HomeMy Public PortalAbout6231 SULTANA AVE_Plumbing__ • WORKERS'COMPENSATION DECLARATION AAIP LPCAT�®N FOR PLUMBING PERMIT
• .kI.hertabv-affTrm t)Sat 1'hale a certificate of consent to self 76A667A
•iOslure, ova cei►tificote of Workers'Compensation Insurance, CE 817(REV. 10/81)
'orrpa�ceerrtified cop thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
P6 y No00�oC mpany d&LkdW&lz k-RL*(_
❑ 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 @ FEE
p LOCALITY
WATER CLOSET �Ja
Date -Apr Or D 0� NEAREST
CERTIFICATE OF EXEMPTIOOM WORKERS'
BATH TUB ®(> CROSS ST.
COMPENSATION I RANCE OWNER
(This section need not be completed if the work involved by SHOWER
the permit Is for one hundred dollars($100)or loss.) LAVATORY 'nth MAIL
1 certify that in the performance of the work for which this -ql
Y/'V ADDRESS .
permit is issued, I shall not employ any person in any manner SINK CITY gig
TEL.NO.
so as to become subject to the Workers'Compensation Laws. DISHWASHER
�� CONTRACTOR C
Date Applicant CLOTHES WASHER G/►/ ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate oft'J
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
CITY -
Compensation NO.• p
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM i o o�
with comply with such provisions or this permit shall be STATE //���� LIC.
0®
deemed revoked. WATER HEATER LICENSE NO. 8-® � CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PR ED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (/�f x
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER >_
and Professions Code,and my license is in full force
�and
�effect. 5 PER SYSTEM FINAL ✓ � VALID ION
License NumberLic. Class DATE0
FIN Rf
Contractor Date BY
jr
I am mpt under Sec. �
B.&P.C. for this reason y
Plan check fee
Date:
Signature PLUMBING PERMIT ISSUING FEE$ ® c 3 3 9.7 A
TOTAL FEE
# 000005
Plan check applicant
SINGLE FAMILY I o 171350
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License o - 17a5 Q 5
Law for the following reason (Section 7031.5, Business and Address
Professions Code): City Tel. No. ( 1.05-85
❑ 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). 10>
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
Signatur Permittee I Date U
76A667 088 17 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY �'
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN. 14G 1
D S R O. GROUP R 9•
I
P
LUMBER
R 9231 W
R Consolidated Plumbing C • RECE ED BY READY FOR DATE ISSUED
. Huntington Dr. FIRSTINSPECTION -7_/
Monrovia E18-6878 BUILDING 6233 N. Sultana
CITY
TEL N0. ADDRESS
NO. 6977M LOCALITY Temple City
LCEN
NEAREST K
PERMIT FEES CROSS ST. . osemead
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER reative Bldg.
MAIL
WATER CLOSET(TOILET) 0.50 !¢ ADDRESS 3106 Live Oak
1 BATHTUB @ 0.50 507 DITY Temple le U ity TEL. No.
SHOWER 0 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
1 LAVATORY (WASH SABIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
1 KITCHEN SINK 0.50 50 ANSTATE LAWS REGULATING PLUMBING.
TCERTIFY THAT I POSSESS THE ABOVE VALID LOS
1 LAUNDRY TUB OR TRAY ® 0.50 50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
1 GAS SYSTEM-3—CUTLETS @ 0.50 5A SI THE RESIDENTIAL ROP RTY RIBED ABOVE.
C SIGNATURE OF //py
1 WATER HEATER (4'! 0.50 50 PERMITTE
' SLOP SINK @ 0.50 INSPECTION RECOR
FLOOR SINK 0.50
FLOOR DRAIN 0.50
DISHWASHER 0:50
DRINKING FOUNTAIN 0.50 yy 11�� / Q11
URINAL fib 0.50 !/Alov-.J1"I'lfdl�.�
p. Q
HOUSE SEWER 13.50 l ?
MISCELLANEOUSI n fLr' _ L r e-A e A, 0
_ Q'
Cf- Ar
c.M /t R R
. APPROVALS
DATE INSPEECTORPB/NAME
ROUGH PLUMBING /( N
v -
GAS PIPING
GAS VENT
CESSPOOL @ 1.430 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) 1.00 SEWER
PERMIT 1.00 GAB TEST
TOTAL•FEE # 4 15;0 UTILITY CO.NOTIFIED rl v, 16.-,
. ..
