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Home My Public Portal About5656 SULTANA AVE_Plumbing__ ,,i'WOR,�KE��RS'CO.MPENSATIO.N:DECLA.RATION APPLICATION FOR PLUMBING PERMIT I hereby offi.rm"fhat I. have a certificote of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, 'CE 817(REV. 10/81) oi't certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY N Policy No.LLIL�4 Company A141,®N Z Certified.copy'is.herebyfurnished. BUILDING //�� pp�� El APPLICANT TO,FILL IN(PRINT OR TYPE) ADDRESS jp ... � di�QJ �/ Certified,copy is filed with the county building inspec- tion department. � NUMBER FIXTURE OR ITEM ® FEE LOCALITY _ e G T Date A PP 4 li an WATER CLOSET _ 6. NEAREST CERTIFICATE OF EXEMPTI N FROA WORKERS' BATH TUB CROSS COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved-by MAIL the permit is for one hundred dollars(sf00)or less.) LAVATORY ADDRESS A11D W0141 1y0XD I certify that in the performance of the work for which this permit is issued, I shall not employ any person in.any manner SINK CITY. 6 snFlTEL. O. so as to become subject to the Workers'Compensation Laws. DISHWASHER 0-' + CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this .Certificate of ll� L''F_4JT Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code,.,you must forth- LAWN SPRINKLER SYSTEM CITYG� �/Z.i TEL. with comply with, such provisions or this permit .shall be STATE deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO CESSED BY I hereby affirm that I am licensed.under,provisions of Chapter 9 GAS SYSTEM OUTLETS J AZO, (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER '� ' and Professions Code,and my license is in full:force arid effect. 5 PER SYSTEM FINAL IL p VALID ION O License Number & �2.91 L.'ic. Class5Se��° DATE -r. FIN Contractor 601ifieeP A* Date Z 7, B ❑ I am exempt under Sec. S, L� 1 B.BP.C. for.rhis reason Plan check fee ► + 01 2 8 O A Date: PLUMBING PERMIT ISSUING FEE$ v # 0 0 0 0 0 5 Signature ' TOTAL FEE Plan check applicant ( 0 ° 3 Q•5 0 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name o o 9'3 0.5 0 2 1 hereby affirm that,I.am exempt from the Contractor's License ss Addre Law for the following reason (Section 7031.5, Business and 2 28-84 Professions Code): City Tel. No. ❑ I,.as owner of the property, will do the work arid the I., 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 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 laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned Ierty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE as Z igna re of FTermittee Date WORKERS'COMPENSATION DECLARATION � 1 A P P L I C A T ION O R PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self CH c� 81 e�7 z-eo � G. insure,or a certificate of Workers Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) I COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company iC��,.` C]. Certified copy is hereby furnished. A FOR APPLICANT TO FILL IN (PR'INT OR TYPE) BUILDING // �-+! p� ADDRESS S tD IP 1.I. SU Certified copy is filed with t unty b ilding inspection + NUMBER FIXTURE OR ITEM • FEE 9 a an / WATER CLOSET LOCALITY DatApplicant. NEAREST BATHTUB CROSS ST. CERTIFICATE OF EXEMP FROM WORKERS" COMPENSATION INSURANCE SHOWER OWNER MAI L /�1A1 � (This section, need not be,completed if the work involved I LAVATORY ADDRESS ty�rC#2 6L. by'the permit is for one hundred dollars ($100) or less.) O I SINK CITTEL.NOS ysr/ () I certify that in the performance of the:work for which this ,' + DISHWASHER , permit is issued, I shall not employ any person in any manner 1 d� 'CONTRACT O O so as to become subject to the Workers',Compensation Laws: CLOTHES WASHER' ADDRESS P (~j Date °' Applicant SWIMMING POOL RECEPTOR W NOTICE TO APPLICANT: If, after making this Certificate of CIT TEL.NO. Exemption, you should become subject to the Workers' LAWN SPRINKLER.SYSTEM 2 S.TATE� n lip LIC- e Compensation'provisions:of the Labor Code;you must forth- LICENSE NO. of 1101 CLASS p�0 with comply with such.• provisions or this .permit shall be WATER HEATER deemed revoked'. GAS SYSTEM OUTLETS DISTRICT NO.. P. CESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER V iDd I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of'the Busi- FINAL ness and Professions Code., and.my license is in full force and (SATE 3 dZ VALIDATION�� effect. 1�� q(,1 all I6 �3b FINAL" License Number ic.Class BY Contractor Date 0. I am exempt f4 the licensing requirements as I am a I Plan!check fee licensed architect or a registered professional•engineer PLUMBING PERMIT ISSUING FEE$ a acting in my professional .capacity (Section 7051, Bus- 1 iness and Professions Code). TOTAL FEE Lie.or Reg.No. Data Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address i License Law for the following reason (Section.7031.5., Busi- city Tel.No. ness and.Professions Code) : I, as owner of the property, am exclusively contracting i with licensed contractors to construct the project ;9;3 1 1. 1 A (Section 7044,Business and Professions Code). # 000005 CONSTRUCTION LENDING AGENCY I I hereby affirm that there is a construction.lending agency i 2 c'c 1 2-50 for the--performance of the work for which this permit is issued( ec .3097,Civ.C:). I'' c c .Q 1 2 5 0 3 Lender's Name 03,01 —82 (Lender's Address l ' 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 me ed pDoperty for inspection purpose I . ISignator ermittee Date ; 76A667 -CE#817 5/63 APPLICATION FOR PLUMBING RMIT COUNTY-OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ��, 14 WILLIAM A. JENSEN. Sup'T of BUILDING LOCALITY 't FOR APPLICANT TO FILL IN NEAREST �/� — _ CROSS ST. O !r NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET ;1.25 MAIL 9 BATH TUB 1.25 ADDRESS SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR SING 1.25 ADDRESS,.i . ' DISHWASHER 1.25 CITYP�]<�1 ,,�.'�? TE NO.S 5^0'�w / LAUNDRY TUB 1.25 r/ REGISTRATION NO. 17/-130Y COSTATE UNTY CLOTHES WASHER 1.25 DISTRICTNO. GROUP zONE PR �ESSED BY WATER HEATER, 1� 1.50 / D GASDUSTRIAL I CL SYSTEM , OUTLETS 1.50 �- ' ( WASTE APPROVAL QU OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD Lu - -- D- Z �• APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING �. �r GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER (� PLUMBING. ' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES CE LINSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST RESIDE IN, THE ABOVE SCRIBED RESIDENTIAL PROP TY. UTILITY CO. NOTIFIED '- SIGNATUR A AM Plld nn OF PERMI FINAL VALIDATION ROBERT A. WOOD cK. M o. CASH SUPERVISING MECHANICAL ENG'R 0151 " 16 5D 66.00— a