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HomeMy Public PortalAbout4807 CLOVERLY AVE_Plumbing__ 76A667-CE817 12/59 TEMPLE CHTY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING r��{�7�a�.BD $AFETY IVISION EUILDING �7 {{ Z JOHN A LA�v1BIE COUNTY hNGINEER ADDRESS / �� f`I WILLIAM A JENSEN SUPT OF BUILDING -� I OCALITY f FOR APPLICANT TO FILL IN Coss ST NUMBER FIXTURE OR ITEM OWNER lz_ WATER CLOSET MAIL `. BATH TUB ADDRESS �O L SHOWER C NO TEL t 6/ LAVATORY CONTRACTOR�� ADDRESS SINK _ DISHWASHER CITY �^' G —TEL NO — S�d CONTRACTOR S f el STATE LAUNDRY TUB REGISTRATION NO / COUNTY ❑ CLOTHES WASHER DISTRICTNO GROUP Z NE P SSED BY WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL Q /INSPECTION RECORD � � a 0 o a ! z z Q $1 00 PER ITEM OR FIXTURE $ APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2 Loo UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM HE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL-RO RTY UTILITY CO NOTIFIED SIGNATURE ./� A/n OF PERMITTEEFINAL 01, VALIDATION ROBERT A WOOD cK m 0 cesH SUPERVISING MECHANICAL ENG R 7 3 3r_33 2) 3 5 D 3.0 0 76A667 (CE-817( - 1/75 �r APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO BUILDING ADDRESS tjCJ HARVEY T BRANDT, COUNTY ENGINEER LOCALITY Gs ' FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST NUMBER FIXTURE OR ITEM @ FEE OWNER WATER CLOSET 2 00 > ` ,r' MAIL �j BATH TUB 2 00 ADDRESS 1i SHOWER 200 CITY / TEL NO i LAVATORY 200 CONTRACTOR SINK 200 ADDRESS DISHWASHER 2 00 CITY �e TEL NO _ CLOTHES WASHER 200 STATE LIC LICENSE NO ?��'! CLASS SWIMMING POOL RECEPTOR 2 00 LAWN SPRINKLER SYSTEM 2 00 DISTRICT NO GRP yZONE PRO SED BY S WATER HEATER 200 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 2 00 INSPECTION RECORD a OUTLETS OVER 30 U 5 PER SYSTEM O F-- U W a N Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 0 TOTAL FEE APPROVALS DATE INSPECTOR 5 SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel NO GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES BI �.7 WITM ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMNG GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REQUIRE Y LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT A THE LEGAL OWNER OF,�NTEND TO /l RESIDE IN THE ABOVE D SC IBED RESIDENTIAL PR �r FINAL e'�/�+7> SIGNATURE OF PERMITTEE PERMIT VALIDATI N cK 0 CASH PLAN CHECK VALI ION CK M 0 H 1 7 7 2N^npp lg g D 7.5 0 ®-'>) c �MCERS COMPENSATION DECLARATION 20 0026 DPW 4/87 2 ° APPLICATION FOR "PLUMBING PERMIT` !t a r t • �h(eF7by,'affirm that I have a certificate of consent to self'in- 76A667A, - �- � • - 'dull sura or a certificate of Workers Compensation Insurance or a CE 817(REV 8/86) p lcertified copy thereof (Sec 3800 Lab' C') t ;+ � � COUNTY OF LOS ANGELES DEPT .OF PUBLIC WORKS Policy No ompany M - J Certified copy is,hereby furnished I y FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING O { Certi4fied copy is filed with the county building inspection ADDRESS , department 5, NUMBER r FIXTURE OR ITEM @ FEE LOCALITY PJ.' Date 4 Applicant, J WATER CLOSET (TOILET) 4 6 ~ NEAREST s ``CERTIFICATE OF EXEMPTION FROM'WORKERS, 5 CROSS T"~,J COMPENSATION INSURANCEBATH TUB' 'SHOWER' OWNER` a (This section need not be,completed if the work involved by y MAIL B the permit Hs for one hundred dollars ($100) or less ) LAVATORY ADDRES �y-NL7 c. t I certify that in the performance of the work for which this per r SINK �D mit is issu ed I shall not employ any person in any manner so CITY, „ , TEL as to become-sublect to the Workers Compensation Laws / DISHWASHER CONTRACTOR Dote__ Applicant CLOTHES WASHER y ADDRESS a NOTICE TO APPLICANT If after making this Certificate of Ex- #1 SWIMMING POOL"RECEPTOR ,. emption you should become subject to the Workers Compen _ CITY TEL NO sahon'provisions of the Labor Code you must for'thwith'comp- iLAWN SPRINKLER SYSTEM - ly with such provisions or this permit shall'be deemed revok- STATE ^�Q LIC ed' .,' { - r , d WATER,HEATER LICENSE NO 3 /' G1,9e CLASS ,' I ' LICENSED CONTRACTORS DECLARATIONDISTRICT NO P OCESSED BY - I hereby affirm that I am licensed under provisions of GAS SYSTEM OUTLETS`Chapter - _ r^ C> 9(commencing with Section 7000)of Division 3 of the Business OUTLETS'OVER P VALI ATION and Professions Code and my license`is in full force and ef- 5 PER SYSTEM _ FINAL ��.q� >- fect fCL DATE 0 License IN umber37&6Lic Class' U n n p FIN Contractor'Pr;,,_04gMa &_t,. Date �v B a O I am exempt under Sec r W