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Home My Public Portal About5516-5518-5520-5522 SULTANA AVE_Plumbing__ WO affirm that I have a ION DECLARATION cKet - APPLICATION FOR PLUMBING PERMIT I hereby,affirm that 1 have a certificate of consent to self ce an Ix+el Insure, or a certificate of Workers'Compensation Insurance,or ^7� C , . a certified copy thereof(Sec 3800,Lab C) / y�t95 oa $o �L COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company s^�,G d � 5 Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) - BUILDING ADDRESS 'Z Certified copy is filed with the county budding inspection NUMBER FIXTURE OR ITEM • FEE 777"'---"ill,(��QQeri LOCALITY en WATER CLOSET Date S^�- 1 Applicant �,`r/- NEAREST 'LA CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST 1 COMPENSATION INSURANCE SHOWER OWNER (Thu section need not be eom leted if the work involved MAIL p LAVATORY ADDRESS c1b(a a by the,permit u for one hundred dollars ($100) or less) SINK CITYTEL NO 330 623 I certify that in the performance of the work for which this DISHWASHER ` �� r O permit u issued I shall not employ any person in any manner CONTRACTOR lC Ml so as to become subject to the Workers'Compensation Laws CLOTHES WASHER ADDRESS ^� ' F- Date Applicant I �� A-u W SWIMMING POOL RECEPTOR NOTICE TO APPLICANT If after making this Certificate of CITVS �A C& i EL NOy U3 Exemption, you should become subject to the Workers LAWN SPRINKLER SYSTEM STATE �7 LIC Z Compensation provisions of the Labor Code, you must forth WATER HEATER LICENSE NO JCI CLASS with comply with such provisions or this permit shall be deemed revokedGAS SYSTEM OUT ETS DISTRICT NO PROCESSED BY - LICENSEDCONTRACTORSDECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter a PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi FINAL / y ri= and Professions Code and my license is in full force and GATE 3 �tp �/J VALIDATION effect q 39 /3 FINAL " License Number Lw Clan C c3 BY Contractor j(n�J(7 '.v8 Data 7 F1 I am exempt from the licensing requirements as I am a Plan check fee �^ ✓ r licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE acting in my professional capacity (Section 7051, Bus inns and Professions Code) O TOTAL FEE Lrc or Reg No Date Plan check applicant HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Addrea License Law for the following reason (Section 7031 5, Bum city -Tal No ness and Professions Code) LF 43 Q 8 A 1, as owner of the property am exclusively contracting a e a a e Jr with licensed contractors to construct the project (Section 7044,Business and Professions Code) ' 2'•'• i Q00 CONSTRUCTION LENDING AGENCY • e e 1 0.006 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) 0 3,0'6—8 1 Lender's Name 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above mentioned property for inspection purposes Signature of Perm Ilea Date ' WOR]�ERS'COMPENSATION DECLARATION I 7GA6QA 111'reby affirm that 1 have a certificate of consent to self car ear (a-ae) APPLICATION Fq,R PLUMBING PERMIT insure ora certificate of Workers'Compensation Insurance,or (� a certified copy thereorj�c 3800,Lab C) .-y COUNTY OF LOS ZGEES BUILDING AND SAFETY Policy No! T/ Ira Comps 1 Certified copy s hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BU I LD IDDRENS I AS �II 4 �CerFlFled copy s Flied 1 he count building inspection NUMBER FIXTURE OR ITEM • FEE 4e art nt O LOCALITY L �Datt�s/,�b A --/C.e-�-be WATER CLOSET Ppli NEAREST BATHTUB 2 i CROSS ST �e CERTIFICATE OF E MPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER M LAVATORY MAIL (Thu section need not he Completed if the work Involved ADDRESS gor?0,3 16 -a?jeJ4dWA4e ' by the permit u for one hundred dollars ($100) or leas) I } SINK CITY TEL NO� 0 1 certify that in the performance of the work for which this DISHWASHER U permit n issued, I shall not employ any person in any manner CONTRACTO so as to become subject to the Workers' Compensation Laws CLOTHES WASHER ADDRESS 3 O Date Applicant ':9!21- POOL RECEPTORtL) NOTICE TO APPLICANT If after making this Certificate of CITY r' TEL NO �Wqjf_3 d Exemption, you should become subject to the Workers' . - STATE LIC A IL Compensation provisions of the Labor Code, you must forth WATER HEATER LICENSE NO �� CLASS C Z with comply with such provisions or this permit shall be / deemed revoked • DISTRICT NO PR CESSBD BY OAS SYSTEM OUTLETS �^ LICENSED CONTRACTORS DECLARATION OUTLETS OVER S. Q I hereby affirm that I am licensed under provisions of Chapter 8 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi FINAL ^/! �/ VALIDATION nese and Professions Code and my license is in full force and DATE (O effect qq�?��q�Q � ` FINAL - License Number.-✓7 7f-3 Lin Class C -34 BY "r� Contractor ,/�jbate �10—7I-.k t 112 F1 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§ 3767 acting in my professional capacity (Section 7051, Bus an=and Professions Code) TOTAL FEE Lac or Reg No Date Plan check applicant HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address, License Law for the following reason (Section 7031 5, Bust City Tel No $2 5(�7 A nese and Professions Code) 0 1, as owner of the property, am exclusively contracting , with licensed contractors to construct the project # • • • • a 5 (Section 7044, Business and Professions Code) 2 . 13b00 CONSTRUCTION LENDING AGENCY 'a • 136005 I hereby affirm that there s a construction lending agency , for the performance of the work for which this permit is issued(Sec 3097 Civ C) 1 G07-80 Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is correct I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the ---Lq(we mentioned/p/r/pperty for inspection purposes d Signature of Permittee Date