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Home My Public Portal About5561 SULTANA AVE_Plumbing__ r EP*RTMENT OF DUILDING AND SAFETY t APPLICATION FOR PERMIT 1 r. COUNTY OF LOS ANGELES P��V _ WM.J. FOX.CNItF KNOINtta NATURE OF 'ERM1717 NO. ROUGH FIXTURES _ NEATER CESSPOOLREADY SEPTIC TAME R ETYED B7 FRiST IMSPFOR DATE ISSUED M APPLICANT FULL IN HEAVILY'OUTLINED PORTION ONLY M NAME M. C. NOrnNGRAM • woGaESS ��J q f� ADDRESS 123 No. Clover Ave. 'LOCALITY jNEA RST ■ Cm TEMPLE C=vXAW, CROEBET. COUNTY CERT NO EXPIRES i�' NAME /) .t O t041tJ LOCATION OF SEPTIC TANK, OR CESSPOOLMAIL aI ADDRESS NORTH O CITY TEL NG 1 AMTHE LEGAL POSSESSOR OF TME ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. rn,e, YSDt Y TME LEGAL OWNER OF THE PROPERTY DESCRIBM ABOVE \ OWNER I CORRECTIONS SOUTH J DESCRIPTION OF WORK i LHOWER TM TUB FURNACE i C ^IGH WASHER O VATORY REFRIGERATOR TCHEN SINK WATER SOFTENER R SINK RANDTRAP LTOTAAL SINK FLOOR DRAIN TRAY URINAL APPROVALS R CLOSET DRINKING FOUNTAIN DATE IMVD`.TOP•RAN[ R HEATER DENTAL LAVATORY ROUGH PLUMBING OAS SODA FOUNTAIN GAB PIPING OUTL OAS VENT CESSPOOL �' Y R�7 3 NUMBER OF FIXTURES SEPTIC TANK OOL SEPTIC TANK / O SEWER S UTILITY CO MOrTFIRD D e.i.Ih atM tarn nra '%' '� APPLICATION 'FOR PR'RffiT DEPARTMENT OF MMMING AND SAFM �� ' COUNTY OF LOS ANGRI •� WM J FOX.CHIKP ENGINESI! - NATURE O D rffJtMFT NO FIITURM COMPLBT[ // - �o CESSPOOL SPIIC TANK READY FOR FIRST INSPECTION �T[ISSUED 1 -/'I- AAPPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY 21 jo p' (/// r I��I ADDRESS 8'I 6 O r C9 K g N A Q,St LOCALITY 1 MONT% TSL No 'fr-i "CROSS Er NO z o QPIR Z�.30-y ` 6 NAME OF SEP'T'IC TANK, O$ CRSSPOO MAIL NORTH ADDRESS CRY TEL NO •O ANGELES COUNTY CERTIFICATE F Q IPI /�Vi LOS (. . "1�7r�.�. RYYtR 1 AM THE LEGAL OWNER OF TNI PRO IUM DESCRIBED ABOVE OWNSU CORRECTIONS SOUTH DESCRIPTION OF WORK BATH TUB FURNACE C NOW[R DISHWASHER O VATORY ✓ REFRIGERATOR ITCHIN SINK WA-hM SOFTENER R BINK -----SAND TRAP LOP SINK FOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET V ^RINKINGFOUNTAIN DATE INtF[CT011•MAYt WATER HEATER --------MENTAL LAVATORY ROUGH PLUMBING 3-2 .V� 6TE QAS MODAFOUNTAIN GAS PIPING OUTL OAS VENT CESSPOOL TOT AL NUMBER OF FU[TURM S/D SEPTIC TANK CIBSPOOr ANR'IC TANK GKWER S TOTAL FEE �� UTILITY O NOTIFIED FINAL �— -eA&CT CK#4117 x e1 — APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER RULING AND S�FETY RMSION wDRDeseG JO A LAMBIE DUNrr NGIHEER WILLIAM A JENSEN Sup i OF BUILDING LOCALITY 77 c- SS FOA APPLICANT TO FELL IN �ss T NUMBER FIXTURE OR ITEM EACH IEE OWN® WATER CLOSET $1 25 57Afi. RATH TUB 175 ADDRESS SHOWER 115 C17Y NO LAVATORY 175 CONTRACTO � 14 SLNR 175 .ADDRESS '71-Z ic DISHWASHER 115 CRT a 6 y LAUNDRY TOR 175 CONTRACTOR S STATE B REGISTRATION NO C/ ce. a COUNTY CL07HPJ3 WASHER 1'LS DIST NO GROUP ZONE P D BY WATER HEATER 150 GAS SYSTEM OUTLETS 1 50 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYRTEM 50 DISPECTION RECORD d O V OL O 44 Z-N4 C W IL N T. APPROVALS DATE INepLQOR t SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING I X[IQSY ACKNOWLLRG[ THAT I MAV[ IKAO THIS ARLICAT. H GAS VENT ANR STAT[ THAT TMC AROVL It COgL[R AMO AGq[[ TO COMpLi WITH ALL COUNTY OgDInAMOb AND STAT[ LAWS REGULATING HOT WATER HEATER PLUMBING 1 HSR[Ov ctq(Ipv THAT I AN Pgop[LLv q[Oltrtgt0 ANO/oq PLUMBING FIXTURES LICLNLLD At MQU1RLD BY LOS ANO[LLS COUNTY AND STAT[ OF GAS TEST CALIF MIA OR THAT I AM TNL "GAL OWH[q 01 NO IM[ OTO ROIDE IN THE APV[DSSCRISSO R[SIDENTIAL TRY UTILITY CO NOTIFIED f SIGNATURE 11 SII OF PERMITTEE FINAL C o ALIDATION ROBERT. WOOD w G CASH SUPERVISI GIMECHANICAL ENG R LACp4 8 8 1t`d SEP27 5 D 3.50 0 DEPARTOffi4T OF COUNTY ENGINEER. 