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Home My Public Portal About4949 CLOVERLY AVE_Plumbing__ CE 817(REV 1 1/78) APPLIC(AITION OR PLUM G RM IT COUNTY OF LOS ANGELES BUILDING AND SAFETY " p FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS / , c) �gL,/ NUMBER FIXTURE OR ITEM ® FEE LOCALITY WATER CLOSET NEAREST BATH TUB CROSS ST d SHOWER OWNER. MAIL LAVATORY ADDRESS SINK CITY TEL N0)8�-393 DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS d C go SWIMMING POOL RECEPTOR CITY g TEL NO yy3-Y6- LAWN SPRINKLER SYSTEM STATE LIC y� WATER HEATER LICENSE NO `7 CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING V GAS VENT HOT WATER HEATER 0 PLUMBING FIXTURES bj GAS TEST y Plan check fee UTILITY CO NOTIFIED PLUMBING PERMIT ISSUING FEE$ TOTAL FEE FINAL Plan check applicant PLAN CHECK VALIDATION Name Address City Tel NO I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION 2 9 9 1,9 A I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFO A OR THAT AM TH # O O 0.0 o 5 LEGAL OWNER OF AND INTEND TO IN THE ABOVE ESCRIBED RESIDENT PROPERTY 2 0 - 2500 SIGNATURE OF PERMITTEE ✓ )O o 0 2 5, 0 0 xu DIST CT NO O SSED BY Q IL 1 6-80 INDUSTRIAL WASTE APPROVAL 76AC67 -C E#817 4-64 APPLICATION FOR PLUMBINGr PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ADDRESS <j! , BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE COUNTY ENGINEER WILLIAM A JENSEN SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST caoss sr NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET ;1 25 MAIL BATH TUB 125 ADDRESS CITY TEL O SHOWER 1 25 n LAVATORY 125 CONTRACTOR Y SINK 125 ADDRESS DISHWASHER125 CITY L NO CTOR S LAUNDRY fUB 1 25 REGISTRATION NO Z �Q STATE COUNTY CLOTHES WASHER 1 25 DISTRICT NO GROUP ZONE PR ESSED BY WATER HEATER 1 50 Op Z INDUSTRIAL a GAS SYSTEM OUTLETS 1 50 WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V oC O F- n. N Z APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK e� ROUGH PLUMBING , „ TOTAL FEE ' GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH COUNTY ORDINANCES AND STATE LAWS REGULATING PLMBING HOT WATER HEATER 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 1 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF /w/�/�^► ��A�_ ^�- CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO GAS TEST RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED' 1'-�""'��-- - „i SIGNATURE .� } OF PERMITTEE ,,/ FINAL � i✓/,� ` ,N LIDATION ROBERT A�WOLOD I cK M o CASH SUPERVISING MECHANICAL ENG R PAw9 6 5 0 f-IAR2 4 5 D j.50 WORKERS'COMPENSATION DECLARATION 76A667A I hereby affirm that I have a certificate.of consent to self ce ei 7 (,z-e0) APPLICATION FOR PLUMBING P E R M I T- insure, or a'certificate of Workers'Compensation Insurance,or aertif dopy thereof(Sec 3800,Lab c� COUNTY OF LOS ANGELES BUILDING AND SAFETY u v Po i N `—Iddtompany d Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING La ADDRESS l ertified copy'is filed with the co buildm inspection NUMBER I FIXTURE OR ITEM FEE department WATER CLOSET LOCALITY D to Applicant NEAREST BATH TUB CROSS ST GZ. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER' . ri. W LAVATORY MAIL p } (This section,need not be completed if the work involved ADDRES `/t O by the permit is for one hundred dollars ($100) or less) SINK CITY v T U V�, I certify that in the performance of the work for which this DISHWASHER' - �. permit is issued, I shall not employ any person in any manner CONTRACTOR , O so as to become subject to the Workers' Compensation Laws CLOTHES WASHER U ADDRESS Date" Applicant SWIMMING POOL RECEPTOR LU NOTICE TO APPLICANT If, after making this-Certificate of CITY ` TEL U) Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM - STATE ' LIC- z _ Compensation provisions of the Labor Code, you must forth WATER HEATER LICENSE NO CLAS with comply with such provisions or this permit shall be deemed revoked < GAS SYSTEM OUTLETS DISTRICT NO PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER S. Q I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000),of Division 3 of the Busi, FINAL VALIDATION ness and Professions Code, and my license is in full force and DATE ?rO % — effect FINAL „�/� License Lic'Class BY t`"�''�•® . Co rac r Date ' 71� I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional-capacity-(Section 7051, Bus- j mess andPro TOTAL FEE Lic or Reg No Date Plan check applicant ,HOMEOWNER BUILDER DECLARATION Name re 20`021 A I hereby affirm, that I am exempt I1rom the Contractor's Address 3 i License,Law for the following reason (Section 7031 5, BusiCity Tel # 0 0'0 0 o'5 ness and Professions Code) E] I, as owner of the property, am exclusively contracting 2 0 0(1',3,0 0 with licensed contractors to construct the project o 0 0 ,1 3 0 Q v (Section 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY 0622-81_ ° r r I hereby affirm that there is a construction lending agency ,for the performance of the work for which this permit is ' v issued(Sec 3097,Civ C) " Lender's,Name t Lender's Address n e I certify that I have read this application and state that the R above information is correct I agree to comply with all County, { _ ordinances and State laws regulating Plumbing, and hereby SEE REVERSE FOR EXPLANATORY-LANGUAGE authorize representatives of this County to enter upon,the " -menho pr ert for inspection pur ose .f --„ � - gnature of fee Date r' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0809160037 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT (LEGAL ID I FEES PAID I BUILDING ADDRESS I ITR 11454 LT 14 I 1 4949 CLOVERLY AV I IFEE DESCRIPTION QUANTITY DOM AMOUNT I TEMP CA 917803811 1 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 18590-022-005 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID J5 LOCALITY TEMPLE CITY, Cl 1 151 LOW PRS GAS 5 OUTLET 1 00 SYS 16 20 1 I ITENANT I TOTAL FEES 43 95 (ISSUED ON PROCESSED BY PLAN BY EXPIRES ON I 09/16/08 SR 03/15/09 (OWNER TEL NO I IFINAL DAT FIN&L BY CODE INEVAREZ, RUBEN (626) 287-3974- 1 I 14949 CLOVERLY AV I I ITEMP 917803811 1 IDESCkIPTION OF WORK 1 IGAS LINE FOR HVAC SYSTEM I (APPLICANT TEL NO 1 I I IPELL AIR & HEATING, INC (866) 646-8499- I I I 11495 W 9TH ST 201 I ISPECIAL CONDITIONS I (UPLAND, CA 91786 I 1 I I I I I ICONTRACTOR TEL NO (APPROVALS DATE INSPECTOR SIGNATURE IPELL AIR AND HEATING INC (866) 646-8499- 1 1 I 11495 N 9TH ST #201 LIC NO 1 (UNDER SLAB WORK UPLAND CA 91786 848196 IWATER SERVICE I I 1 I 1PLASTIC Y/N METAL Y/N (ARCHITECT OR ENGINEER TEL NO I - IROUGH PLUMBING 1 LIC NO I I IGAS PIPING IGAS VENT 1 1 I I I I IHOT WATER HEATER I I I I I I I IPLUMBING FIXTURES I I I I ILAWN SPRINKLERS I I I I I I I IGAS TEST 1 I I I I I (UTILITY COMPANY NOTIFIEDI I I Icwv I I I IGRAY WATER SYSTEM 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 I I I I I I I I IREPORT ID DPR263 ROUTE TO BS0508 1 I I I i I