HomeMy Public PortalAbout4526 CLOVERLY AVE_Plumbing__ DM-1710.55 APPLICATION FOR PLUMBING PERMIT 1
DIVISION OF I)MIDDING AND SAFETY
D:p=bma t of Connt� Eat
o! Los An
JOHN A. LMBIE,( oUNT-rY EN
1. OIN6SR AD RffZg I�
CAABATT D,GRIFFIN,SUP'T OF BUILDING
L LITE
FOR APPIJ FILL IN N EAR MST
C SS
DIEIT 1 0. GROUP zw READY FOR INSFICTIOII
MAIL
ADD (o
TILL- INDUSTRIAL
C
WASTE A-PPROVAL
PLUNGER INSP=ON RECORD
ADDRIL"
C1TY TEL NO 0�/ �^
LIC
NUtlsRR n-P1 R ructURE OR mw F[.[
WATu CLOSET (T04 ) 1.00
BATH TUB 1.00
SHOWER 1.00 ,
LARY (WASH BASIN) 1.00
KITCHEN SINK 41.00
DISHWAAFH ,00
LAUNDRYTUBOR Y 411.0or
CLOTH WASHWZ .FI.00.
W TSR HEA 1.00
GA&SYST 01.00
AMQVAIS
DATA . JNSPECTQR'R SIGNATURi
JABOYE
NDER BLAB WO
PERmrr ROUGH PLUMBING
AB PIPING
TQTAL FEE AD VENT
Al1 HERP,9Y ACKNOWLEDGE THAT 1 HAVE READ THIS AP
l STATE THAT THE ABOVE 98 CORRECT AND AGREE THOT VVTER HEA
WITH ALL COUNTY ORDINANCES AND STATE LAWS R
PLUYB�NG. UMBING 1'LXTURES
1 HEREBY C5RTIFY THAT 1 AY PROPERLY RTzQISTEREGAS TEDT -
LICEMSED AS REQUIRED BY L ANGELES COUNTY AND
CALIFORNIA OR THAT 1 AY TH LEGAL OWNER 00 TUTILITY CO.NOTIP'IED
DESCRIBED RE:0DENTIAL P P
S 1 G NA'CJJ 1
O I<P SR.Y I TT[[ FINAL
JQHN A.LAMBIR, rOUNTY EN¢INIEER VALIDATIONS ROBERT A.WOAD, C.H16F PLBp. INSPECTOR
4 3 5 4t-; NOV18 3 2.00 �
I
KERS'COMPENSATION DEaARAT10N APPLICATION FOR PLUMBING PERMIT ►
Irm that I have a certlflmte of Ronson$ to self 76A667A
a certlflcate of Workers' Compensbtlon Insurance, CE 817(REV. 10/8I) u
od copy therd f�ec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy Is hereby furnished. ADStS J
FOR APPLIUNT TO F1 LL IN(PRINT OR TYPE) L (p
❑ Certified copy Is filed with the county bulldlag Inspec- NUMBER FIXTURE OR REM Q FEE AXV4 fO
tion department.
Date Appllgant WATER CLOS€T NEAREST
CERTIFICATE OF Dff11APTIQN FROM WORKERS' BATH TDB CROSS ST.
COMPENSATON INSURANCI OY04ER
(ThD ssxtkm need not be Completed If the work Inroly by SHOWER
MAIL
the penult Is for one hundred dollars ($100)or hes.) LAVATORY ADDRESS
I certify that In the performaoee of the work for which this
permit Is Issued, I$Fall not employ any Person In any rrgnner SINK CITY TEL NO.
sa as to become subject to the Workers Compensation Laws. DI51-WASFIt1t
CONTRACTOR
Date D Apphcant apT}S WAR App aS
NOTICE TO. APPLICANT: If, after making this Certificate of MAY
SWUMA1tJ0 POOL RAPTOR
Exemption, you should bgobme subject to the Workers' Cry U
TEL NO.
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
with comply with such provlslons w this permlt.-shall be STATE UC
deemed revoked. WATER HEATER LKlNSENO. CLASS
LICENSED CDNTRACTORS DECLARATION DISTRtSq t ,/ &Y
1-hereby affirm that I am licensed under provisions of C}apter 9 GAS SYSTEM OLMEI-S r 1J1 rJ✓(
(rommencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professlons Codtr,and my llcerue fs In full force and effect. 5 PER SYSTEM FINAL V ATION
i DATE
Ligonse Number I Ic. Class Q
FI C.�.
Contr actor Date $Y
❑ 1 am exempt under Sec. - F-
BAP.C. for this reason Pion check fee
Date: N
PLUMBING PERMIT ISSUING FEES Z
Signature_ r-.
TOTAL FEE
SINGLE FAMILY
Plan check appllcgnt 1 6 4 b 5 A
,
HOME OWNER-BUILDER DECLARATION Name #,o o 0'o 0 5
I hereby affirm thW I am exempt from the Contractors Llcensc Addreu
Law for the following reason (Sectlon 7ss 031.5, Busineand I('o o 1 f 5 Q
Iona Code): City Tel.No.
at owner of the property, will do the work and the Io 0.0 1 6 5 Q
sfruftre Is not Intended or offgred fop ;alb (Section , 0204-87
7041, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a constryction lending agency for
the performance of the work for which this permit Is Issued
(Sec. 3097, Cly, C.).
lender's Name
Lender's Address
I certify that I have rood 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- rgpre�entatly of this County to enter upon the
Aa nod pr for Inspection purposes.
SEE REVERSE FOR EXPLANATORY L*NGUAGE
Sig ure of Pwrmlttee Date