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Home My Public Portal About5426 CLOVERLY AVE_Plumbing__ 76A667 (CE-817) — 5/73 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDI=- _MAKE CHECKS PAYABLE TO: ADDRE 'f . ' m' L w/� HARVEY T. BRANDT, COUNTY ENGINEER ,l LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEARESTw CROSS ST. f A a', NUMBER FIXTURE OR ITEM @ FEE , y!" WATER CLOSET 1,75 OWNER ` MAIL BATH TUB 1,75 ADDRESS SHOWER 1.75 CITYf;;IJEL. NO. LAVATORY 1.75 CONTRACTOR SINK 1.75 ADDRESS v,. � .. �✓.jf/' �'�,,,. ,'!d DISHWASHER 1,75 CITY ,. /� ,,.'. TEL NO---^.,/ CLOTHES WASHER 1.75 STATE LIC - f'' % SWIMMING POOL RECEPTOR 1,75 LICENSE NO. CLASS�� • t DISTRICT NO. GROUP ZONE�.,"ROCESSED BY LAWN SPRINKLER SYSTEM 1,75 WATER HEATER 1,75 INDUSTRIAL r WASTE APPROVAL GAS SYSTEM OUTLETS 1.75 INSPECTION RECORDr.i OUTLETS PVER 30 y 5 PER SYSTEM >- Plan Check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTA qFEE APPROVALS DATE INSPECTOR s 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 WITHALL COUNTY ORDI NANC ES AND STNTE LAWS REGULATING PLUMBING. 1 GAS TEST I HEREBY CERTIFY THAT I`•'QM PROP �4 VY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REpUIREQ BY�4',OS ANGE S+COUN TY AND STATE OF CALIFORNIA OR THAT A}� THE LEGA PPPPPP OWNER OF, ANO IN TEND TO RESIDE IN THE ABOVE��,LS CR I..BE D RES;�ENTIAL PROPERTY. FINAL �T} f SIGNATURE OF PERMI T'ri EEes"t PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.D. CASH Fa6C7-CE917 12/59 APPLICATION FOR PLUMBING PERMIT 4 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING <<- ,; ; JOHN A. LAMBIE, COUNTY ENGINEER ADD RESS J 'e azr M1�•ttm+-`/+ i'*�*• WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY ;7 jV40"�� ,f'7f FOR APPLICANT TO FILL IN CROSS ST. ,r��{c' ,,�r�♦„'��. "' NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL ADDRESS BATH TUB CITY TEL. NO. SHOWER CONTRACTOR LAVATORY ' SINS ADDRESS , ,. _ .. DISHWASHER CITY TEL. NO. f i fr;I j1y _ CONTRACTORS , . STATEElLAUNDRY TUB REGISTRATION NO. f �r" COUNTY ❑ CLOTHES WASHER DISTRICT NO. GE�O_UP ZONECg iPROESSEDIBfY WATER HEATER i3 i GAS SYSTEM �- 'C- INDUSTRIAL WASTE APPROVAL a INSPECTION RECORD 0 U W a w z 0 a W F ca $1.00 PER ITEM y OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE -H PERMIT $ ?.100 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING I 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 PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES;COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEQA OWNSA OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ,'� UTILITY CO.NOTIFIED 7 ;Jd SIGNATURE �•-„�;..: � OF PERMITTEE �' �' S ' FINAL OF VALIDATION ROBERT A. WOOD, CIC. Y.0. CASH SUPERVISING MECHANICAL ENG'R 76A667 (CE-817) - 5/73 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING ? , ADDRESS ; HARVEY T. BRANDT, COUNTY ENGINEER74 LOCALITY--/ r., l FOR APPLICANT TO FILL IN (PRINT OR TYPE( NEAREST CROSS ST. NUMBER FIXTURE OR ITEM @ FEE OWNER WATER CLOSET 1.75 MAIL BATH TUB 1,75 ADDRESS SHOWER 1,75 i CITY TEL. NO. LAVATORY 1.75 ;x` CONTRACTOR SINK 1,75 '' ADDRESS DISHWASHER 1,75 CITY TEL. NO. CLOTHES WASHER 1,75 STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1,75 DISTRICT NO. GROUP PROCESSED BY LAWN SPRINKLER SYSTEM 1.75 ,. �,ZONE� „ �” } WATER HEATER 1,75 # INDUSTRIAL / �I ! p WASTE APPROVAL U GAS SYSTEM OUTLETS 1.75INSPECTION RECORD J OUTLETS OVER .30 W 5 PER SYSTEM C CD C- w F— Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 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 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL SIGNATURE OF PERMITTEE PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 76A667-CE817 12/59 . 