HomeMy Public PortalAbout6167 SULTANA AVE_Plumbing__ i°' ,�• . wbRK)pRS'COMPENSATION.DECLARATION k' APPLICATION FOR PLUMUNG PERMIT
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� :51 h. 1 ff r .that I have a certificate df consent to self , 76A667A L1
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rnsu ..;'oc,o car ificetQ of Workers'Compensation Insurance, �'CE 817(REV. 10/81)
.or m certified copy thereof(Sec. 3800, Lab.'C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY ,
P❑olico No. '98108_' Company—'pUhl i re Tn :Fqnni-Ey #1123
Certifie c.py is hereby furnished. BUILDING , ,
FOR.APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 61 ;Sultana
Cert'ifigd copy'is filed with the county building inspec
tion department. • NUMBER FIXTURE OR ITEM FEE LOCALITY 1 'j'em g it�7
Date ' 7.2?/86.Appli;an" > .SCG 1 WATER CLOSET —' NEAREST
API
BATH TUB CROSS ST.'
CERTIFICATE OF EXEMPTION FROM WORKERS' " t a�• ,
COMPENSATION INSURANCE SHOWER OWNER Battac]la'' , IF1Cy�l ti,l};, +4• i.°
(This section need not be completed If the work involved by MAIL 1OT N� Orange Aver `
the permit Is for one hundred dellors':(;100)or leas.:) �' LAVATORY ADDRESS'
1.1.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 TIITeSt Covina TEL.NO.960-5393
so.as to become subject to:the Workers'Compensation Laws. / DISHWASHER CONTRACTORFrank Marrone and Sons, InC.I
Date Applicant . ... CLOTHES WASHER
d — . ADDRESS' 9860 Lower. Azusa Fd
NOTICE TO:APPLICANT: If, after.making. this Certificate�of SWIMMING POOL RECEPTOR
Exemption, you should. become sublect :to the Workers' CITY TEL..NO.
Compensation provisions•of the.Labor Code, you must forth- LAWN.SPRINKLER SYSTEM
MOnte 444-2548
with comply with such provisions or this permit shall be STATE 397884 Lic' C/36 + ''
deemed revoked. WATER.HEATER LICENSE NO. 1 r i CLASS.
LICENSED CONTRACTORS DECLARATION DISTRICT NO. P�. EDI hereb offirm•that I am licensed•under rovisionsof Cha ter9GAS SYSTEM. OUTLETS
Y P P c ' 1) 1' V.tit. ,
(commencing with Section 7000) of Division 3 of the Business
OUTLETS OVER
and Professions Code,and•my license is in fuII,force and effect.. 5 PER SYSTEM FINAL 'i
VALI TION.
License Number :397884 Lic. Class W36. DATE 1 I i 1
FIN
ContractorMarrone Date 7/22/86 B
I am exempt under Sec. ` li r 1 C
B.BP.C. forPhls reason }: s 4
r Plan check fee l 4
Date. PLUMBING PERMIT ISSUING FEE$ Q f
Signaturei , 1
TOTAL FEE j> 1
Plan check applicant
SINGLE FAMILY / r
HOME'OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from.the Contractor's License Address r
Law for }lte following reason (Section 7031.5, .Business and
Professions Code):� City Tel. No. ? �52`.3:9A
I, as owner of the property, will do the work and the
.structure is not intencidd or offered foe sale (Se !on o 0
7044, Business and Professions Code). J L _f:o'o
CONSTRUCTION LENDING AGENCY O,o o 8 8,5 U
U
I.hereby affirm that there is a'construction lending agency for cal i
the-performance of the work for which this permit is issued
(Sec.:3097, Civ. C.). 11
Lender's Name
Lerider's Address
1 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
Signature of Permittee Date 1 ,