HomeMy Public PortalAbout5319 CLOVERLY AVE_Plumbing__ 76A667-CE817 6-60 'j j" l/ �
APPLICATION FOR PL fMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A L.AMBIE COUNTY ENGINEER ADDRESSITY
WILLIAM A JENSEN SUPT OF BUILDING .- 7���
LOCAL
FOR APPLICANT TO FILL IN CR T
ST
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET MAIL
ADDRESS
BATH TUB
CITY TEL NO
SHOWER
CONTRACTOR
LAVATORY _
SINS ADDRESS
DISHWASHER CITY No.CONTRACTOR S �e��ff 0 STATE
LAUNDRY TUB r REGISTRATION NO 5Z;-Z COUNTY El
CLOTHES WASHER i DISTRICT NQ - GR P ZONE PR ES BY
WATER HEATER ' I' Qf Y
r GAS SYSTEM *: INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
D.
a
w
00, U
O
6�r a
/ $1 00 PER ITEM /}'�
OR FIXTIJRE / v APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2� 00 UNDER SLAB WORK
TOTAL FEEROUGH PLUMBING A q // ► �r
GAS PIPING 4`"� �f � ���/�4"C¢N
1 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
PLUMBING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I A TH LEG WNER F THE AB VE GAS TEST
DESCRIBED RESIDENTIAL P� UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE FINAL
®� VALIDATION ROBERT A WOOD,
CK to 0 CAffl SUPERVISING MECHANICAL ENG R
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8 4 1 3 2 5 0 3.0 G
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71S 667 17 5-150.19 APPLICATION FOR PERMIT
NEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J FOX CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRITO GROUP ZONE PERMIT NO
,6 5-7 e/
PLUMBER Belvedere Plumbing- CO RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
ADDRESS 136`� S e Palm Ave•
BUILDING 5319
3 11 Q Cloverl
CITY Zl ha;Tlhra TEL NO AT(arC�
i2S ADDRESS J J
-COUNTY -
LICENSE NO $0$M EXPIRES 6/3 /51 LOCALITY Temple City
NEAREST Olive
PERMIT FEES CROSS ST
OWNER Jewel Newman
NUMBER TYPE OF FI TURE OR ITEM FEE
MAIL
1 I/WATER CLOSET (TOILET) a O 50 $ 1� ADDRESS
-I-BATH TUB a O 50 I 10 CITY TEL NO
ISHOWER a O Sol 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
1 �I'LAVATORY (WASH BASIN) Q O 50 O APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
l I`KITCHEN SINK a O 50 O STATE LAWS REGULATING PLUMBING
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
1_ "I LAUNDRY TUB OR TRAY Q O 50 O ANGELES COUNTY LICENSE OR t AM THE LEGAL OWNER
1 I OUTLETS a O 50 I 1� OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
GAS SYSTEM
SIGNATURE OF /'1 d,�{J /�/�
WATER HEATER + a O 50 0 PERMITTEE' L ,4Ae� 4.
1. 1 Yob1-m-grc Disposal a o 5O I ICU INSPECTION RECORD
�1 FLOOR SINK Q O 50
FLOOR DRAIN a O 50
1 DISHWASHER a O 501
DRINKING FOUNTAIN a O Sol
URINAL a O 501 L V J
I HOUSE SEWER a 0 501 I Q
1 Z
MISCELLANEOUS �1
1 0
I�
1 1
1 APPROVALS
1 DATE INSPECTOR S NAME
1 ROUGH PLUMBING
'gyp
GAS PIPING v �'
1y
GAS VENT
CESSPOOL a 1 OOI CESSPOOL
1 SEPTIC TANK 1 SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1 001 1 SEWER
PERMIT I 1 00 GAS TEST
_UTILITY CO NOTIFIED /
TOTAL FEE $ 5 00
FINAL
ve 44 M
s
76A667-CE817 6-60
APPLICATION FOR PLUMPI C PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING -
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN SUPT OF BUILDING
LOCAL
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM OWNER �✓ jj
WATER CLOSET MAIL ��///✓
ADDRESS
BATH TUB X f p }� ,y
SHOWER CTPY /'( h F-= ( , NO.
LAVATORY CONTRACTOR
SINK ADDRESS
DISHWASHER CITY TEL NO. S �` �lo�'S /
CO CTOH S STA
LAUNDRY TUB REGISTRATION NO COUNTY
CLOTHES WASHES DISTRICT O GROUP I ZONE I PRO ESSED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
N
a
O
U
Al
0
F
U
W
P.
W
ra
f $100 PER ITEM
OR FIXTURE S APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I 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 HOT WATER HEATER
L
CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
S REQUIRED BY„LOS ANGELES COUNTY AND STATE OF GAS TEST
OR THAT I THELE L OWNER OF THE ABOVE
IRESIDENTIA OP UTILITY CO NOTIFIED
EITTE FINAL �QJi
I
®. VALIDATIO SUUPBERv SING MECHANICAL ENG-R
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