HomeMy Public PortalAbout4541 CLOVERLY AVE_Plumbing__ 7#,067 n 5-50 KB APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J FOX CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT�rvO GROUP ZONE PERMIT NO
PLUMBER �.. p RECEIVED BY READY FOR DATE ISSUED
,��(w A FIRST INSPECTION
ADDRESS � /S �6J �N��!'.�'d.�bA/�/,I � ,� P�Oytf�\ �
1 �.4.qe f� � y�EL NO BUILDING // ,[� c,ti Al �/ `�,ev
ADDRESS 'J V f ` V
CITY o
COUNTY �j �°'' LOCALITY 61 S P" e- �{
LICENSE NO ��{ / EXPIRES J V K +"+ NEAREST
PERMIT FEES CROSS ST C t�>� !2tj Ir �E
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER d- Q sMAIL
0
(,/S
WATER CLOSET (TOILET) Q O 50 I$ I ADDRESS Al `/ T 1� /o u Py [ (
BATH TUB @ O 50 I� CITY 460.S9 vas(?4 TEL NO
SHOWER Q O 50 I 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) O 50I APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK Q O 50 I STATE LAWS REGULATING PLUMBING
I LAUNDRY TUB OR TRAY Q O 50 I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
ANGELES COUNTY LICENSE OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
GAS SYSTEM OUTLETS @ O 501 `
SIGNATURE
ERM PERMITTEE 40
WATER HEATER Q O 501
SLOPSINK 0 O 501 1 INSPECTION RE RD
FLOOR SINK Q O $01
FLOOR DRAIN @ 0 501
DISHWASHER Q O 50I
DRINKING FOUNTAIN Q O 501
I URINAL @ O 501 1 .J
HOUSESEWER Q O 501 1 Q
_Z
1 MISC LLANEOUS i D
I� o
I-1
APPROVALS
DATE INSPECTOR S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL 1 00 I CESSPOOL
SEPTIC TANK 1 SEPTIC TANK
DRAIN ( ) PIT ( ) ® 1 001 SEWER
PERMIT I 1 00 GAS TEST
t UTILITY CO NOTIFIED
TOTAL FEE I-S 1. 6 6 1 FINALw��—
WORKERS' COMPENSATION DECLARATIO41 , r APPLICATION FOR PLUMBING PERMIT
�
I hereby affirm that I have a certificate of consent oto self 76A667A ®t t'G
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) f! 6
or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES 6 U I L D I N AND SAFETY
Policy No. Company 0 Vkba k, 0a +-t4
Certified copy is hereby furnished. it
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) B ILDING
Certified copy is filed with the county building inspec- ADDRESS (.7 ,
tion department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY
WATER CLOSET
Date Applicant NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER a CZ J
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO.
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR `
Da
te It-1. bv� 1 CLOTHES WASHER
NOTIC TO PPLICANT: If, after making this Certificate of ADDRESS
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY et /
a v TEL. NO.
with comply with such provisions or this permit shall be STATE 0'" 1 �u LIC.
deemed revoked. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER 151
and Professions Code,and
Amy license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION O
License Number
32�`� "Lic. Class i8J DATE
FINAL
BY
Contractor Xld, Date
El �J
I am exempt under Sec. �
B.&P.C. for this reason
Plan check fee
g Date: PLUMBING PERMIT ISSUING FEE$ t
Signature—
TOTAL FEE �lJ sf
SINGLE FAMILY
Plan check applicant ?
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 Address r
Professions Code): City Tel. No. j t u U 0 c
❑ I, as owner of the property, will do the work and the J`
structure is not intended or offered for sale (Section ® (11 ( I C 0,
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY / U `
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 and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned property for inspection pur ases,
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee 7 bate
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0203260014
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADD ESS:
TR: 12998 LT: 4 4541 CLOVERLY AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804204
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA
8592-003-026 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
07 BATHTUBS/SHOWERS 2.00 FIX 32.40
TENANT: 25 LAVATORIES/SI'NKS 2.00 FIX 32.40 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
45 WATER CLOSET/URINAL 2.00 FIX 32.40 03/28/02 JK 09/24/02
TOTAL FEES 124.95
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
WONG;SAMMY (626) 673-8103-
4541 CLOVERLY
TEMPLE CITY 91780 DESCRIPTION OF WORK
PLUMBING FOR ADDITION
APPLICANT: TEL. NO:
SAME AS OWNER -
SPECIAL CONDITIONS:
7E 's
CONTRACTOR:
TEL. NO: - ®� ✓jj'� APPROVALS DATE INSPECTOR SIGNATURE
SAME AO
LIC. NO UNDER SLAB WORK
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO: /
r- ROUGH PLUMBING
LIC. NO: ____ __ ___ "1111111 1,
GAS PIPING
GAS VENT
HOT WATER-HEATER
61
PLUMBING FIXTURES
---- Y
--� ,- --- -
,Ii LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
CWV
PC-
P19i(C
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508