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Home My Public Portal About6240 SULTANA AVE_Plumbing__ . .-it WOJhat.I COMPENSATIONate of consent to 76A667APw9/89 APPLICATION FOR PLUMBING PERMIT 1 hereby affirm)hat I 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(PRINT OR TYPE) -AD SS IQA40 M, < r� Q Q, ❑ Certified copy is filed with the county building inspection department. NUMBED FIXTURE OR ITEM ® FEE LOCALITY lgf6 Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. LDwdtn COMPENSATION INSURANCE BATH TUB ASSESSOR (This section need not be completed if the work Involved by the SHOWER- permit HOWER- MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) LAVATORY OWNER I yid &-41 )�An andi I certify that in the performance of the work for which this permit MAIL Y �'1 is issued. I shall not employ any person in any manner so as to SINK MAILADD �, become subject to the Workers'Compensation Laws. � � �� DISWASHER CITY• Mu TEL.NO. Date Applicant CLOTHS WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code,you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER. 0. (commencing with Section 7000)of Division 3 of the Business and 1 STATE LIC. l GAS SYSTEM OUTLETS LICENSE NO. CLASS a Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESSED BY OUTLETS OVER 5 PER SYSTEM 0 License Number Lic.Class DATE J MVID&TION Contractor Date ` _— _ 15ti.j, FINAL -"�}°''� ❑ I am exempt under Sec. �y gy B.&P.C.for this reason f'/ Date: Plan check fee Signature PLUMBING PERMIT ISSUING FEE$ 1916 ❑ TOTAL FEE .L L_:._r SINGLE FAMILY Plan check applicant _ HOME OWNER-BUILDER DECLARATION Name l i I � � m �-; I hereby affirm that I am exempt from the Contractor's License Law ; j�t:�;• 150 a_l e;l_ for the following reason (Section 7031.5, Business and Professions Address Code) i'�l�lINEE l�l� City 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 r 9, sr,: 10 and Professions Code). CONSTRUCTION LENDING AGENCY 2.16 7 Ail I Q C,5 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 10> 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 c?. G2' �7�' f I t-( -4 a Signature of Permittee Date 76A667-CE#B17 2-62 TEMPLE, CDTv ' APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 6 WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN Naos ST NUMBER FIXTURE OR ITEM EACH FEE Y OWNER WATER'CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR ' SINS 1.25 ADDRESS DISHWASHER 1.25 CITY TEL.NO. LAUNDRY TUB 1.25 CONTRACTOR'S STATE ElREGISTRATION NO. el COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT NO. GROUP I ZONE P ESSED BY WATER HEATER 1.50 of( GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD d U ®C H APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE 5GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICA ION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER ,y I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFGAS TEST - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL 6 A�l `(6MALIDATION ROBERT A.WOOD (/x M.0. CASH SUPERVISING MECHANICAL ENG'R 2 8'1-12 AM22 5 D 5.75-�', 9