1 PLUMBING 1 DIVISION OF BUMMING AND SAFETY - PERMIT APPLICATION OOUNTY OF LOS ANGELES BUILDINGR WILLIAM J FOX. COUNTY [NOIHEER ADDRESS FOR APPLICAN O FILL IN LOCALITY < Gf BUILDING [�/JQ C' e1 NEAREST C N s BUILDINGADDRESS .7 J s / CH0R88T /J DISTRICT NO GROUP /20NE PP)Efl/MIT NO LOCALITY .5-' Z /7 / 3-76 NEAREST CROW S7 RECEIVED Rg0y In 1[IFMIoO DA E ISS ED OWNER yy G ADDRESS � /I .S S WASTE APP OVAL G� clTv [L NO INSPECTION RECORD PLUMBER ADDRESS I CITY L NO B ATE LICENSE NO fX1U E PERMIT FEES Z MUM[[R "PC OF FI%TYRt OR ITSM F[[ O WATER CLOSET(TOILET) 0 080 i BATH TUB 0 coo SHOWER 0 040 LAVATORY(WASH BASIN) 0 080 KITCHEN SINK @ OEO LAUNDRY TUB OR TRAY 0 080 SLOP BINK 9 0 MI FLOOR&NK 4 OM _ FLOOR DRAIN 0 0110 DISHWASHER 0 080 DRINKING FOUNTAIN 0 0 W URINAL 0 OLO GASSYSTEY _OUTLETS 0 100 WATERHEATER 0 100 MISCELLANEOUS _ APPROVALS DATE INSPECTOR S SIGNATURE UNDER SLAB WORK PERMIT { 1 00 ROUGH PLUMBING TOTAL FEE 2 a4o OAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI GASVENT CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE NOT WATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES 1 NEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY BAB TEST AND STATE OF CALIFORNIA OR THAT I LEGAL OWN- OF THE ABO DESCRIBED REBID I Pfl ERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE FINAL 70AE07 DBS 1T 1/011 vr0(2KER5 COMPENSATION DECLARATION 20DDYeDPW„B7 APPLICATION FOR PLUMBING PERMIT t hereby, affirm that I have o certificate of consent to self In 76A667A sure or a certificate of Workers Compensation Insurance or a CE 817(REV 8/8e) certified co y thereof Sec 3800 L ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Policy No Company Certified copy Is hereby furnishe Certified Co a filed with the coup building ms FOR APPLICANT TO FILL IN(PRIM OR TYPE) BUILDING departmentPY N B pest on NUMBER FIXTURE OR ITEM ® FEE ADDRESS OCAU Dot Appbca WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OW (This section need not be completed If fhe work Involved by _ MAIL , the permit is for one hundred dollon($100)or less ) a LAVATORY I certify that in the performance of the work for which this per- SINK TFL O mit is Issued I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws 3 DISHWASHER C Date Applicant CLOTHES WASHER ' NOTICE TO APPLICANT If, after making this Certificate of Ex SWIMMING POOL RECEPTOR emption, you should become subject to the Workers Compen TE station provisions of the Labor Code you must forthwith comp- ly with such provisions or this permit shall be deemed revok STATE LIC ed 3 WATER HEATER LICENSE NO CUSS LICENSED CONTRACTORS DECLARATION DISTRICT n!O PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fed Professions Code and my license is in full force and of 5 PER SYSTEM FINAL VALI TION a , DAT & r C License Uc Class n.( Q ` �7 FI Conhactor Dote.7— O f– I am exempt under Sec W 6 B 8P C for this reason N Plan check fee , _ Date PLUMBING PERMIT ISSUING FEE S Q U Signature TOTAL FEE A 0 1 6 4 A SINGLE FAMILY k hec HOME OWNER BUILDER DECLARATION Plan capplicant # S 1 hereby affirm that I am exempt from the Contractor s License Name Law for the following reason (Section 7031 5, Business and ( s 2 1 4 5 0 Professions Code) - Address ' I, as owner of the property will do the work and the City Tel No • • 2 1 k Jr 0 6 structure is not intended or offered for sale(Section 7044 Business and Professions Code) , 07. 13-88 CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for r the performance of the work for which this permit is Issued (Sec 3097, Civ C ) Lender's Name Lenders Address y a I certify that I hove read this application and mote that the - ION. Information is correct I agree to comply with all County ordmances and State laws regulating Plumbing, and hereby , authorize representatives of this County to enter upon the boy n phoned o erty for inspection purposes L44.9f SEE REVERSE FOR EXPLANATORY LANGUAGE SI n tura of ermittee Date , •.WORKERS COMPENSATION QkCLARATION APPLICATION FOR PLUMBING PERMIT rhere8y af(irni that I have a certificate