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Home My Public Portal About6323 SULTANA AVE_Plumbing__ a WOIt'kERS'COMPENSATION DECLARATION 7eae67n I hereby affirm that I have a7 certificate of consent to self •- CS 817(2-8e) APPLICATION FOR PLUMBING PERMIT insure,or a certificate of Workers'Compensation Insurance,,or rt' ' th-reof'(See;380 b. .) COUNTY OF LOS ANGELES �' BUILDING AND SAFETY P �N Compan- Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS ' C tired c is filed wit co my in ins action NUMBER FIXTURE OR ITEM • FEE i- WATER CLOSET LOCALITY �°►PPlicant NEAREST • CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST'. COMPENSATION I.NSURANCE SHOWER OWNER (ThisLAVATORY _MFAIL . section need not be completed if the work involved ADDRIPSS p, by the permit is for one hundred dollars ($100) or less.) SINK CIT T V I certify that in the performance of the work�for which this DISHWASHER ermit is issued, I'shall not employ a rson in any manner CONTRACTOR O o ads" �o(y �bject to rke 'Co.. La CLOTHES WASHER ADDRESS `i3Afe �'� °�=—Applican SWIMMING POOL RECEPTOR NOTICE TO APPLICANT: If,.after making this Certificate of CITY t' .� TEL. Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE jj�� LIC. MCESSFLDBY,� z Compensation provisions-of the Labor Code, you must forth- LICENSE NO. �i�� CLAS with comply with such provisions or this permit shall be WATER HEATER deemed revoked. iGAS SYSTEM OUTLETS ' DISTRICT NO. PR LICENSED CONTRACTORS DECLARATION OUTLETS-OVER Sid I hereby affirm that I am licensed under provisions of Chapter 5 PER.SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL' � / ness and Professionst'.. Code,and my license is in full force and DATE VALIDATION effect. 1 . Licens FBYIN AL ss Contr ate • - 5-74 I am exempt from the licensing requirements as I ani a Plan check fee 'z licensed architect or a registered. professional engineer ; acting in my professional capacity ;(Section 7051, Bus- PLUMBING PERMIT ISSUING FE.E$ iness and Pr sions oTOTAL FEE Lie,.or Reg,.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address �O O a 6 A License Law for the following reason (Section,7091.5, Busi- City. Tel.No. nese and Professions Code): # o 0 0 0 0 6 I, as owner of the property, am exclusively contracting with licensed contractors to construct the ' project 2 0 0 3.00 (Section 7044,Business and Professions.Code). CONSTRUCTION LENDING.AGENCY 0.0 o 0 v I'.hereby affirm •that there is a. construction lending agency 0625 -81 for the. performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lend'er'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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby thorize: representatives of this 'County to enter upon the ab -meat operty for inspection purses. .� � � i /ls7—�C—JO�`J ature of a ee Date WORKER'S COMPENSATION DECLARATION 8DPW 9l89 APPLICATION FOR PLUMBING PERMIT 76A68 .I hereby affirm that I have a certificate of consent to self Insure, 76A6s7A of 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) BUILDINSG_/._ J 37 Certified copy is filed with the county building inspection ADDRE � V �' department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. Loo' Pt COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work Involved by the l SHOWER MAP BOOK x PAGE 1992-1 PARCEL 03a permit is for one hundred dollars($1.00)or less.) LAVATORY WNER il' 3\la�T CkA eA31A I certify that in the performance of the work for which this permit Is Issued. I shall not employ any person in any manner so as to SINK MAIL ADDRESSIpp►'�$20t�tw��1/ become subject to the Workers'Compensation Laws. -t DISWASHER CITY sauAftV_ C/11%,X TEL.NO. Date Applicant CLOTHES WASHER CONTRACTOR �L� �`S NOTICE TO APPLICANT: If, after making this Certificate of r spw�Ti Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code,you must forthwith comply with such ADDRESS SNltr� provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY ' �-�=- Gtc"f TEL.NO.2&6—lf0- .1 a I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. CLASS STATE LIC. Q Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED PROCESSED BY a 5 PER SYSTEM License Number Lic.Class Gyt�r—ea!—✓ F-- FINAL LL DATE VALIDATION W Contractor Date 2r f!) FINAL Z ❑ I am exempt under Sec. BY B.&P.C.for this reason CZ Date. Plan check fee , -` PLUMBING PERMIT ISSUING FEE$ r __ Signature TOTAL FEE 3-D17 39.+=0 Plan check applicant i i TEMS SINGLE FAMILY , ..; HOME OWNER-BUILDER DECLARATION Name TOTAL I AL 39 m 30 I hereby affirm that I am exempt from the Contractor's License Law .,.,�': for the following reason(Section 7031.5, Business and Professions Address 441E 39.30: Code): City Tel.No. CHIA1151 .0 1,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). , CH1JD0-[,f30 i M/ 5/9 CONSTRUCTION LENDING AGENCY t. 1 hereby affirm that there is a construction lending agency for the -� '— ill I ' 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 Pol.information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representati es of this County to enter upon the above-mentioned. pr arty fa, I spar ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE J. l� J l't l Gd Signature of Permitte Date