The URL can be used to link to this page

Home My Public Portal About5702-5704 SULTANA AVE_Plumbing__ WORMS'C90PENSATION DECLARATION 20-0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that'I"have a certificate of consent to self in- 76A667A - spre,•or a certificat+Workers'Compensation Insurance,or a CE 817(REV.8/86) certifigd copy thereof(Sec. 3800, Lab. C.) Policy No.7O3�3 7 97Company- 57J9 1: 601412 COUNTY OF LOS ANGELES, DEPT. OF PUBLIC WORKS. Certified copy is hereby#urnisf-1,6• , .hed. - - _ ., y,, - FOR APPLICANT TO FILL IN(PRINT OR.TYPE) BUILDING,5 •' O. SOL Certified copy is filed with the county building inspection ADDRESS NUMBER FIXTURE OR ITEM LOCALITY -? OLS Cl r�/ „ department. Q '�� 6_ / I y_s WATER CLOSET(TOILET) Date' Applicant N REST CROSS ST.' •,�' °.J[Jet�y9S' CERTIFICATE-OF EXEMPTION FROM WORKERS'. BATH TUB U p COMPENSATION INSURANCESHOWER G OWNER Ro V r (This section need not be completed if the work involved by —9MAIL ' the permit is for one hundred dollars($100)or less.) 1 LAVATORY ADDRESS I certify.that in the performance of the work for which.this per- SINK mit is issued, I shall not employ any person in any manner so 911 CITY TEL. NO. as to become subject to the Workers'Compensation Laws. DISHWASHER • CONTRACTOR �Ov GD�QL �LVJYI�� (7' Date Applicant CLOTHES WASHER ADDRESS q(� NOTICE TO APPLICANT:-If, after making this Certificate'of Ex- � c.� + Q lYr7''f emption,yoo should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR CITY Zv,C d TEL. NO. 3LI, 4 1s sation provisions-.of the Labor Code,you-must forthwith comp- LAWN SPRINKLER SYSTEM �l ly with such provisions.or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER. U 01 LICENSE NO. 0(, CLASS G+ 1A LICENSED CONTRACTORS DECLARATION DISTRIC- . ` PROC D BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS /✓'(}J( 9(commencing with Section 7000)of Division 3 of the Business ' OUTLETS OVER fe d, Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL P VALID ION 2/� DATE C License Numbar 0151 Lic. Class G—. ` �� p� FIN �9 3,1,2 A � 7 D OC Contracto �� Date B o 0 0 040 5 O I am exempt under Sec.- V �` p I 258,50 a B.&P.C. for this reason ► • Plan check fee • Date: PLUMBING PERMIT ISSUING FEE$ o - 25a5'O 5 Signature TOTAL FEE O(� O rJ' 88 SINGLE FAMILY - HOME OWNER-BUILDER DECLARATION Plan check applican4t I hereby affirm that I am exempt from the Contractor's License Name 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 City Tel. No. 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 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 herebyte authorize representatives of this County to enr upon the abov mentioned - per y for' spection purposes. , .`�rS SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date WORKERS'COMPENSATION DECLARATION A'PPLI'CATION FOR PLUMBING PERMIT y *hal!!=h�iv`e a certificate 20-0026 DPW 4/87 n I hereby, affirm tof consent to self in- '76A667A I'LJII ' sure,or a certificate cif Workers'Compensation Insurance,or a CE 817.(REV. 8/86) cdrtified ccIpy the/reof;'(Sec. 3$00, Lab.-Ci) • • Policy No.70r363�0/Com an Sr19IC JCUND COUNTY OF LOS ANGELES DEPT�`OF PUBLIC WORKS y P Y F Certified copy is hereby furnished. _ BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) )'Q( Certified copy is filed with the county building inspection ADDRESS �d`' ' S17[,r M� department. NUMBER FIXTURE OR ITEM @ EE (_ Q + LOCALITY �C (� CITY Ddte �-S �� —Applicant qJ WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION N FROM WORKERS' BATH TUB 2 v LCROSS.$T•' "yt, jCOMPENSATION INSURANCE SHOWER i1WNER d Birt?7' )I G(�/AC (This section.need not be completed if the work-involved by V MAIL the permit is for one hundred dollars.($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL. NO. mit is issued, I shall not employ any person in any manner so OT as to become subject to the Workers'Compensation Laws. DISHWASHER p n CONTRACTOR Ov 1 r6.,0 L PtvnnBlAdC De Applicant CLOTHES WASHER ADDRESS &06 , O . Jq NG£ NWe TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'.Compen- CITY , 1C� TEL. NO.33y-yG/s sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM v✓ ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. • • • •WATER HEATER LICENSE NO. pZ O( CLASS LICENSED CONTRACTORS DECLARATION -, DISTRICT NO. PRO SED BY I hereby affirm that I am licensed under provisions of ChapGAS SYSTEM OUTLETS (J ter �^ 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER 22 and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FIN L VALI ION a 'feet. 7 p License Numb r• �"0 Lic. Class V FI p� Contractor D'ate '� rQ 00 ❑ I am exempt under Sec. W IL B.BP.C. for this reasonPlan check fee Date: PLUMBING PERMIT ISSUING FEE$ lU S SignatureTOTAL FEE 9 31.3 A SINGLE FAMILY, # o 