of consent to self in 760667 DPW�� sure,or a certificate of Workers Compensation Insurance,or a CE BI77 REV 8/86 certified copy thereof (Sec 3800 L ) ( ) COUNTY OF LOS ANGELES DEPT OF'PUBLIC WORKS Policy No g8'3�Compan � 1 S Certified copy is hereby furnished ir FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING department copy a fled with a county budding impeders ADDRESS.]S/o `dejsartment NUMBER FIXTURE OR ITEM ® FEE IOCALIT Dot✓S�Applic WATER CLOSET(TOILET) `_ LOCA57 CERTIFICATE OF EXEMPTION FROM WORKERS' Q BATH TUBU CROSS Sr COMPENSATION INSURANCE SHOWER , ^ O (This ssidlon need not be completed If the work involved by 1A MAIL the permit Is for ane hundred dollars (5100)or less ) LAVATORY ...� A I certify that in the performance of the work for which this per- SINK r2b mit is issued I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws _ DISHWASHER CON Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If after making this Certificate of E. SWIMMING POOL RECEPTCIR emption you should become subject to the Workers Compen abhon provisions of the Labor Code you must forthwith comp LAWN SPRINKLER SYSTEM / ly with such provisions or this permit shall be deemed revok SIATI LIC 7 ad IWATER HEATER .36) ...r LICENSE N CLASS 42-7 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions NO D BY ons of Chapter GAS SYSTEM OUTLETS Q SV 9(commencing with Section 7000)of Division 3 of the Business _ OUTLETS OVER c and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VA DATION Lifact t�� e 3L DATE�— — License umb �LL.�-L��• Lm Class ` fl / FINAL Contractor Date Z 1' BY @Oil Q 5 A O 0 I am exempt under Sec # s s e is 0 5 V W B 8P C for thn reason - ► y Plan check fee 1 - 32Z50 = Date PLUMBING PERMIT ISSUING FEE$ (f • - 322505 Signature TOTAL FEE U 0 713-88 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Nome 'T Law for the following reason (Section 7031 5 Business and Professions Code) Address I as owner of the property will•do the work and the Is City _ Tel No structure is not intended or offered for sale(Section 7044 Business and Professions Code) ► CONSTRUCTION LENDING AGENCY 1 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 ) ` Lenders Name Lender's Address I certify that I have read this application and state that the Poo information is correct I agree to comply with all County ordinances and State jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the I bove mentioned prjrty for inspection purposes - S�$� SEE REVERSE FOR EXPLANATORY LANGUAGE XgKottre of PeAnittee Date RS TION 4ORn that IOaveto cart APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have to certificate of consent to self m m'�Ovw 4i� sure,or 6 certificate of Workers Compen non Insurance ora CE)7B 7 REV 9/86) - 1 cenrfied copy�thereof (Sec 3800 t COUNTY OF LOS ANGELES DEPT sOF PUBLIC WORKS' Policy No.76�CompanyLW _ a el Certified copy is hereby furnished rth FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING t e county building Inspection Cemhed copy is fled wADDRESS department NUMBER FIXTURE OR ITEM ® FEE L LI ApplKo WATER CLOSET(TOILET) NEAREST OF CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWN (This section m lon ad not be completed If the work involved by MAIL the Portrait Is for one hundred dollars($100)or lass ) LAVATORYLIV ADDR I certify that in the performance of the work for which this per SINK / mit is issued, I shall not employ any person in any manner so f� as to become subject to the Workers Compensation Laws DISHWASHER ' `� Co Date Applicant CLOTHES WASHER 56 A NOTICE TO APPLICANT Iafter making this Certificate of E. SWIMMING POOL RECEPTOR emption, you should becoo me subject to the Workers Compen Yation provisions of the Labor Code you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit sholl be deemed revok A LIC ed 1 WATER HEATER LICENSE CLASS LICENSED CONTRACTORS