11G APPLICATION FOR PL.UMBPERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY IDMSION BUDS <.— JOHN A LAMBI COUNTY NGINEER WILLIAM A JENSEN, SUPT OF BUILDING T��J�� C/�✓ LOCALITY / / FOR APPLICANT TO FILL IN NEAREST CROSS ST T�.QOWa 4;f Y NUMBER FIXTURE OR ITEM OWNER ( T 11 C' DQUA WATER CLOSET AD BATH TUB DRESS — -"/^— CITY TEL NO — SHOWER LAVATORY CONTRACTOR ADDRESS SIN$ DISHWASHER CITY 'f TEL N011,1. CONTRACTOR S �r STATE ❑ LAUNDRY TOB REGISTRATION NO 1 COUNTY ❑ CLOTHES WASHER DISTRICT O GROUP ZONE �FOCESSED BY WATER HEATER GAS SYSTEM INDUSTRIA7. WASTE APPROVAL INSPECTION RECORD w 0 U a 0 U W p- $1 $1 00 PER ITEM �r} OR FIXTURE S v APPROVALS DATE INSPECTOR S SIGNATURE PERMIT S 2100 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING I 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 PLUMBING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES OUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEG L NER F THE ABOVE DESCRIBED RESIDENTIAL PRO E TY UTILITY CO NOTIFIED SIGNATURE OF PERM ITTE'r FINAL OF, VALIDATION ROBERT A WOOD, cK m 0 CASH SUPERVISING MECHANICAL ENG R LA[C05486 -0 llPfIl4 5 D 400 n 1 DEIS 177 10 SB APPLICATION FOR PLUMBING PERMIT ,1 DBS DIVISION OF BUILDING AND SAFETY Deportment of County Engmeer County of Los Angeles BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS La VG'/� L CASSATT D GRIFFIN,SUP T OF BUILDING LOCALITY 7 M f'L 1= C- I T FOR APPLICANT TO FILL IN I NEAREST ,ea A o w A CROSS ST /L1.3 = T OWNER MAIL /30 v Z>tz i=-- v DISTRICT NO / GROUP I�a EAOY FOR INSPECTION ADDRESS , 7 �'` N CLC �/' CITY T F M ��L eC) r� EL NO !TT C� 0 3 CJ � INDUSTRIAL WASTE APPROVAL PLUMBER INSPECTION RECORD ADDRESS CITY TEL NO LICENSE N NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1 00 $ BATH TUB @ $1 00 SHOWER @ $1 00 LAVATORY (WASH BASIN) @ $1 00 KITCHEN SINK @ $1 00 DISHWASHER @ $100 LAUNDRY TUB OR TRAY @ $1 00 CLOTHES WASHER @ $1 00 WATER HEATER @ $1 00 GAS SYSTEM @ $1 00 r APPROVALS DATE INSPECTOR S SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUMBING i GAS PIPING TOTAL FEE 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 PLUMBING FIXTURES \ A 1,I I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITYCO NOTIFIED DESCRIBED RESIDENTIAL PROPERTY SIGNATURE OF PERM ITTEEFINAL r` JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR m 0 CASH LG1`7 9 3- ca29 3 2.00 °' h 76A667 CE817 12/59 TEMPLE CITY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND rj�nTY 7RIVISION BUILDING JOHN A LAMBIECOUNTY tNGINEER ADDRESS Caf.d/ WILLIAM A JENSEN SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS T O NUMBER FIXTURE OR ITEM OWNER ® WATER CLOSET MAIL ADDRESS aS /xf BATH TUB CITY TEL NO SHOWER LAVATORY CONTRACTOR F4 / SINS ADDRESS 5"-74 dft& /,c DISHWASHER CITY 1 TEL NO , �318l CONTRACTOR S STATE El LAUNDRY TUB REGISTRATION NO ® COUNTY ❑ CLOTHES WASHER DISTRICT NO GUP ZONE P ESSED BY WATER HEATER Jc O' t —_ GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD w O U a d�9lrM Al IlWr4 vr2�11 �a� l 1M'PA/, 52lFleh /LLOR$1 DU PER ITEM I D n 7-0 8,9c tc- ,,--/Z/- OR FIXTURE $ APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 100 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE sv ra GAS PIPING I 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 