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Home My Public Portal About5508 CLOVERLY AVE_Plumbing__ DEPARTMENT OF COUNTY ENGINEER PLUMBING 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING WILLIAM J FOX, COUNTY ENGINEER ADDRESS 5 LOCALITY FOR APPLICANTTO FILL IN C BUILDING NEAREST ADDRESS CROSS ST DISTRICT NO GROUP ZONE PERMIT NO LOCALITY NEAREST CROSS ST RECEIVED BY Ready for Inspection DATE ISSUED OWNER MAIL INDUSTR ADDRESS WASTE APPROVAL CITY �f TEL No INSPECTION RECORD PLUMBER S� ADDRESS ,� �,y� I ♦.Ili 1 L9 CITY _ TEL.NO,*T-+4044 ❑STATE LICENSE NO �I (» ® 7 !� ❑COUNT) PERMIT FEES NUMBER TYPE OF FIXTURE OR ITEM _ FEE LI WATER CLOSET(TOILET) 080 $ a ,! BATH TUB @ 080 0 SHOWER @ 080 LAVATORY(WASH BASIN) @ 0 80 KITCHEN SINK @ 0 80 LAUNDRY TUB OR TRAY @ 0 80 SLOP SINK @ 0 80 FLOOR SINK @ 080 FLOOR DRAIN @ 080 DISHWASHER @ 0 80 DRINKING FOUNTAIN @ 080 URINAL @ 080 GAS SYSTEM OUTLETS @ 1 00 4 O WATER HEATER @ 1 00 Q MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK / PERMIT $ I 00 ROUGH PLUMBING TOTAL FEE l /I_Q,Q GAS PIPING IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI GASVENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST g AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTI L PROPERTY UTILITY CO NOTIFIED r a • SIGNATURE OF PERMITTEE 440 ! FINAL Ih "�- 76A667 DBS 17 1/53 DEPARTMENT OF COUNTY ENGINEER PLUMBING 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING G WILLIAM J FOX, COUNTY ENGINEER ADDRESS ✓ D FOR APPLICANT TO FILL IN LOCALITY BUILDING 5-Se 75 Av /JH NEAREST !i CROSS ST ADDRESS J/ DISTRICT NO GROUP ZO E;-�! PERMIT NO LOCALITY NEAREST CROSS ST REC,EII�VjEDD BY Ready for Inspection DATE ISSUED OWNER MAIL INDUSTRIAL ADDRESS WASTE APPROVAL CITY w TEL NO ® INSPECTION RECORD PLUMBER Q �p�Geeta ADDRESS CITY /A) TEL.NOSTATE gip/lU��L dY �6 �� O / On LICENSE NO ,j PERMIT FEES a _z NUMBER TYPE OF FIXTURE OR ITEM FEE C7 WATER CLOSET(TOILET) @ 080 $ � O BATH TUB @ 080 SHOWER @ 080 ~LAVATORY(WASH BASIN) @ 0 80 KITCHEN SINK @ 0 80 LAUNDRY TUB OR TRAY @ 0 80 O SLOP SINK @ 080 FLOORSINK @ 080 FLOOR DRAIN @ 080 DISHWASHER @ 0 80 DRINKING FOUNTAIN @ 080 URINAL @ 080 GAS SYSTEM OUTLETS @ 1 00 WATER HEATER @ 1 00 MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT ; 1 00 ROUGH PLUMBING 3AB S✓ eei� TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI GAS VENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER / n TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES S �� 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- s ER OF THE ABOVE DESCRIBED RESID N IAL PROPERTY UTILITY CO NOTIFIED S/ SIGNATURE OF PERMITTEE _ _ FINAL 76A667 DBS 17 1/53 i` WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT P y affirm that I have a certificate of consent to self 76A667A insure or a certificate of Workers Compensation Insurance CE 817(REV 10/81) or a certJflecl copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY YU��(��ho(i�z' Policy No_ 1/J-115,1�Company�ll Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING I Certified copy is filed with the county building mspec ADDRESS tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY ++'n WATER CLOSET° , Date IlY Applicant NEAREST CERT) KATE OF EXE MP ON FR �®RKE�RS' BATH TUB CROSS ST COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER MAIL the permit is for one hundred dollars(;100)or less) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner SINK CITY EL NO so as to become subject to the Workers Compensation Laws DISHWASHER �Q, CONTRALTO 6 ' Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after making this Certificate of Exemption, you should become subject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code you must forth- LAWN SPRINKLER SYSTEM CITY Y' TEL NO�]� with comply with such provisions or this permit shall be STATE LIC 1 deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTR5 NO 'F PR SED 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 aDATE -� VALIDATION }: License NumbeZ` /�l4 p Lic Class_» Q Zal ,01ce� FIN U Contractor i JI; ate BY ❑ I am exempt under Sec 0 U B 8P C for this reason Plan check fee ® CLI DatePLUMBING PERMIT ISSUING FEE$ 10 W ;268&3A Z Signature TOTAL FEE 1 #,- 0002 Plan check applicant o -1650 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name - o o s (�5,0 5 I hereby affirm that I am exempt from the Contractor s License Address Law for the following reason (Section 7031 5 Business and 0 ( 5 $7 Professions Code) City / Tel No ❑ 1, as owner of the property will do the work and the structure is not intended or offered for sale (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 ' )'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 representotives of this County to enter upon the above-meat oned pr�rty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE gna ure a Date i ,