DECLARATION DIST No, PR D Yhereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 70DO)of Division 3 of the Business OUTLETS OVER and Professions Code and my license is in full force and of 5 PER SYSTEM FINAL > fact 7y��/_�r(� DATE LIDATIO y License Num erJ_WLic Class� O U FINA Contract Dat.I� BY O H I am exempt under Sec W A. B 8P C for this reason Plan check fee , _ Dote PLUMBING PERMIT ISSUING FEE§ Q V Signature TOTAL FEE D SINGLE FAMILY Plan check a licant A 01 6 6 A HOME OWNER-BUILDER DECLARATION PP I hereby affirm that I am exempt from the Contractor's License Name #fa a s is a 5 Law for the following reason (Section 7031 5 Business and 9 Professions Code) Address 1 * 456.50 I, as owner of the property will do the work and the City Tel No a a 4 5 Q,5 0 5 structure is not intended or offered for sale(Section 7044 Business and Professions Code) Poo. 0713-88 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 ) i 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 ordinances and State jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the above mentioned property for inspection purposes J� s �' SEE REVERSE FOR EXPLANATORY LANGUAGE SI n tura of ermittee Date • WORKFRS�COMPENSATION PECLAIRATON r 'I h �oTfv'm tftot I havab certificate of consent to self in PO DPM DPW 4/87 i APPLICATION FOR PLUMBING PERMIT er sure,or 00 certificate of Workers Compensation Insurance or a CAREV 8/86 _ certified copy thereof Sec 3800 La ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS fl Policy No Company • -013 .� Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING CeA�C�pymed with the county building inspection ADDRESS!•`deNUMBER FIXTURE ORITEM e FDate.1Appl�ca5�7 / WATER CLOSET (TOILET) NEAREST , BATH TUB .• I CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS W COMPENSATION INSURANCE SHOWER _ JA (This stolon need not he completed it the work Involved by 111,the permM Is for onehundred dollars ($100)or less ) LAVATORY I certify that in the performance of the work for which this per- SINK mit is Issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws DISHWASHER Date Applicant CLOTHES WASHER vir"my La- NOTICE TO APPLICANT If, after making this Certificate of Ea SWIMMING POOL RECEPTORcilists emption you should become subject to the Workers Compen T 'cation provisions of the Labor Code you must fodhwah comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok STATE LIC iD ed WATER HEATER ' LICENSE CIASS L+7 LICENSED CONTRACTORS DECLARATION7cI DISTR�LNO my F hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 70DO)of Division 3 of the Business OUTLETS OVER (/ and Professions Code and my license is in full force and of 5 PER SYSTEM FINAL VAL ION fact DATE Q _License NWmb Llc Clam U �t �/f,{/ FINA Contractor 7 Date J—Z v ,' BY O F1- Iam exempt under Sec _ ~ U W B 8P C for this reason d Plan check feepop. to Date PLUMBING PERMIT ISSUING FEE$ 0167 A z Signature TOTAL FEE U ��•,• • • • 5 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant ( - 45b.50 I hereby affirm that I am exempt from the Contractor s License Nome s s 4 54.5 055 Law for the following reason (Section 7031 5 Business and Professions Coda) Address p7, 13-88 ❑ I as owner of the property will do the work and the City Tel No structure is not intended or offered for sole(Section 7044, Business and Professions Code) pop,CONSTRUCTION LENDING AGENCY I hereby off irm that there Is o construction lending agency for ' the performonce of the work for which this permit is issued (Sec 3097 Civ C ) I 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 ' ordinances and State jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the lcibmove mentioned qucLarty for Inspection purposes sof/ SEE REVERSE FOR EXPLANATORY LANGUAGE g ure of B rmittee Dote WORK i cNirmERat I hav -a certificate DECLARATION APPLICATION FOR PLUMBING