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Home My Public Portal About6122 SULTANA AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION ;. APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have .a certificate of consent to self 76A667A in,Vre, or a certificate of Workers'Compensation Insutance, CE 817(REV. 10/81) �^ c or a certified COUNTY OF LOS ANGELES cop thereof(Sec. 3800 Lab. C.) i ' / � BUILDING AND SAFETY W'Policy Nod ' Compony�104•r� rc. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building i p - ADDRESS tion department. NUMBER FIXTURE OR,ITEM @ FEE LOCALI r +��+ '' WATER CLOSET , r r Date AppIIgan. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER .eLo SL (This section need not be completed if the work involved by 4 the permit.is for one hundred dollars($100)or less.) LAVATORY MAIL ADDRESS 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 e �.� TEL.NO,aQ ,. so as to'become subject to the Workers'Compensation Laws. t DISHWASHER CONTRACTOR, Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR ADDRESS SS Exemption, you should become subject to the Workers' CITY 71\ TEL.NO Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM 7� v with comply with such provisions or this permit shall be STATE3 -t LIC. deemed revoked. WATER HEATER LICENSE NO. / r CLASS LICENSED CONTRACTORS DECLARATION. DISTRICT NO. P ESSED BY I hereby.affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER `J and Professions Cade,and my license is in full force and effect: 5 PER SYSTEM FINIAL VALIDATION . 0 DAT y 7 Q �Q License Number37b ` O Lic. Class O--83 Contractor 0 I am a Impt underPA B.&P.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING.FEE Signature . r TOTAL FEE, V �y o n SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name � "` I hereby affirm that I am exempt from the Contractor's License Address ° ° 3.0. r C Law for the following reason,(Section 7031.5, Business and ..y TelNor Cit Professions Code): (i 0 I, as owner of the property, will do the work and the structure is not intended or offered for sale .(.Section , ) I � "`F,3 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-men'o d ropU." ' inspection purposes. o r� SEE REVERSE FOR EXPLANATORY LANGUAGE �� -3. ignature of Permittee Date 76 A 567—CE 817 8/68 APPLICATION FOR PLUMBING PERM COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUM-DING 6/ BUILDING AND SAFETY DIVISION rOL JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN(PRINT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE WATER CLOSET 1.50 OWNER_ BATH TUB 1.50 ADDRE SHOWER 1.50 CITY _TEL. NCj� LAVATORY 1.50 CONT OR SINK 1.50 ADDRESS DISHWASHER 1.50 CITY TEL.NO 0� CLOTHES WASHER 1.50 -STATE LI LICENS NO. Q CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GRO E P OC BY LAWN SPRINKLER SYSTEM 2.00 r v WATER HEATER � INDUSTRIAL Zo WASTE APPROVAL v GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD Lu OUTLETS OVER 30 to 5 PER SYSTEM Z Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE S 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant. UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel. No. HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR UTILITY CO.NOTIFIED ` LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I THE LEGAL OWNER OF,AND INTdND TO RESIDE IN,THE ABOVE D CRI ED RESIDENTIAL PROPERTY. FINAL 11,K11 PC/ SIGNATURE JACK R. ALLEN, SUPERVISING EC ANICAL OF PERMITTEE PERMIT VALIDATION C . j M.O. CASH PLAN CHECK VALIDATION CK. M.0. CASH 7SAS57-CE-#9172-52 TEMPLE CO 19 `t;p• APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING y /y JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS. h fxL WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY .� FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE WATER CLOSET $1.25OWNER L AL BATH TUB 1.25 ADD SHOWER1,25CITY;Alta TEL. NO LAVATORY 1.25 CONTRA OR SINS 1.25 ADDRES c DISHWASHER 1.25 CITY TEL.N u7� LAUNDRY TUB 1.25 CONTRA R'S. STATE REGISTR ION NO. COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PR CESS BY WATER HEATER. 1.50 GAS SYSTEM OUTLETS. 1.50 INDUSTRIAL. WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD C}. Ed u W R APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2JON DER SLAB WORK ROUGH PLUMBING TOTAL FEE S PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICt AND STATE THAT THE ABOVE IS CORRECT AND.AGREE TO COS VENT PLUMBING. N6TH L COUNTY ORDINANCES AND' STATE LAWS REGULT WATER HEATER , �(y, �;;:} /y�•'"'� 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANINC FIXTURESLICENSED AS REQUIRED BY LOS ANGELES COUNTY ANDTS TEST CALIFORNIA OR THAT I A THE AL OWNER OF,AND INTENRESIDE IN,T:HE ABOVE 1) RIB RESIDE L P BERTILITY CO.NOTIFIED SIGNATURE / l IOF PERMITTE NAL 17,4fl0, 1 Q VALIDATI ROBERT WOOD CK. M.o. CASH SUPERVISING MECHANICAL ENG'R Li11 5 1 9 5w PlAy ?4 5 D 35QN r 76A 687-C'E*S17 9/89 •' 9APPLICATI N FORPLUM IVIG PERMIT COUNTY OF LOS ANGELES u DEPARTMENT OFCOUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A.LAMBIE.COUNTY ENGINEER ADDRES. �'• WILLIAM A.JENSEN,SUPT'OF'BUILDING •'LOCALITY FOR APFLICAN.T TO FIMIN NEAREST CROSS ST. NUMBER FIlGTURE.OR-ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL / A BATH TUB 1.25 ADD / •SHOWER — 1.23 . CITY �. TEL..NO ,� e�� LAVATORY 1,25,. CONTRAC E%9�IE SINK' 1.25 ADDRES .a DISHWASHER 1.25 CITY TEL. NO SZZ LAUNDRY TUE. - 1:25' CONTRAC R'S STATE REGISTRATION NO.. COUNTY CLOTHES WASHER 3.$S. DISTRICT NO. GR E P WATER HEATER ' 1.50 . P 'GAS SYSTEM, OUTLETS 1.50 INDUSTRW. 0 WASTE'APPROVAL OUTLETS OVER 5 PER SYSTEM .80 U INSPECTION RECORD x a q r a c4&g� PL= pt k7'u ta - t, Z tL''L21A1 APPROVALS j,DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK $.ipl,X., PERMIT S 2.. 00 • e � ROUGH PLUMBING TOTAL FEE 17 . GAS PIPING' 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ 'THI8 A PLICATION ,GAS VENT ' AND STATE THAT THE.ABOVK IS CORRECT AND, AGREE TO- COMPLY WITH .ALL COUNTY ORDINANCES AND: STATE LAWS REGULATING HOT WATER HEATER _ PLUMBING: 1 HEREBY CERTIFY THAT I AM P PERLY :REGISTERED AND/OR PLUMBING FIXTURES' LICENSED AS 'REQUIRED BY LOS GELEB COUNTY AND STATE. OFA GAS TEST CALIFORNIA OR THAT I AI..THE. GAL OWNER OF AND NTEND TO RESIDE IN,THE.ASO .DE RIB RESIDENTI. PR RTY - TILITY CO,NOT.IFIED _ SIGNATURE' OF PERMITTEE FINAL f' ° VAI IDATIO ROBERT A.W )OD CK. M.0. CASH SUPERVISING MECHANICAL E•NG'R 12-.2 5Y 4 5 D 7.00K