The URL can be used to link to this page

Home My Public Portal About5512 CLOVERLY AVE_Plumbing__ 1 CEA817 10-62 CITY OF TEMPLE .0 I TY APPLICATION FOR PLUMBING PERMIT _ COUNTY OF,LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 5512 C 1 ove r 1 y AVE . JOHN A LAMBIE COUNTY ENGINEER WILLIAM A JENSEN SUP T OF BUILDING LOCALITY Temple City(city) FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM EACH FEE Broadway WATER CLOSET $125 OWNERPhillip I n a MAIL BATH TUB 125 , ADDRESS 6415 Rosemead Blvd. SHOWER 125 CITY San Gabriel TEL NO AT-78603 LAVATORY 1 25 CONTRACTOR Jose h C a d i l l i P l b , C o. SINK 1 25 ADDRESS 7821 E Garvey Ave. DISHWASHER 125 cut. San ,Gabriel TEL NO AT-05349 LAUNDRY TUB 125 REGISTRATION NO 13 493 5 C 3 6 COUNTY ACTOR S STA 0 CLOTHES WASHER 1 25 DISTRICT NO GROUP I ZONE P CESS D BY WATER HEATER 150 GAS SYSTEM 1 OUTLETS 1 50 0 INDUSTRIAL d WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V OC O 181 APPROVALS DATE' INSPECTOR S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING I � TOTAL FEE GAS PIPING 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES , LICENSED AS REQUIR BY LOS ANGELES COUNTY AND STATE OF GAS TEST a CALIFORNIA OR THAT I AM THE LEGAL OWNE AND INTEND TO _ RESIDE IN THE ABO SCRIBED RES DENTI P PERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTE FINAL VAIJDATION ROBERT A WOOD M O CASH SUPERVISING MECHANICAL ENG R L CO 6 7 6 2;.o' .JUS! 27 5 D 3.5 pM J76A667 CCE-817) - 5/73 4 � APPLICATION FOR PLUMBING "PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION B U LD NG MAKE CHECKS PAYABLE TO A ADDRESS - Oveq' HARVEY T. BRANDT, COUNTY ENGINEER, t LOCALITV �l FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS,ST NUMBER FIXTURE OR ITEM @ FEE OWNER WATER CLOSET 1 75 MAIL , 'p BATH TUB 1 75 ADDRESS SHOWER 1 75 --CITY TEL NO �Q LAVATORY 1 75 / CONTRACTOR SINK 1 75 ADDRESS/7/ C DISHWASHER, 1 75 CITY TEL NO CLOTHES DASHER 1 75 STATE / n� LIC y LICENSE NO C iG! CLASS QG SWIMMING POOL RECEPTOR 1 75 DISTRICT NO -GROUP 1ZONE PROCESSED BY LAWN SPRINKLER SYSTEM 1 75 ^ GI WATER HEATER 1 75 INDUSTRIAL WASTE APPROVAL d GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD v OUTLETS OVER 5 PER SYSTEM 30 O F- U , - Z Plan check fee 'See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE ' 1 APPROVALS D TE I PECTOR 5 NATLRE Plan check applicant UNDER SLAB WORK -,- Name ROUGH PLUMBING Address GAS PIPING City Tel NO , GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE 7 T I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS C RECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINA CES ND STATE LAW REGULATING GAS TEST V 1 D PLUMBING 1 HEREBY CERTIFY THA I M PROPERLY STEREO AND/OR UTILITY CO NOTIFIED + LICENSED AS REOUI RED B S.ANGELES CO AND STATE OF CALIFORNIA OR - HE LEGAL OWNE F AND I ND TO RESIDE IN TH ABOVE DE RESIDENTI R PERTY FINAL SIGNATU OF PE MIT E PERMIT VALIDATIONCK M 0 CASH PLAN CH ALIDATION CK M o CASH i 1 2 9 NOV 5 0 8.2 5 ®'j:, I _ r 7 `7 2 62 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES r DEPARTMENT OF COUNTY ENGINEER' BUILDING AND SAFETY DIVISION BUILDING JOHN A -LAMBIE COUNTY ENGINEER ADDRESS WILLIAM A JENSEN SUP T OF BUILDING LOCALITY Tem le Cit FOR APPLICANT TO FILL IN NEAREST CROSS ST BroadWay NUMBER FIXTURE OR ITEM EACH FEE OWNER R. Fortner WATER CLOSET $125MAIL BATH TUB 1 25 ADDRESS CITY TEL NO SHOWER 125 1 LAVATORY 125 CONTRACTOR Van Curen Plumbing 1 SINK 125 1 25 ADDRESS 425 W. Chestnut St . DISHWASHER 125 CITY Monrovia TEL NOEL 9-713 CONATE LAUNDRY fUB 1 25 REGISTRATION NO 191691 CACTOR S OU TY 1 CLOTHES WASHER 1 25 DISTRICT NO GROUP ZONE PR SSED BY 1 WATER HEATER 1 50 1 0 -(,el GAS SYSTEM OUTLETS 1 50 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD / d o ix 1 v c � W {4�,r�_ ♦z r- '/ '� 4� N wA 9 APPROVALS DAT//E ' INSPECTOR S SIGNATIiRE PERMIT $ 2 00 UNDER SLAB WORK )V/ {� 1/1V1/ ' ' ROUGH PLUMBING TOTAL FEE 11 2 GAS PIPING n I HEREBY ACKNOWLEDGE THAT 1 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 I 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 LEGAL OWNER OF AND INTEND TO �q RESIDE IN THE ABOVE DESCRI ED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE FINAL �- of /-'VALIDATION ROBERT A WOOD U 1 (` cK M O CASH SUPERVISING MECHANICAL ENG R 5 3 8 21 OCT 10 5 D 11 .25- c w WORKERS' COMPENSATION DECLARATION20026 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A-0667APW 4/87 sure,ora certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. f ompany (`D_ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN (PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS X department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY 5 y Avenue Date Applicani t� T(Z ;_ PitTLf, WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL • • vjcfta coo i 11W. the permit is for one hundred dollars ($100) or less.) LAVATORY ADDRESS !j_-45,0 AlbAad=a Road I certify that in the performance of the work for which this per- SINK CITY TELNO mit is issued, I shall not employ any person in any manner soZXjWeggg . . as to become subject to the Workers' Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS 0WW Bros• PlumbiM, Zsc• -NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR 4265 N. -emplion, you should become subject to the Workers'Compen- sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM CITYEl monte TEL. NO. 443-0078 ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRI PROCE I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER p, and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. DATE License Number 211 7$1 Lic. Class C36=20=1 6 J FINAL ILL Contractor 06 1 RMP1_ P1JQb Date BY >_ 1 am exempt under Sec. Q 8.8P.C. for this reason Plan check fee ► d Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant 1 hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No.112 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 551? Clinypr][31 tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date 1 � Applicantweft ` WATER CLOSET NEAREST Vaple City lbg CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER D.W. McNeil CO. Inc. (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 5350 Alhambra lvp- I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY Angaleft TEL. NO. 925-5694 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR •r Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of 4265 N. Baldwin Ave. Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY En Monte TEL. NO. 443-0078 P Y LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. ? I V I CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS } (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER 0 and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION U DATE License Number 223 743 ClassQ36-20-16 J FINAL ty, ContractorDate ]�6��Z BY ❑ I am exempt under Sec. ¢, B.BP.C. for this reason , Plan check fee Date: 0. PLUMBING PERMIT ISSUING FEE$ W Signature f- TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ I, 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 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date