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Home My Public Portal About4824 CLOVERLY AVE_Plumbing__ 76A657'(CE-817)-8-71 `; C � APPLICATI N FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS (J LOCALITY F �aT FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST./L(/LV 42a—SA i NUMBER FIXTURE OR ITEM @ FEE 1 WATER CLOSET 1.75 OWNERMAIL BATH TUB 1.75 ADDRESS SHOWER 1 .75 C ITY TEL. LAVATORY 1.75 CONTRACTO �� SINK 1.75 ADDRESS '� DISHWASHER 1.75 CITY• l L. N G CLOTHES WASHER 1.75 STATE /� LIC LICENSE NO. // CLASS SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. GROUP ZONE PRO ESSED BY LAWN SPRINKLER SYSTEM 1.75 ��ow � WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD OUTLETS OVER 30 5 PER SYSTEM 0 6451 P!an check fee See reverse. PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. NO. GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES Q WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY R ISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES CO TY AND STATE OF CALIFORNIA OR THAT I AM T E LEG OWNER OF, AND INTEND TO /Ir RESIDE IN THE ABOVE DE BED SIOENTI ROPE RTY. FINAL / SIGNATURE OF PERMITTEE PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M,O. CASH NOV 5 a .7 5 N L L'S-17 25M SETS 12-45 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING 1 Wm J FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO GROUP ZONE PERMIT NO ROUGH FIXTURES COMPLETE HEATER CESSPOOL -I SEPTIC TANK RECEIVED BYI READY FOR DATE ISSUED FIRST INSPECTION 6A8 MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY E NAME AODDRESS W 0 ADDRESS LOCALITY Y c. D NEAREST IL CITY TEL No CROSSST COUNTY m I CERT No EXPIRES C NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL 3 ADDRESS NORTH 0 - CITY TEL No IAM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION PLUMBER 1 AM THE LEGAL OWNER OF THE f ROPERT�1' OF-SCRIBED ABOVE /�_ - �f�s!i✓t� �,( ��,,�Qd CORRECTIONS SOUTH DESCRIPTION OF WORK ATH TUB FURNACE (� w SHOWER DISHWASHER LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP LOP SINK FLOOR DRAIN -WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER-GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL �\� - TOTAL NUMBER OF FIXTURES � SEPTIC TANK I CESSPOOI- SEPTIC TANK SEWER UTILITY CO NOTIFIED TOTAL FEE ��- �,� FINAL A,`�^7 v - D B S-17 26M SETS 12-46 APPLICATION FOR PERMIT ..J)PIPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELESL Wm J FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO GROUP ZONE PERMIT NO ROUGH FIXTURES COMPLETE Iff^ /O RECEIVED BY DATfi ISSUED READY FOR HEATER CESSPOOL SEPTIC TANK F FIRST INSPECTION 2/A v � GAB MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY NAME M. J� NUMNURAM_u(). JOB ADDRESS 10.2- w N J m ADDRESS 123 No• Cloverly, Ave. LOCALITY _ A CITY TEMPLE CIUXALIF. CROSS ST �t COUNTY CERT No EXPIRES K NAME �"/tJ � �Ul1c-GILcW� LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL r NORTH O ADDRESS CITY TEL No 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE OWNER CORRECTIONS SOUTH a DESCRIPTION OF WORK MATH TUB FURNACE Cd ROWER DISHWASHER _LAVATORY REFRIGERATOR —KITCHEN SINK WATER SOFTENER FLOOR SINK AND TRAP LOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING. METER GASaODA FOUNTAINOUTL GAS PIPING GAS VENT CESSPOOL 1 TOTAL NUMBER OF FIXTURES SEPTIC TANK • CESSPOOL SEPTIC TANK (� SEWER TOTAL FEE UTILITY CO NOTIFIED / t FINAL ,f66 E#B-1-7*2-66 APPLICATION F R PLUMBING PERMIT COUNTY OF LOS ANGELES ��07 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 1 BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS COLEMAN W JENKINS SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1 2S NAIL BATH TUB 1 25 ADDAE SHOWER 125 CITY TEL NO LAVATORY 125 CONTRACTOR SINE 125 