HomeMy Public PortalAbout6229 SULTANA AVE_Plumbing__ 76AS67 CBS 17 7-81 1 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY I
COUNTY OF LOS ANGELES ii
PLUM-015"ING
WILLIAM J. FOX, CHIEF ENGINEER
FCJJJ(APPLICANT TO FILL 114
.--WE--A0YrOR DATE ISSUED
PLUM a "tl
7m
ADDRESS IBILDN
0-0
DiTY
-rei- ADDRESS
COUNTse Y LOCALITY
-J,07 4d ZZ ; NEAREST
CROSS ST. Ark
PERMIT FEES I I
NUNWA TYPE OF rixTuRc OR ITEM FEE it OWNE
MAIL
WATER CLOSET(TOILET) 0 D.So 6 ADDRESS /0" —
BATH TUB a 0.501 4410
11TY TEL NAo-
SHOWER a 0.60 1 163Y K EDGE THAT I HAVE READ THIS
r
APP 3. 0 THAT THE A313VE 18 CORRECT
0.50 AND WITH ALL COUNTY ORDINANCES
LAVATORY (WASH BASIN) L f
I - jEE TD a LA OULATING PLUMBING.
KITCHEN SINK 0.50 AND
CERTIFY THAT I POSSESS THE ABOVE VALID LOS
0.50 ANGIELE I IIENSE, OR I AM THE LEGAL OWNER
OF
THE
LAUNDRY TUB OR TRAY _0 COUNTY
P%OPERTY EM IBE
Or THE RESIAWNTILJ�' ABOVE.
BAB SYSTZM-----J0UTLE`M tLSC SIGNATURE OF
WATER HEATER mrso PERMITTE I a
SLOP OINK CLOD INSPECTION RECORD
FLOOR SINK 0.50
FLOOR DRAIN 0.50
DISHWASHER C.'so
DRINKING FOUICrAIN 0.30 J
URINAL.
HOUSE BLVIER 0.80
6
MISCELLANEOUS lz
13
APPROVALS
DATE INSPECTOR'S NAME
- :-HP
LUMBING
-SASPIPING
I
,SAS VENT
CEBSPOOL 1.00
SEPTIC TANKS 'SEPTIC YANK
DRAINPIT 1.00 SEWER
PERMIT . . . . . . a GAS TEST
— I —%L(UTILITY CO.NOTIFIED
T13TAL FEE N'6"e- I FINAL
W WC2R(CERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
• .}-1 berebyoaftiinm'that I•.have a certificate of consent to self 76A667A
JnsOrey or..a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81)
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
P) 305a -&010 �� J���I � G11 ny 7 +
Certified copy,is hereby furnished.
® FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspec- ADDRESS
tion department. NUMBER FIXTURE OR ITEM @ FEE
9� �0� LOCALITY
Date 9 D Applicant. AZJA2--& 113WATER CLOSET �.UJ 00 NEAREST
CERTIFICATE OF EXEMPTIOOM WORKERS' , BATH TUB 00 CROSS ST.
COMPENSATION I RANCE SHOWER O OWNER eJ
(This section need not be completed if the work involved by MAIL
the permit Is for one hundred dollars($100)or less.) LAVATORY 00 ADDRESS i 0.
I certify that in the performance of the work for which this `
12
permit is issued, I shall not employ any person.in any manner SINK 00 CITY O TEL.NO.
U7-
so as to become subject to the Workers'Compensation Laws, b' DISHWASHER
00 CONTRACTOR r
Date- Applicant CLOTHES WASHER 1,017 ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of qae!
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
911
Compensation provisions of the Labor Code, you must forth- CITY ; TEL. NO. ,J
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE ���
deemed revoked. WATER HEATER 0 LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NQ ESS BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS S v
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL V IDATION
3 DATE 0
License Number Lic. Class
r FINA s2°
Contractor Date 4 — �� BY
�Il
❑ I amfm
nder Sec.
B.BP. . s reason
Plan check fee ► �
Date: PLUMBING PERMIT ISSUING FEE$ )Olga
Signature
TOTAL FEE p 3 3 9.8 A
SINGLE FAMILY Plan check applicant # 0 0 0 0 0 5
HOME OWNER-BUILDER DECLARATION Name II - 9 4 5 0
1 hereby affirm that I am exempt from the Contractor's License Address
Law for the following reason (Section 7031.5, Business and o 94505
Professions Code): City Tel. No.
❑ 1, as owner of the property, will do the work and the J 1.05-85
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-menf• ned property for inspection purposes.
i
SEE REVERSE FOR EXPLANATORY LANGUAGE
X1,1—ys
Signal of Permittee —� Date