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Home My Public Portal About6164 SULTANA AVE_Plumbing__ ION 2D-002 WORKER'S have a certificate of consent to 76AS66DPw9/89 APPLICATION FOR PLUMBING PERMIT 78A557A I hereby affirm thatrl have a certificate of consent to self Insure, or a certificate of Worker's Compensation Insurance,or a certified copy thereof(Sec.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(POINT OR TYPE) B ILDING DRESS El Certified copy Is filed with the county building Inspection department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. COMPENSATION INSURANCE BATH TUB ASSESSOR SESSOR (This section need not be completed if the work Involved by the SHOWER MAP BOOK • PAGE PARCEL permit is for one hundred dollars($100)or less.) LAVATORY WNE 1 t 1 I certify that in the performance of the work for which this permit �� is issued, I shall not employ any person in any manner so as to SINK AD AIL become subject to the Workers'Compensation Laws. I ( -46 -94n QP DISWASHER Applicant%Z f1 CLOTHES WASHER CI ` �t TEL.NO. n R�9 Date� , NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR '0p-r Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO.. � I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE LIC. (commencing with Section 7000)of Division 3 of the Business andGAS SYSTEM OUTLETS 0 CENSE NO. CLASS 0 Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PAOCESSED BY ,r- 5 PER SYSTEM License Number Lic.Class VZOATION { �c LUDATE ,�i 4 IL e Y Contractor Date I ITEMS 9L ❑ I am exempt under Sec. BY AL r TOTAL 4 -1 o'83 � BAP.C.for this reason I CHECK 41.85 Date: Plan check fee 01. Signature PLUMBING PERMIT ISSUING FEE$ V-161 400 CHANGE .00 ❑ TOTAL FEE Plan check applicant 001-10_I�)_i3IL '� '�lY SINGLE FAMILY X452 IL AM ILLI:5 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Address Code): rCity Tel.No. I,as owner of the property,will do the work and the 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 arlyesenat'ves of this County to enter upon the above-mentioned or insp tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sldnetu rmittee Date I WORKERS'COMPENSATION DECLARATION r W. APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consenrfo•self '" X60, �/YY�' insure, or a certificate.of Workers'Compensation Insurance, E 817(REV. 10/81) ^� or a certified copy thereof(Sec. 3800, Lab. C.) I COUNTY OF LOS ANGELES / , BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished.❑ BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM Q /FEE LOCALITY Date Appligant WATER CLOSET & t� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE (This section need not be completed If the work involved by DO SHOWER OWNER the permit is for one hundred dollars($100)or less.) LAVATORY D MAIL . ADDRESS I certify that in the performance of the work for which this i permit is issued, I shall not employ any person in any manner SINK CITY TEL..NO. 6 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRALTO Date Is 5015921APPlicant-92h, CLOTHES WASHER NOTICE TO APPLICANT: If, after making tis Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL.,NO. with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC. , deemed revoked. WATER.HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED B I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER ,i and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL DATE e. VALIDATION 0 License Number Lic. Class 3 FINAL Contractor Date BY L, Ell am exempt under Sec. I LU tn B.&P.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ S� Signature 8-99. ] P y TOTAL FEE SINGLE FAMILY Plan check applicant o o'o a o HOME OWNER-BUILDER DECLARATION Name 'I o,o C 0 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5; Business and Address Profssions Code): City Tel.No. O'2, 1 u--8 4 I, as owner of the property, will do the work and the 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 above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r Sigri-d-turef P rmittee Date 76A667-CE617 12/59 � i_£r-'tsJ 'wil r. ^ w APPLICATION FOR PLUMBING PERMI` ' COUNTY OF LOS ANGELES . DEPARTMENT OF-COUNTY ENGINEER Y.4. BUILDING AND SAFETY DIVISION N . BUILDING 1 JOHN A. L AMBLE, COUNTY EN�3INEER ADDRESS WILLIAM A.JENSEN. SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CN A SST . NUMBER FIXTURE OR ITEM' OWNER ' WATER CLOSET // // [/ IL BATH TUB ADDRESS G? (fes / Ly A CITY TEL NO. SHOWER . LAVATORY CO OR �f sm ADDRESS ` DISHWASHER CTEL. NO li-&./ CON_ OR'$ p j ATE LAUNDRY TUB REGIST TION NO. / COUNTY p CLOTHES WASHER DISTRICT NO. GROW36r yE_ P SSEa B WATER HEATER ....� D U 1 GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD O _ IIOC� r. q W OR FEPER KTTUREE I $ I 1 O ' APPROVALS DATE INSPECTOR'S SIGNATURE` E� r PERMIT $ 2 00 UNDER SLAB WORK TOTAL FEE pQ ROUGH PLUMBING GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE. TO COMPLY .. LC,ALIFORNIA COUNTY ORDINANCES AND STATE LAWS REGULATING NOT WATER HEATER'.Y CERTIF�f:THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES AS REQUIREDBY LOS ANGELES COUNTY AND STATE OFGAS TEST IA OR THAT I AM THE LEGAL OWNER OF THE ABOVE D RESIDENTIAL OPE TY. TILITY.CO.NOTIFIED RE iMITTE FINAL IDP VALMATIROBERT A.WOOD: OE. M.,L .ppgg SUPERVISING MECHANICAL ENG'R.