/ FINAL
7BABOT
13190.1-1 9-98 APPLICATION FOR PLUMBING PERMIT 1
DIVISION OF BIDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING
LOCALITY
FOR APPLIC NT TO FILL IN NEAREST
CROSS ST.
Av
OWNER DISTRI O. GROUPI .Zv9NF I READY FOR INSPECTION
MAIL v�V t llfi
ADDRESS "
INDUSTRIAL
CITY TEL.N WASTE APPROVAL
loor
PLUMB rsJ INSPECTION RECORD
ADDRES
e Q r
CITY y� TEL.N ' '�/✓f
LICEN ✓ic .`
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) $
BATH TUB
SHOWER
LAVATORY (WASH BASIN) v S � r✓�� /
KITCHEN SINK llfFPL�(,•Lr���»�P/✓� �q"✓,� / /
DISHWASHER
LAUNDRY TUB OR TRAY '
CLOTHES WASHER
P
TOTAL NO. @ 0.80 APPROVALS
D
GAS SYSTEM OUTLETS @ 1.00 ATE INSPECTOR'S SIGNATURE
(Eta 1.00 AA
WATER HEATER UNDER SLAB WORK V
ROUGH PLUMBING
PERMIT S 1 00
GAS PIPING
TOTAL FEE 'a Dv GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED B LOS ANGELES'COUNTY AND STATE OF
CALIFORNIA OR THAT I LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIA OPT Y.
SIGNATURE
OFPERM ITTE FINAL ?7'�r CiLJ•f�1G�„G{'
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD,CHIEF PLBG.INSPECTOR
ACID-8 3 7 91S SEP 27 3 2.0 0 In
CE 81.7(REV.6%7s{)
®S e 1
APPLIF
.CATIO OR PL BINE PERMIT
COUNTY OF LOS ANGELES BUILDING AND S FETY
FOR APPLICANT TO.FILL IN.(PRINT OR TYPE) BUILDING'
ADDRES -
NUMBER FIXTURE OR ITEM ® FEE
LOCALITY
WATER CLOSET
-'NEAREST c
BATH TUB CROSS ST.
SHOWER OWNER. �-
LAVATORY MAIL.
ADDRESS
SINK CITY TEL:'NO.
DISHWASHER- CONTRACT
CLOTHES WASHER ADDRESS .
L SWIMMING POOL RECEPTOR
CITY TEL.NO.
LAWN SPRINKLER SYSTEM
STATE: LIC. +�
WATER HEATER. LICENSE NO. / / CLASS rc�
GAS SiE O LETS APPROVALS DATE INSPECTOR'S.SIGNATURE
OVER
UNDER SLAB WORK
5 ST
UROUGH PLUMBING
GAS PIPING
of GAS VENT
IRS
HOT WATER HEATER
PLUMBING FIXTURES a
GASTEST -
PIOn Check fee UTILITY CO:NOTIFIED g
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE' FINAL
Plan check applicant _PLAN.CHECK VALIDATION
t1�- �p
Name Q�V N390
Address [a / (v
City Te.l..No:
1 HEREBY ACKNOWLEDGE T I H VE.REA `HIS APPLICATION AND STATE q L 10
7 n
THAT THE ABOVE I3 CORRECT.AN BEE COM RHALL COUNTY ORDINANCES V lG / 1'1
AND STATE.LAWS REGULATING UMBING 'PERMIT VALIDATION' �y
1 HEREBY CERTIFY T IAM OFERL R .1 TIERED AND/OR LICENSED AS .y 0 0 10 0 0 5
REOUIBED BY LOS ANGEL CO AND 5T. F AL-IFO.R.NIA OR THAT.I AM THE
LEGAL.OWNER OF,AND TO RESIDE I.N. E OVE DESCRIBED RESIDENTIAL 2 O o 130.0
PROPERTY.
SIGNATURE �O O O 1 3 0'0 V
OF PERMITT E o a t 3'-7 9
DISTRICT NO. R OC.22,L
BY '
..��.� a ..
INDUSTRIAL
WASTE APPROVAL