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HomeMy Public PortalAbout6210 SULTANA AVE_Plumbing__ 'rsass't — o$s17 stvo APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGIIVEER surznlNc BUILDING AND SAFETY D ON BUILDING s j JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W.JENKINS. SUPT. OF BUILDING LOCALITY ? C_ . FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 1.50 BATH TUB 1.50 AD r C' SHOWER 1.50 CL,- C TEL.LAVATORY 1.50 1.50 CONTRACTOR ) SINK 1.50 ADDRESS DISHWASHER 1.50 TELNO. 62012=4 CLOTHES WASHER 1.50 STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP E ESSED BY LAWN SPRINKLER SYSTEM 2.00 I �$ ✓ WATER HEATER 1.50 !.? WASTE APPROVAL GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD OUTLETS OVER 5 PER SYSTEM .30 O 1n 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 18 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER Off.AND INTEND TO RESIDE IN.THE ABOVE DESD RESIDRqNTIAL P PERTY. FINAL 7-71 G" SIGNATURE tIL JACK R.ALLEN, sUPERVISIN HANI CAL ENG'R. OF PERMITTEE-74) PERMIT VALIDATION c_�/ M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH • r J J ', . WORKERS'COMPENSATION DECLARATION APPLICATION ���I�+p��®pO � [PLUMBING ®f�®AAI I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/87 A CA N l!' PJM ®� PERMIT Rev■ sure,ata certificate of Workers'Compensation Insurance,or 76A667A P CE 817(REV.8/86) certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No.10-0489604 Company CNA Insurance F1 Certified copy is hereby furnished. © FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS 6210 Sultana department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date 4-18-91 Applicant OWPn BMS;_ P11Tmh, 1 WATER CLOSET(TOILET) ] 7150 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER pat Murray (This section need not be completed If the work involved by MAIL the permit is for one hundred dollars($100)or less.) 1 LAVATORY 7 So ADDRESS 3606 N. Rio Hondo I certify that in the performance of the work for which this per- SINK CITY TEL. NO. mit is issued, I shall not employ any person in any manner so 1 7 50 Rosemead 443-1579 as to become subject to the Workers'Compensation Laws. ] DISHWASHER 7 50 CONTRACTOROWen Bros. PlLmlbl I Date Applicant 1 CLOTHES WASHER 7 50 ADDRESS 4265 N. Baldwin Avenue NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM El Monte 443-0078 ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. 231 741 CLASS C36-20-16 LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 1 GAS SYSTEM 2 OUTLETS 7 50 N�f7 Lim 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �j 0 and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL!--q 9/ VALIDATION a fect. DATE License Number 231 741_ Lic. Class 036-20-1 6 V FINAL Contractor QWP_n RTnS P1mhDate 4-18-91— BY O H ❑ I am exempt under Sec. W CL B.&P.C. for this reasonPlan check fee s© U) Date: PLUMBING PERMIT ISSUING FEE$ 13 00 Signature TOTAL FEE 58 00 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant " 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): AddressI:-t FJ I, as owner of the property, will do the work and the City Tel. No. _ c', lG structure is not intended or offered for sale(Section 7044, i 1 I Es ii Business and Professions Code). TOT E AL X 4 CONSTRUCTION LENDING AGENCY ® 1 I hereby affirm that there is a construction lending agency for CHECK 53.0", the performance of the work for which this permit is issued C,C (Sec. 3097, Civ. C.). Lender's Name illil T '7* y Lender's Address y(�__�_=; i 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 yhorize representatives of this County to enter upon the e-mentioned property for inspection purposes. 4-18-91 SEE REVERSE FOR EXPLANATORY LANGUAGE i ature of Permittee Date