PERMIT //""�I • 'I heroby~affum that I haveV certificate of consent to self in- 7a�Z6 DPW°/k u1 I •sure,or b certificate of Workers Compensation Insurance or o CE 81 7( ILL' Pe CE 817(REV B/80) t certified copy thereof Sec3800 Lo 1 Policy No Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished BUn= Certified copy is filed with the county budding inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRE ' department NUMBER FIXTURE OR ITEM Q FEE LOCALITY a 9L + WATER CLOSET(TOILET) G Dat Applico NEAREST - CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST - COMPENSATION INSURANCE SHOWER- OWNS (This settlers nosrd not be completed if the work Involved by MAIL y+ the Permit Is for a"hrmdnd"Ion($100)or less ) tAVATORv 1 .... gppRE C I certify that in the performance of the work for which this per _ _ mit is issued I shall not employ any person in any manner so SINK CI L d as to become subject to the Workers'Compensation Laws DISHWASHER AIOPr• CONT Data Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of Ex- emption you should become subject to the Workeri Compen SWIMMING POOL RECEPTOR E 'satinof the Labor Code you must forthwith comp LAWN SPRINKLER SYSTEM ly insuch provisions such proo visions or this permit shall be deemed revok STATE 3 UC a ad WATER HEATER g LICENSE NC1J � CLA55 ✓ LICENSED CONTRACTORS DECLARATION K DISTRICL.WQ PROLE By 1 hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS — `(LJ 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code and my license is in full force and of 5 PER SYSTEM FINAL �� VA ATION y DAT eE _Ucens Nu Lic Class V t FIN - Contra Date`�— FIBY cc H •❑ Ions exempt under Sec W B 8P C for this reason O 1 b 8 A H Plan check fee Z r Date PLUMBING PERMIT ISSUING FEE$ Q O t 1 . 4 5 4 5 0 Signature TOTAL FEE V • • (154.505 � SINGLE FAMILY plan check applicant HOME OWNER-BUILDER DECLARATION pp 07. 1 3 x 8 8 I hereby affirm that I am exempt from the Contractor s License Name Low for the following reason (Section 7031 5 Business and Professions Cade) Address I as owner of the Property will do the work and the City Tel No structure is not intended or offered for sole(Section 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructwn lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ C ) Lenders 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 ordinances and State lows regulating Plumbing, and hereby authorize represen atives of this County to enter upon the o ve-mentioned ro erty for inspection purposes r �t SEE REVERSE FOR EXPLANATORY LANGUAGE 'S,incifure,of P rmitfee Data • „WORK tRcrf I avela certificate of consent N APPLICATION FOR PLUMBING PERMIT I hefeby affvm that hovers certificate of consent to self m 770A-00 7ADPW 4/� r c, I sure or a certificate of Workers Compensation Insurance or a CE 817 REV 8/86 cerhfied ca ther�e�o�f�/(S�ec 3800 La ( ) t Pallcy No.F+�-'--f'-r--I—Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified copy Is filed with the county budding inspection RE ADDRESS department NUMBER FIXTUOR ITEM ® FEE LOCALITY OaterQ�Apphmnt WATER CLOSET(TOILET) ^ NEAREST . CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed H the work involved by MAIL the perrnit Is for one hundred dollars(6100)or less) LAVATORY ADDREV41412 k I certify that in the performance of the work for which this per- SINK mit Is issued I shall not employ any person In any manner so GTV TE as to become subject to the Workers Compensation Laws DISHWASHER 1 . CONTRA Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption you should become subject to the Workers Compen / iEl w` sation provisions of the Labor Code you must forthwith comp LAWN SPRINKLER SYSTEM S 7 ly with such provisions or this permit shall be deemed revok STATE LAC ed I WATER HEATERLICENSE CLASS .3 LICENSED CONTRACTORS DECLARATION ^ DISTRICT NNNggq PROVSSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER