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Home My Public Portal About5076 SULTANA AVE_Plumbing__ 7eAM7�7Io.w TELE CITY, c- APPLICATION FOR PLUMBING PERMIT f COIINTY OF LIANC,L13.F�_, DEPA�RpTMENT�OpF pr:�vGu�rrit $obi N LNO 5076 SultnnA A NRINrr�Nl aISI�ON D tm WILLIAM A JEEBBN. BDP r Or Bu1LDIMO LOCALRY FOR APPLICANT TO FILL IN >, E CEOSS BY NUMBER FDITURB OR ITEM OWE Gene Rislin2 ..WAffi CLOSET KAM BATH TUB ADDBEN CRY TE.NO. sHOWRR LAVATORY c0RTRACs0R Van Curen Plumbin � ADDBEBB DISHWA� - CRT TEL NO LAUNDRY TUBd7. szoansmON NO 191691 coUNrY 1 CLOTHES WARN® GIST/RIOT[N'oo ORO/U2. ZONE m BY WATER BEATER7i 0 7f .A 1 cm Bra= UWUST IAL WARTS APPSOVAL �. / nQPscnoN.BRconD d O 7 ° ogP ro� s APPROVALS 16AYE �INe=o•A164ATuFrKA1j11f� PERMIT S 2 00 UNDER SLAB WORK / TOTAL FEE ROUGH PLUMBING GAS PIPING 1 X%=X THAT TNLCOOt E 19 1 HAV[ FEAR THIS ArrLIGTION AND rtwT• THAT Tl1e ASov¢ IY CORA[CT wHD THIS To COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND RAT[ LAKY IROULATINO rLumaINO HOT WATER HEATER 1 R[NSEY CSRIrY THAT 1 AN PROPLRLx REOIRES[O AND/OR PLUMBING FIXTURES UCENEED AS IROUIRED eY LOS Alhlo 2 COUNTY AND RATA Or GAS TEST 1 / CALIFORNIA OR THAT 1 AN THE LEGAL OWNER Or THE AEOve macR1e® REsloER PR P[STY UTILITY CO NOTIFIED /I . �/JY\�\ Il SIGMArunR n \n / I 1_ ilUl OP PERMITTE / !, 1 V I `� Y� FINAL ,,-�ALIDATION ROBERT A WOOD I V ✓ cE// M o CAEN SUPERVISING MECHANICAL ENG R ( �9055e RAR 2 5 D 9.00 M I WORKERS'thatCOMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT hereby, affirm that have a certificate of consent to self r a 76A667 DPW 490 sura,or a certificate of Workers'Compensation Insurance,ora 7tSAbe7A certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY 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 If the work Involved by MAIL the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL NO. mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR - Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that)am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER y and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB DATE U License Numberw Lic. Class - t FINAL a Contractor' - -Date BY k ¢ cc I am exempt under Sec 4, ¢ B.BP.C. for this reason Plan check fee ► 1 Y10% IL TINAf Date: PLUMBING PERMIT ISSUING FEE$ :- f+'.:'"t., W Signature TOTAL FEE SINGLE FAMILY 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 flry�kn,_nrsn� �� Professions Code): r - Address ow"" I, as owner of the property, will do the work and the City Tel. No. � 1 AM S structure is not intended or offered for sale(Section 7044, Business 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 Nome 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 ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date