a certificate of Workers'Compensation Insurance,or a 76A667A - �7 certified copy thereof(Sec 3800, lab C ) �IILJIII -- COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No Company ❑ Certified copy is hereby furnished APPLICANT E:] Certified APPLICATO FILL IN(PRINT OR TYPE) / Certified copy is filed with the county balding inspection ADDRESS (/ bil..u✓ department NUMBER FIXTURE OR ITEM B FEE LocnLm Date Applicant - WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed B the work Involved by MAIL the permR A for one hundred dollen(fI00)or less) LAVATORY ADDRESS .5.77 1 certify that in the performance of the work for which this perSINK- mit is issued, I shall not employ any person in any manner so CITY TEL NO as to become subject to the Workers Comperuotion a DISHWASHER CONTRACTOR Date—3m Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Worker'Coni cry p / .�r� A satan provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS i 4..4 /C ly with such provisions or this permit shall be deemed revok- STATE UC ed WATER HEATER - / LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION G DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS y 9(commencing with Section 7000)of Division 3 of the Business OUTLETS CHER 'DO Z and Professions Code, -land my license is in fullforceand ef- 5 PER SYSTEM B fectDATE VALIDATION Y zn License Num pyo/ Lic Cl= /� Contractor �'si Q e'� (J BY� .CTvt tJ 3 43.4(p I am exempt under Sec 1 ITEMS W B 8P C for this reason Date Plan check fee ► TOTAL 43 4CJ PLUMBING PERMIT ISSUING FEE f CHECK Signature 43.40 /�,LfJ � .00 SINGLE FAMILY TOTAL FEE- HOME OWNER-BUILDER DECLARATION Plan check applicant - I hereby affirm that I am exempt from the Contractor s License Name Law for the following reason (Section 7031 5, Business and 0"0001 3/14/96 Professions Code) Address 1 AM 9%49 1, as owner of the property, will do the work and the City Tel No structure is not intended w offered for sale(Section 70", _ Business and Professions Code) Poo.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, Gv C ) Lender s Name - - Lenders 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 State jaws regulating Plumbing, and hereby authorize representaty, s of is County to enter upon the above menooned ope1h Inspection purpoVs I 9� SEE REVERSE FOR EXPLANATORY LANGUAGE nature of P rmittee Date