0 0•0 0 5 HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt:from-the Contractor's License Name 1 0 2 5 a 5 0 taw for the following reason (Section 7031.5, Business and Profession's Code): Address o - 25a506 I, as owner of the property, will do the work and the City Tel. No. 0 4.0 5—8 8 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 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 a=d p rty or in ction.,purposes. ' SEE-REVERSE FOR EXPLANATORY LANGUAGE Si nature of Permittee Date WORKERS'COMPENSATION DECLARATION '76A667A hereby affirm that I have g certificate of consent to se CE e,7(:_60) APPLICATION FOR PLUMBING PERMIT nsure,or a certificate of Workers'Co ensation Insuran i certified copy thereof(Sec.3800,L .C) COUNTY OF LOS ANGELES B ILDfN A SAFETY 'olicy No. Company zzxav Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING �a Certified copy is filed with the county buil NUMBER FIXTURE OR ITEM • FEE ADDRESS p g inspection LOCALITY 1407 1 d rt e r WATER CLOSET Date�Applicant NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER JOWNER MAI L (This section need not be completed if the work involved LAVATORY ADDRESS ILL by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.NQ , SU [ certify that in the performance of the work for which this DISHWASHER - Ir permit is issued, I shall not employ any person in any manner CONTRACTOR O ;o as to become subject to the Workers'Compensation Laws. CLOTHES WASHER rd V ADDRESS C Date Applicant ` d SWIMMING POOL RECEPTOR N NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. �J O Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE `JLIC. Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO. //� CLASS with comply with such provisions or this permit shall be Teemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. P CESSE'D BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM (commencing with Section 7000)of Division 3 of the Busi- FINAL r !� VALIDATION ess and Professions o e and my license is in full.force and DATE J 'r ffect. C _? /_ FINAL icense Number Lic.Class 1J So BY ontractor Date 1- (m I am exe rom the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- �o iness and Professions Code). TOTAL FEE Ap2 Ly ic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name � hereby affirm that I am exempt from the Contractor's Address .icense Law for the following reason (Section.7031.5, Busi- City Tel.No. .ess and Professions Code): 3 9 6 0 A I, as owner of the property, am exclusively contracting o, with licensed contractors to construct the project ! ); o'0 0 0 0 G (Section 7044,Business and Professions Code). ao ��_ CONSTRUCTION LENDING AGENCY 1250 hereby affirm that there is a construction lending agency ° 0 0 1 2 5 0 3 or the performance of the work for which this permit is ssued(Sec.3097,Civ.C.). 05 1 2-82 ,ender's Name i .ender's Address certify that I have read this application and state that the bove information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ! -rdinances and State laws regulating Plumbing, and hereby uthorize representatives of this County to enter upon the bove-mention0 property r Inspection purposes. —C� ! Signatu of Permittee Date 7OA687 17 9-49-® APPLICATION FOR PERMIT DEPARff&NT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES : PLUMBING 1 WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT N'O. GROUP I ZONE �P MIT NO. *� O L,S/" PLUMBERF 1`CTAN!� PLUMBING CONTRACTORS RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS 344 W. Garvey - Monterey Park, Calif. - (� A antic 5 - l muerlan BUILDING sem' ® aq Al CITY TEL. NO. ADDRESS COUNTY !�6 �� LOCALITY �, 9 LICENSE NO. a EXPIRES x/.30 PERMIT FEES CROSS ST. �? //��AA �s _�i •� NUMBER TYPE OF FIXTURE OR ITEM FEOWNERE •� _ _ MAIL _ / WATER CLOSET (TOILET) Cd) 6.50 $ ADDRESS ATH TUB 0.50 CITY TEL. NO. SHOWER 0.50I 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND LAVATORY (WASH BASIN) ® 0.501 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. -**-KITCHEN SINK ® 0.50 oo ( CERTIFY THAT I POSSESS THE ABOVE VALID LOS 1 LAUNDRY TUB OR TRAY O.SO ANGELES COUNTY LICENS OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PRY DRT� SCRIBED ABOVE. GAS SYSTEM__3_OUTLETS @ 0.50 SIGNATURE OF �� 1 I-WATER HEATER Q 0.50 I �� PERMITTEE .l SLOP SINK 0.50 I INSPECTION RECORD FLOOR SINK Q 0.501 a FLOOR DRAIN ® 0.301 DISHWASHER ® 0.501 DRINKING FOUNTAIN a 0.501 URINAL ® 0.50 �?� Cn..�i_®P'c-T /eCwJ. 1�[a.v 17' .J HOUSE SEWER ® O.SOI !/ Q Z MISCELLANEOUS a 3 C.n��L?� i�'e9 ldJn i✓ O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING 1 GAS VENT CESSPOOL Q 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 I SEWER PERMIT . 1.00 GAS TEST �q TOTAL FEE I $ //I �® UTILITY CO. NOTIFIED / .g _ r 17 FINAL f>