B &P C for this reasonPlan check ee `` ► N U) 2r r r Date PLU BING PERMIT ISSUING FEE$ v ° Signature" -+ _ TOTAL FEE � 1 3 6 9 A _ SINGLE,FAMILY i Plan check applicant - t r # o o�0 0 0 5 HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor s License Name Law for the following reason (Section 7031 5 Business and -" r ) I °'° 4 Q 5 0 Professions Code) Address - o � 4Q50b ❑ I as'owner of,the property will do the,work and the Crty Tel No F, - structure is not intended or offered for sale(Section 7044 i, Y 1 220,-88 ' Business and Professions Code) - r ® "CONSTRUCTION LENDING AGENCY t + I hereby affirm that there is a construction lending agency for _ t `,d + k �• $' e the performance of the work for°which"tliis:permit is issued (Sec 3097 Civ C ) I - - r o - Lender s Name Lender s Address t 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 lows`regulating Plumbing, and hereby authorize representatives of this County to enter upon the s above-mentioned operty for inspection purpposses „ e e� l SEE REVERSE FOR EXPLANATORY LANGUAGE � Permittee c ' Date ;. WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT _ I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 41e7 sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) ` certified-copy there/off(Sec. 3800, Lab. C.) ''Policy No©Iaf 6631 Jtom an �?tpTC FUN1� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS pony E Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING �—T�• ❑ Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY �F AA Date �T�' i, Applicant WATER CLOSET(TOILET) NEAREST //"" . V��'��r� 2.(�{ CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST L1C 0 V COMPENSATION INSURANCE SHOWER OWNER ®� (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY Cj ADDRESS I certify that in the performance of the work for which this per- SINKn mit is issued, I shall not employ any person in any manner so ()(� CITY TEL. NO. as to become subject to the Workers' Compensation Laws. DISHWASHER UU CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- rnl L I C tion, you should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR em P Y I P CITYTEL. NO. - sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM 'e ly with such provisions or this permit shall be deemed revok- STATE UC. � ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. R ESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS �� 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER J b and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINALVAL TION fect, , DATE a License Number j74-�� Lic. Class O U FIN ir Contractor Date I B O t- I am exempt under Sec. W a B.BP.C. for this reason ► Z Plan check fee Date: PLUMBING PERMIT ISSUING FEE $ 0 Signature �Ji1 T TOTAL FEE `(V INGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. structure 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 and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the / ov -mentioned property for inspection purposes. / � �0q SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of rmittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PE DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS - PL;0508_9812020022) BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (818) 285-0488 EXT GAL ID FEES PAID r--BUIL-DING-ADDRESS_ `xg TR 11454 LT 1 —4807-'_CLOVERLY AV'Z FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP-CA-917803809 ASSESSOR INFORMATION B NEAREST CROSS STREET LOWER AZUSA 8590-021-001 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID J5 LOCALITY TEMPLE CITY 64 WATER PIPNG <= 1 1/2 1 00 LIN 16.20 TENANT TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON 12/02/98 UT 12/02/99 _ OWNER TEL NO FINAL DATE FINAL BY ODE TSAY SHWU-WOEI (323) 223-2441- 4807 CLOVERLY AV -- TEMP 917803809SCR N - -- NEW_WATER MAINFROM-HOUS TO METER- APPLICANT TEL NO ADEE PLUMBING AND HEATING, INC (213) 296-8787- 5457 CRENSHAW BLVD SPECIAL CONDITIONS LOA ANGELES, CA CONTRACTOR TEL NO ®� ����� ®��l y. APPROVALS DATE INSPECTOR SIGNATURE ADEE PLUMBING AND HEATING (213) 290-8100- 5457 CRENSHAW BLVD LIC NO UNDER SLAB WORK LOS ANGELES CA 90043 240186 C36 DATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER NO - / ROUGH7 PLUMBING LIC NO / 1111111 GAS PIPING GA L � r�U ��" ����� HOT ANE ATER PLUMBING XT R �+ LAWN SPRINKLERS O 0 i? GAS TEST 0 UUTILITY COMPANY NOTIFIED Ell _n9 $`�"® WV GRAY WATER SYSTEM * ADDITIONAL DATA ON FILE REPORT ID DPR263 ROUTE TO SS0508 t i