PLUMBING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AHD/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGEL COUN AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE L OWN OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTE FINAL OFVALIDATION ROBERT A WOOD cK M 0 CASH SUPERVISING MECHANICAL ENG R UIC0 3 7 6 4 il,AR 1 5 D 6 �,�Zti6�GG��yc/ D S S-17 25M SETS „-46 t - APPLICATI014�P'OR PERMIT DEPARTMENT OF BUILDING AND SAFETY 2 r- COUNTY OF LOS ANGELES PLUMBING Wm J FOX. CHIEF ENGINEER NATURE OF INSTALLATION t DISTRICTNO GROUPIo P RMI H ROUGH FIXTURES COMPLETE ( 4/7— ,' HEATER CESSPOOL 1-1 SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED P FIRST INSPECTION JAI, _� A8 MIBCfiLLANEOU APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB NAME G / 1/� ADDRESS D S W 2 ADDRESS U LOCALITY e. 3 o NEAREST 101, .J CITY TEL No T� D CROSS ST 1 COUNTY CERT No EXPIRES K NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL 3 ADDRESS NORTH O �} CITY 7 1?1/ l I AM THE LEGAL POSSESSOR F THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. OWNER CORRECTIONS SOUTH FW' DESCRIPTION OF WORK BATH TUB FURNACE a SHOWER DISHWASHER 3 AVATORY REFRIGERATOR �ICITCHEN SINK W WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR S MANS WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER—GAS SODA FOUNTAIN OUTL GAS PIPING i GAS VENT I CESSPOOL TOTAL NUMBER � URES 3 SEPTIC TANK CEBBPOOIC TANK Q Q SEWER � _t�~J�'\ UTILITY CO NOTIFIED I I TOTAL FEE doeV v FINAL • • COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I herbV.ff, -, i I have a certificate of consent to self 76A667A insure Dr a cerhf~cate of Workers Compensation Insurance, CE 817 (REV 8/86) or a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS 1 Policy No Company ' Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS tion department NUMBER FIXTURE OR ITEM @ FEE p LOCALIT Date 'Appli4ant WATER CLOSET NEAREST � CERTIFICATE OF EXEMPTION FROM WORKERS BATHTUB CROSSST COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by AA /the permit is for one hundred dollars ($100)or less ) LAVATORY DDRESS S I r 01/C I certify that in the performance of the work for which this permit is issued I s1qJ not employ any person 'SINK CIT )e �,�� TEL N so as to become sublect to Workers Compensation Laws DISHWASHER ' CONTRACTOR Date scant CLOTHES WASHER ADDRESS NOTICE TO APPLIC T If after making is Cer icate of Exemption, you should Become subject to'ihe Workers SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- ' LAWN SPRINKLER SYSTEM CITY 1 TEL NO with comply with such provisions or this permit`shall be STATE LIC deemed revoked I WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICTO�i/ P OCE55 BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL all r _ _ V (DATION DATE / LJ License Number Lic Class FIN lic Contractor Dote B 0 ❑ I am exempt under Sec � B 8P C for this reason U) Plan check fee Z Date ;27852A} PERMIT ISSUING FEE$ poll- PLUMBING Signature II TOTAL FEE e a Plan check applicant SINGLE FAMILY ( o o 1 6 5 0 HOME OWNER-BUILDER DECLARATION Name o 0 0 �� Qv I hereby affirm that I am exempt from the Contractor's License jJ Law for the following reason (Section 7031 5, Business and Address O9 O .i Pro 'ssions Code) I City ` Tel No I, as owner of the property, will do the work and the structure is not intended or offered for sole (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 above mentions r�,nspect�or� purposes SEE REVERSE FOR EXPLANATORY LANGUAGE i Signature o P rmitt Date