J U fed Professions Code and my license is in full force and of 5 PER SYSTEM FINAL AVALIDATION ra DATE License License Number? L,c Class V fe V FI . Comrocto Dates O ' f am exempt under Sec yVj B 8P C for this reason , N Plan check fee = Date PLUMBING PERMIT ISSUING FEE E Q ;@01 6 9 A Signature TOTAL FEE SO # e e e e e 5 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant 1 - 26250 1 hereby affirm that I am exempt from the Contractor s License Name Law for the following reason (Section 7031 5 Business and • - 26 2 5 0o Professions Code) Address 1 as owner of the property will do the work and the City Tel No 07. 13-88 structure is not Intended w offered for sole(Section 70" Business and Professions Code) , CONSTRUCTION LENDING AGENCY hereby affirm that there is o construction lending agency for the performance of the work for which this permit is issued (Sec 3097, Civ C ) Lenders 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 ► ordinances and State jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the g ve-menti �ed prep• for inapecnon purposes S , /Z,� SEE REVERSE FOR EXPLANATORY LANGUAGE �1 nut re of VfrmhTee Date i S T'°" 'APPLICATION FOR PLUMBING PERMIT r10 0076 DPW /B] r I ' 'r .N/ORKERS COMPEN ¢ay of consem to eel( in 764667A ,'sell • I hereby, off It ho�t I(6hQo,&% Compensation Insurance,or a CE 817(REV 8/86) sure or o c j`jQ< 3800, La Y ihere i t certifi ♦Irl��H Company COUNTY OF LOS ANGELES ADEPT OF PUBLIC WORKS ' Cerrdi -opY it hereby furnished - ' B' / FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDIN , Cert Ad copy s filed with the county building inspection ADDRE C- - dY°rtment NUMBER FIXTURE OR ITEM @ FEE LOCALI V rr WATER CLOSET(TOILET)> pate.7Appbm NEAREST / { CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS Si _ COMPENSATION INSURANCE SHOWER Ow (This section need not be completed if the work Imolved by MAIL C the permit Is for one hundred dollars (5100)or los) LAVATORY Z C- Lcertify that in the performance of the work for which this per- SINK TELJ mit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws DISHWASHER � CO Dote + ApplicantCLOTHES WASHER ..� NOTICE TO APPLICANT If, after making this Certificate of Ex - AD emption,you should become subject to the Workeri Compen SWIMMING POOL RECEPTOR sotion provisions of the Labor Code you moat forthwith comp LAWN SPRINKLER SYSTEM TEL ly with such provisions or this permit shall be deemed revok- TE LIC /� jj b ed / WATER HEATER LICENSE NO CLASS `13 LICENSED CONTRACTORS DECLARATION DISTRICT NO ESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS �• S CL��J/(( 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER aed Professions Code and my license is in full force and ef- 5 PER SYSTEM FINAL / _ VA ATION d /1 DATE3—( O License N mb Llc Class e.3 '4 U �� FIN A G Contract ./ � Dot's —9-y =o BY O I am exempt under Sec yOj B 8P C for this reason Plan check fee ' ;201 7,O A 0) Dote PLUMBING PERMIT ISSUING FEES Ao 5u # - - -,- - 5 Signature TOTAL FEE 5a 50 ( • • 5 2 5 0 SINGLE FAMILY k hec HOME OWNER-BUILDER DECLARATION Plan capplicant • • • 5 2 5 0 6 I hereby affirm that 1 am exempt from the Contractor's License Nome Law for the following reason (Section 7031 5 Business and Q 7�� 3,-88 Professions Code) Address I, as owner of the property, will do the work and the City Tel No structure a not intended or offered for sole(Section 7044 Business and Professions Code) + , CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction pending agency for + the performance of the work for which this permit is issued (Sec 3097 Civ C ) I i 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 paws regulating Plumbing, and hereby thonzs representatives of this County to enter upon the _ v `mentioned pr erty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Slq;otcris of P iitee Date