ADDRESS I DISHWASHER 125 CITY • TEL NO g �Q #931 SATE LIC LAUNDRY TUB 1 25 LICENSE NO 791,041-7CLASS CLOTHES WASHER 1 25 _ DISTRICT_NO GROUP ZONE I PROCIES I SEP BY WATER HEATER ISO GAS SYSTEM OUTLETS 150 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD U CD Lu a V! Z APPROVALS DATE INSPECTOR S SIGNATURE PERMIT 5 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE O GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER LESIDE CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBINGFIXTURES S REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST OR THAT I AM THE LEGAL OWNER OF AND INTEND TO HE ABOVE DECCRIBED RESIDENTIAL PROP v UTILITY CO NOTIFIED E ITTEE FINAL 04 V IMATION JAC R ALLEN v r cK, M o CASH SUPERVISING MECHANICAL ENG'R 9 2 NAY 2 5 D r 3.5 0- WORKER'S COMPENSATION DECLARATION 6DPW 9/89 76A667A APPLICATION 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 ther (Sec.3800 Lab.C.) ,5-27. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No Q� Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING -2f/ � Certified copy is filed with the county building inspection ADDRESS department. �_ /� NUMBER FIXTURE OR ITEM @ FEE LOCALITY �v Date Applicant'✓/ "t70 WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person in any manner so as toMAIL SINK ADDRESS become subject to the Workers'Compensation Laws. DISWASHER CITY ✓ yj�G �� TEL.NO. 5 sr7 l/ Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY / j _ TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER TATE C�— (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. J C� ZZ� CLALIC.SS O Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY O 5 PER SYSTEM 5 License Number �-� Lic.Class` -9,/_�'-t'�.-z�� FINAL V )� �J yn ��t7 VALIDATION LU —�\f/ J2--31 / DATE l` l l Z d Contractor� /Gv� Date (q FI I am�exempt under Sec. FFIINAL ACCT. Z 198 B.&P.C.for this reason qCC Date: Plan check fee , 331017 39.330 Signature PLUMBING PERMIT ISSUING FEE$ p?� 1 1 TEN- ❑ TOTAL FEE 3� TOTAL 39. 30 SINGLE FAMILY Plan check applicant CHECK 39.30 HOME OWNER-BUILDER DECLARATION Name {1■t� r' I hereby affirm that I am exempt from the Contractor's License Law �• it °``0 for the following reason (Section 7031.5, Business and Professions Address Code): ❑ —CMU 1 i 1,f a/ I, as owner of the property,will do the work and the structure City Tel. No. is not intended or offered for sale (Section 7044, Business 6482 1 AM 9,.56 and Professions Cade). , 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.) mow` f Lender's Name Lender's Address 1 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 ffa 0enterupon the above-mentioned on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0309190036 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: EES AID BUILDING ADDRESS: TR: 11454 LT: 26 4824 CLOVERLY AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803808 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 8590-020-009 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 09/19/03 VG 03/17/04 TOTAL FEES 76.35 OWNER: TEL. NO: FINAL DATE BY: CODE: JACKSON BELZORA TR BELZORA JACKSON (626) 285-9717- 4824 CLOVERLY AV TEMP 917803808 DESCRIPTION OF WORK PLUMBING FOR ADDITION APPLICANT: TEL. N0: SMITH (909) 605-6691- 4055 GUASTI RD.#106 SPECIAL CONDITIONS: ONTARIO, CA 91761 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE ENTERPRISE BUILDERS (909) 621-7455- 4045 GUASTI RD., SUITE 203 LIC. NO UNDER SLAB WORK ONTARIO, CA 91761 808254 B WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: LIC. N0: ROUGH PLUMBING � T .c+ GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES M, LAWN SPRINKLERS � GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER S STEM JEE72�od4T-e- goo "6;- REPORT ID: DPR263 ROUTE TO: BS0508