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Home My Public Portal About5313 CLOVERLY AVE_Plumbing__ w 70AGS7 17 5-150'0 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING 1 WILLIAM J FOX CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRTTNO GROUPI ZOPERMIT NO AZ -/ d PLUMBER RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS ' BUILDING ��f CITY TEL NOCOUNTY / ADDRESS !� Zp LICENSE NO , ® EXPIRES [O �D LOCALITY �' NEAREST PERMIT FEES CROSSST Y NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER R- MAIL WATER CLOSET (TOILET) @ O 50 ADDRESS BATH TUB @ O 50 Is CITY TEL NO SHOWER @ O 50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) @ O 50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ O 50 D STATE LAWS REGULATING PLUMBING / LAUNDRY TUB OR TRAY @ O 50 1 ANI CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS ANGELES COUNTY LICENSE OR 1 AM THE LEGAL OWNER ?, OF THE RESIDENTIALPROPERTY DESCRI D A OVE GAS SYSTEM._sq 1—OUTLETS Q O 50 SIGNATURE OF JJJJ WATER HEATER @ O 50 ,�� PERMITTE SLOP SINK @ O 50.1. INSPEC f N RECORD FLOOR SINK @ O 501 FLOOR DRAIN @ O 50 DISHWASHER @ 0 501 '" -"' ' "J 41 er- DRINKING FOUNTAIN @ O 50 � 1 URINAL @ O 501 1 HOUSE SEW ER @ O 50I r'� �10�JO T-7- /V-c, Z MISCELLANEOUS 2 0 1 APPROVALS 1 DATE INSPECTOR S NAME <� ROUGH PLUMBING GAS PIPING GAS VENT �lf" 1 CESSPOOL @ 1 00 I CESSPOOL 1 SEPTIC TANK + SEPTIC TANK f I DRAIN ( ) PIT ( @ 1 00 SEWER /f PERMIT I 1 00 GAS TEST I UTILITY CO NOTIFIED TOTAL FEE 1 $ FINAL DEIS 17 12 84 APPLICATION FOR PLUMBING PERMIT DBS I7 DIVISION OF BUILDING AND SAFETY x - Depaent of County Engmeer - County of Los Angeles WM J FOX, COUNTY ENGINEER ADDRENG 4��- ADDRESS CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST OWNER DIST NO ( G.UWJP I ZONE READY FOR INSPECTION MAILjADDRESS / INDUSTRIAL CITY TEL NO WASTE APPROVAL PLUMBER INSPECTION RECORD ADDRESS O �I�2 1 Z-c� CITY A TEL NO & D- LICENSE NO D 00 ~ NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) i2- BATH 2BATH TUB D� SHOWER 79-ILAVATORY (WASH BASIN) Z aqD KITCHEN SINK DISHWASHER LAUNDRY TUB OR TRAY CLOTHES WASHER TOTAL NO ® \ APPROVALS _ \ DATE INSPECTOR S SIGNATURE GAS SYSTEM OUTLETS @ 100 UNDEIft SLAB WORK WATER HEATER Q 1 00 ROUGH1PLUMBING- I Z., PERMIT S 1 00 GAS PIPING TOTAL FEE 5 j 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 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES Z PLUMBING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS A ELES_ UNTO AND�ST SOF " CALIFORNIA OR THAT 1 M TH EG L 0 NEI OF TH E UTILITY CO NOTIFIED DESCRIBED RESIDEN"IAL OPER SIGNATU OF PERM FINAL WILLIAM J FOX, UNTY ENGINEER VALIDATION 5.00 In a a jqu 24 DEPUTY 0 � G WORKER SCOMPENSATION ate of(/CLARATION 76A&67ADPW9/89 APPLICATION FOR PLUMBING PERMIT hereby a.firm that4l have a certificate oflconsent to self insure, � or a coftificate 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 CompanyEJ - Certified copy Is hereby furnished BUILDING El FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS ( 1 Certified copy is fled with the county budding mspection department NUMBER FIXTURE'OR ITEM @ FEE LOCALITY- Date Applicant WATER CLOSET ti NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS CROSS ST ' BATH TUB i COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAPBOOK PAGE PARCEL permit is for one hundred dollars($100)or less) OWNER ;I certify that in the performance of the work for which this permit MAIL LAVATORY - is issued I shall not employ any person in any manner so as to SINK , ADDRESS �/ become subje to a Workers Compensate n Laws DISWASHER CITY / 191C TEL NO Date Applicant y CLOTHES WASHER CONTRACTOR ' —l.�` / NOT IC T APPLICANT If after ma ng this ertificate of Exemption ou should become subject to the Workers Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code you,must forthwith comply with such ADDRESS provisions or this permit shall be deemed revokedLAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NO I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE cZ�( /o LIC d (commencing with Section 7000) of Division 3 of the Business and / GAS SYSTEM OUTLETS /� LICENSE NO J j7 �(o CLASS O Professions Code and my license is in full force and effect - v J , V / OUTLETS OVER DISTRICT SED P SSED BY X ( � r 5 PER SYSTEM H A y U License Number Llc'Class �/` S` DATE' �Y�� VALIDATION CL Contractor FINAL El `Z I am exempt under Sec � BY (/G B&P C for this reason atPlan check fee e PLUMBING PERMIT ISSUING FEE$ Signature ❑ TOTAL'FEE v Plan check applicant .. SINGLE FAMILY g HOME OWNER BUILDER DECLARATION Name �- I hereby affirm that I am exempt from�the Contractors License Law for the following reason (Section•7031 5 Business and Professions Address Code i I I CO'S ) City Tel No '` � L i� €�---pp a—� ❑ I as owner of the property will do the work and the structure I I_;i FAL 20 : 50 is not intended or offered for sale (Section 7044 Business and Professions Code) }EO CONSTRUCTION LENDING AGENCY t ({,-#ANNE I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 - i 1 CIV Ci Lender s Name _J Pf 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 / W representatives of this County to enter upon the above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE t