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Home My Public Portal About6370 SULTANA AVE_Plumbing__ WORKER'S 0.002 COMPENSATION DECLARATION 28DPW 9/89 APPLICATION FOR PLUMBING PERMIT 20-002 1 hereby affirm that,I have .a certificate of consent to salt insure, 76A667A 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) BUILDING `_�� SUt�A 6 Certified copy Is filed with the county building inspection ADDRESS W department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY / ` Date Applicant WATER CLOSET CNEAREST ROSS ST. ( C)tll�rbQ� CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB SSOR D COMPENSATION INSURANCE MAP BOOK �,�0 0� PAGED/ PARCEIfj�� (This section need not be completed it the work Involved by the a SHOWER permit Is for one hundred dollars($100)or less.) LAVATORY OWNER 3immoy Li M I certify that in the performance of the work for which this permit MAIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS UZt4�Q �� „ become subject to the Workers'Compensation Laws. r�p �/� oMA DISWASHER CITY 5A ti �/r'1 TEL.NO.%'17 45141(p Date Applicant CLOTHES WASHER CONTRACTOR v►i w NOTICE TO APPLICANT: If, after making this Certificate of / DCwGeuizi Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code,you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER CL (commencing with Section 7000)of Division 3 of the Business and STATE LIC. 0 LICENSE NO. CLASS Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS (3 OUTLETS OVER DISTRICT NO. Q� PROCESSED BY Ilt 5 PER SYSTEM License Number Lic.Class FINAL DATE I,.�Z VALIDATION Contractor Date 1144!! IL cc ElFINAL ACCTn V Z I am exempt under Sec. D BY 7 B.&P.C.for this reason 3307 190.65, Date: Plan check fee PLUMBING PERMIT ISSUING FEE$ 1 ITCC�`� Signature e �� TOTAL 190-65 TOTAL FEE r_1 / CHECK 1010.65 SINGLE FAMILY Pian check applicant CHANGE 00 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Address Code): 031300-130111 s/31i 03 ❑ City Tel.No. ' I,as owner of the property,will do the work and the structure 8956 1 AH Cre3`* 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 Pol- and State laws regulating Plumbing, and hereby authorize Irepreatives fthis County to enter upon the above-mentioned for Insp ction pyrposes. SEE REVERSE FOR EXPLANATORY LANGUAGE rA l 31 q3 er rmittsa Date 76t 667,S CE 817 468a-it - APPLICATION FOR PLUM I G PERMI COUNTY OF LOS.ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER Zo COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN(PRINT Olt TYPE) NEAREST , CROSS ST. NUMBER FIXTURE OR ITEM EACH FEES • OWNER `- WATER CLOSET 1.50 MAIL BATH TUB 1.5.0 ADDRESS �y SHOWER 1.50 CITY TEL. NO. , LAVATORY 1.50 CONTRACTOR SINK 1..50 ADDRESS o DISHWASHER 1.50 CITYTEL. NO. CLOTHES WASHER 1.50 STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1.50 I DISTRICT NO.. GRO ZONE P OC LAWN SPRINKLER SYSTEM 2.00 ,`r e7 er WATER HEATER 1.50 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD 0 OUTLETS OVER 30 5 PER SYSTEM {il N z Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE S 2 00 1 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER:SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City. Tel. No. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA.OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE-IN,THE ABOVE DESCRIBED RESJOKNTIAL PROPERTY. FINAL SIGNATURE JACK R. ALLEN, SUPERVISING MECHANIC OF PERMITTEE - PERMIT VALIDATION CK. M.O. ASH PLAN CHECK VALIDATION CK. M. ASH LArt,97.7' 30 14AY 5 A 35 ?