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Home My Public Portal About6358 SULTANA AVE_Plumbing__ RKERS'COMPENSATION DECLARATION 200026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT 1 -I'Retreby,Mf that I have a certificate of consent to self in- 76A667A sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV..8/86) certified copy thereof(Sec'. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS LLJJ Policy No.1.0 061 Company FL Certified copy is hereby furnished. - FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ; Certified copy is filed With the o city buil 'in. inspection ADDRESS Fj C. VIP— department. NUMBER FIXTURE OR ITEM @ FEE / nn ff�� LOCALITY /e CTL Date' ^ Applicant I WATER CLOSET(TOILET) V V NEAREST LL CERTIFICATE OF EXEMPTIOni N OM WORKERS" l BATH TUB v CROSS ST.. COMPENSATION INSURANCE OWNER Q '(This section need not be completed if the work involved by SHOWER = MAIL • the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS' j�✓V� I certify that in the performance of the work.for which this per- SINK CITY TEL. NO. mit is issued, I shall not employ any person in-any manner so 7 as to become subject to the Workers'..Compensation Laws; DISHWASHER ~� CONTRACTOR S Date Applicant CLOTHES WASHER ADDRESS' NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR lAmu;rni c." emption,you should become subject to the Workers'Compen- CITYA f TEL. NO.5��(,�i sation provisions of the Labor Code,you must-forthwith comp- �� LAWN SPRINKLER SYSTEM l.y w-ith such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. COS 1 - CLASS LICENSED CONTRACTORS DECLARATION OUTLETS DISTRICT NO. PROC ED BY d I hereby affirm that I am GAS SYSTEM am-licensed under provisions of Chapter' �1� •• 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is,in full force and ef- 5 PER SYSTEM FINAL VALID ION �' ll fect. DATE ' �� 4 cense Number Lic. Class O Li O t FIN g Contract Uate 7it� , B 5 O I am exempt under Sec. I ACCT■- W Plan check fee B.&P.C. for this reason POO. 335137 40.50 , Date: = PLUMBING PERMIT ISSUING FEE$ - I ITEM Signature - T.OTAL 0_50 • TOTAL FEE SINGLE FAMILY CHECK 40.50 HOME OWNER-BUILDER DECLARATION Plan check applicant I.hereby affirm that I am exempt from the Contractor's License Name CHANGE .00 Law for the following reason (Section 7031.5, Business and Professions Code): Address 0010 0C10i I, as-owner of the property, will do'the work and the City Tel. No.. 1/24/89 structure is not intended or offered for sale(Section 7044, 07 09 1 AM11 o 17 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 I 1A _ - 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 outhorike rdpresentatives of this County to enter upon the above-r1tritioned prNert fpurposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of Permi tee Date I6A667-CE817-8-57 ; APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES )EPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS OHN A. LAMBIE, COUNTY ENGINEER CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST y'`-•.,.,.r R�- ) NUMBER - FIXTURE OR ITEM CROSS ST. OWNER WATER CLOSET IL ADDRESS BATH TUB f ✓ '1 '�' SHOWER CITY EL.NO. "' LAVATORY CONTRACTOR � ✓ SINK ADDRESS DISHWASHER CITYEL.NO. LAUNDRY.TUB CONTRACTOR'S STATE REGISTRATION COUNTY ❑ CLOTHES WASHER DISTRICT NO. GROUP ZONE READY FOR INSPECTION • WATER HEATER CTAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD APPROVALS $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE _ OR FIXTURE $ UNDER SLAB WORK ROUGH PLUMBING PERMIT 5 1 00 ' GAS PIPING TOTAL FEE / GAS VENT 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPYICATION 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 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF . CALIFORNIA OR -THAT 1 AM, THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE • I , OFPERMI•TTE - FINAL wiIIIIIIIIIIII ROBERT A. WOOD, VALIDATION I SUPERVISING MECHANICA:ENG'R 1 .. CK. N.O. CASH F6A667-CE817-8-57 ~ r APPLICATION FOR PLUMBING PERMIT L� COUNTY OFA LOS ANGELES DEPARTMENT OF I COUNTY;ENGINEER BUILDING/1' BUILDING AND;SAFETY DIVISION ADDRESS IOHN A. LAMB(E, COUNTY ENGINEER CASSATT D. GRIFFIN, SUP''T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS , r SHOWERT •CITY , GGf TEL.NO.. LAVATORY CONTRACTOR I - SINK ADDRESS " 'DISHWASHER CITY TEL.NO. LAUNDRY TUB CONTRACTOR'S STATE El REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT NO. GROUP I LNEREADY FOR INSPECTION WATER HEATER _ GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD . b 1 APPROVALS . l @ $1.00 PER ITEM J DATE INSPECTOR'S SIGNATURE, 1 OR FIXTURE $ ] UNDER SLAB WORK ROUGH PLUMBING PERMIT S 1 00 GAS PIPING TOTAL FEE GAS VENT Ii HEREBY ACKNOWLEDGE THAT 1 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. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED DESCRIBED RESIDENTIAL PROPE Y. SIGNATUR OF PERM- FIE ROBERT A. WOOD. VALIDATION PIs SUPERVISING MECHANICAL ENG'R • »• l CK` M.O. CASH DBS-17 12•S4 APPLICATION FOR PLUMBING PERMIT DBS-17 DIVISION OF BUILDING AND SAFETY 1' Department of County Engineer County of Los Angeles BUILDING 771 WM.J. FOX, COUNTY ENGINEER ADDRE S CASSATT D.GRIFFIN.SUPT OF BUILDING LOCALITY VHN +, FOR APPLICANT TO FILL IN NEAREST Qy�r y CROSS ST. OWNER /?® A? ( /a// q*g�'J `,/� DISTRICT NO. - GROUP /ZONE READY FOR INSPECTION MAIL ADDRESS �L3C �/ Y i);CrA IIIA J I L I /I INDUSTRIAL CITY C I L TEL.NO. WASTE APPROVAL PLUMBER � I'e A /L D � INSPECTION RECORD ADDRESS CITY /� S M, TEL.NO. d o LIC NSE NO. C- 36 2 �?,i NUMBER TYPE OF FIXTURE OR ITEM FEE - WATER CLOSET (TOILET) BATH TUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINK DISHWASHER LAUNDRY TUB OR TRAY CLOTHES WASHER TOTAL NO. ® 0.80 APPROVALS DATE INSPECTOR'S SIGNATURE GAS SYSTEM OUTLETS 1.00 DO UNDER SLAB WORK WATER HEATER @ 1.00 ROUGH PLUMBING PERMIT S 1 00 GAS PIPING TOTAL FEE I D 6 GAS VENT I HEREBY ACKNOWLEDGE THAT 1 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. IHEREBY CERTIFY T T I AM PROPERLY REGISTERED AND/OR GAS TEST n� LICENSED AS REOUIR Y LOS ANGELES COUNTY AND STATE OF. CALIFORNIA OR TH I M THE LEG L OWNER OF THE ABOVE UTILITY CO. NOTIFIED 1 DESCRIBED RESIDE IAL ROPER SIGNATURE OF PERMITTEE FINAL WILLIAM J.FOX,COU TY ENGINEER VALIDATION .} 46595 1013 . .3 2.00 BY e.0 DEPUTY