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HomeMy Public PortalAbout4804 CLOVERLY AVE_Plumbing__ 76A667-CE817-I1-57 APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER v BUILDING AND SAFETY DIVISION BUILDING _ B�¢ �. CLO✓- JOHN A LAMBIE Count in Engeer ADDRESS CASSATT D GRIFFIN. Supt of Building LOCALITY MP[.G C T FOR APPLICANT TO FILL IN CNEAREST ROSS ST NUMBER FIXTURE OR ITEM WATER CLOSET OWNER _ BATH TUB ADDRESS ,v =, SHOWERCITY L LAVATORY CONTRACTOR 4. L� L�p.vT/21. SINS ADDRESS J / L v s2 i ✓C. DISHWASHER CITY �L ��D�T� TEL NO CONTRACTOR S STATE LAUNDRY TUB REGISTRATION NO ZO yS ¢ COUNTY CLOTHES WASHER =GROU' DISTRICT NP ZONE READY FOR INSPECTION WATER HEATER - GAS SYSTEM INDUSTEL!tL WASTE APPROVAL INSPECTION RECORD \ .� APPROVALS @ $1 00 PER ITEMDATE INSPECTOR S SIGNATURE OR FIXTURE $ �� a UNDER SLAB WORK yt PERMIT $ OS ROUGH PLUMBING / TOTAL FEE Oo GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 1 PLUMBING PLUMBING FIXTURES I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST S �J LICENSED SBY CALIFORNIA OR THAT REQUIRED L I AME THE ANGELESOS COUNTY N STATE GAL OWNEROFTHEABOVE _ UTILITY CO NOTIFIED n/ � N DESCRIBED RESIDENTIAL PROPERTY SIGNATURE OF PERM ITTEE FINAL ROBERT A WOOD Or VALIDATION SUPERVISING MECHANICAL ENG R CK N 0 CASH i ���n3303 - 'AR11 5 A 11 .00 WORKER'S COMPENSATION DECLARATION 6DPW 9/89 76A667A APPLICATIGN FOR PLUMBING PERMIT 76A66 I hereby affirm that I have a certificate of consent to self insure, 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. BUILDING❑ .�',FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS /�1 Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM t?n FEE LOCALI Date Applicant / WATER CLOSET ,S5 CROSS NEAREST ��s�✓ CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE f ASSESSOR Q�5 MAP BOOK /C� PAGE�aCCS PARCEL I (This section need not be completed if the work involved by the SHOWER a permit is for one hundred dollars($100)or less.) LAVATORY OWNER I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to SINK ADDRESS become subject to the Workers'Compensation Laws. I MAIL DISWASHER CITY TEL.NO. Date - '_527 Applican �' CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making Certificate of -s���-� Exemption,you should become subject to the r<ers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.N0. a- I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE (commencing with Section 7000) of Division 3 of the Business and L CESE NO. CLASS O Professions Code, and my license is in full force and effect. GAS SYSTEM OUTLETS OUTLETS OVER DISTRICT NO. PROCESSED BY a: 5 PER SYSTEM ��� fy O License Number Lic.Class V FINAL DATE G�, �,9� VALIDATION d Contractor Date ❑ I am exempt under Sec. FINAL ZBY i 6.8P.C.for this reason Date: Plan check fee , PLUMBING PERMIT ISSUING FEE$ S� Signature ❑ TOTALFEE Pian check applicant ' SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Namds I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address © �Q Code): �jQ�, City Tel.No. I, 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). , I_`T,"=:Lft:, s -( CONSTRUCTION LENDING AGENCY ;:i=., •i. : _ I hereby affirm that there is a construction lending agency for the �• t ,-i; r f performance of the work for which this permit is issued (Sec. 3097, Civ.C.) Lender's Name - ----• -• ••�• Lender's Address `' ti` 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 f coon pu o es. SEE REVERSE FOR EXPLANATORY LANGUAGE 9 � - - $ignature of P ee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1101250008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I ITR: 11454 LT: 27 4804 CLOVERLY AV 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803808 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LOWER AZUSA 1 18590-020-011 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, Cl 1 107 BATHTUBS/SHOWERS 1.00 FIX 16.30 I (TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.30 (ISSUED ON: PROCESSED BY: PLAN BY: 1 I 145 WATER CLOSET/URINAL 1.00 FIX 16.30 101/25/11 SR 1 1 TOTAL FEES 76.70 1 I (OWNER: TEL. NO: 1 IFINAL DATE FINAL BY: CODE: I IWEN, IIN W (626) 614-8072- 1 [f '/��//� I 14804 CLOVERLY AV 1� �) � �{ ITEMP 917803808 1 1 ESCRIPTION OF WORK I1 I I (PLUMBING FOR BATHROOM REMODEL 1 1APPLICANT: TEL. NO: 1 1 1 ISAME AS OWNER I I (SPECIAL CONDITIONS: I I I I (CONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - 1 I I LIC. NO 1 (UNDER SLAB WORK I I 1 1WATER SERVICE 1 I I I (PLASTIC YIN METAL YIN I 1 1 ARCHITECT OR ENGINEER: TEL. NO: (ROUGH PLUMBING I 1 LIC. NO: 1 I IGAS PIPING I I I IGAS VENT 1 I I I IHOT WATER HEATER I 1 I 1 I IPLUMBING FIXTURES I 1 1 1 ILAWN SPRINKLERS I 1 1 IGAS TEST 1 1 1 1UTILITY COMPANY NOTIFIED( I 1 I I ICWV I I IGRAY WATER SYSTEM 1 1 I I I I I I I I I I I I I I I I I I I I I I I I I (REPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I I i