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HomeMy Public PortalAbout5605 CLOVERLY AVE_Plumbing__ 781867APPLICATI®N FOR PLUMBING PERMIT CE 817 a BUILDING AND SAFETY DMSION Department of County Engineer County of Los Angeles gB U'DDREss fl�/� JOHN A LAMBIE COUNTY ENGINEER /sem CASSATT D GRIFFIN SUP T OF BUILDINGKPOM LOCALITYdzfazHo /r FOR APPLICANT TO FILL IN f I NEAREST CROSS ST OWNER �� 6D/� DISTR T NO GROUP ZONE `,I READY FOR INSPECTION ADDRE53 C9 ' 9 MAIL I H IR-4 INDUSTRIAL CITY TEL NO WASTE APPROVAL PLUMBER INSPECTION RECORD ADDREsJUNTANA PLUMBING CONTRACTORS 13329 EAST ECTOR S CITY mu.T LICENSE NO # 96496 3 So NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $100 Sell— BATH TUB @ $100 I SHOWER @ $100 / m LAVATORY (WASH BASIN) @ $100 — r v KITCHEN SINK @ $100 J DISHWASHER @ $1 00 LAUNDRY TUB OR TRAY @ $1 00 CLOTHES WASHER @ $100 WATER HEATER @ $100 GAS SYSTEM @ $100 — APPROVALS ATE. INSPECTORS iGNATURE UNDER SLAB WORK a 4 r PERMIT $ 7 00 ROUGH PLUMBING 0 { 0© 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 FIXTURES PLUMBING I HEREBY CERTIFY THAT I pPERLY REGISTERED AND/OR GAS TEST LC LICENSED AS REQUIRED BY L b S COUNTY AND STATE OF CALIFORNIA OR THAT OF THE ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDENT dig SIGNATURE Y OF PERMITTEE FINAL ROBERT A OOD, JOHN A LAMBIE COUNTY ENGINEER VALIDATION SUPERVISING MECHANICAL ENG R CH M 0 CASH LG1 3 7`4-" F919 3 A 48-00 M 76A667-CE817-11-57 APPLICATION cFOR PLUMBING PERMIT COUNTY 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ABUILDING DDRESS JOHN A LAMBIE County.En eer C ATT D GRIFFIN Sup t of Building LOCALITY /./. FOR APPLICANT TO FILL IN NEAREST CROSS ST ; NUMBER FIXTURE OR ITEM OWNERl ��y WATER CLOSET BATH TUB ADDRESS G SHOWER CITY TEL NO LAVATORY CONTRACTOR SINS ADDRESS DISHWASHER CITY < TEq. Z LAUNDRY TUB CONTRACTOR S STATE—[] REGISTRATION NO e 6 COUNTY ❑ CLOTHES WASHER DIST IC O GROUP ZONE READY FOR INSPECTION WATER HEATERyf( GAS STEM INDUSTRIAL WASTE APPROVAL y INSPECTION RECORD t- ,r APPROVALS 6 ' 0 $1 00P��EM I $ I OQ DATE INSPECTOR S SIGNATURE Vn UNDER SLAB WORK PERMIT $ 1100 ROUGH PLUMBING TOTAL FEE 2 vv GAS PIPING; I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES 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 O/F THE 'ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTIAL PROPEJc'' ^: SIGNATURE OF PERM ITTE FINAL b`o� , ROBERTA WOOD OF VALIDATION SUPERVISING MECHANICAL ENG R CK N O CASH LCO 5 0 5 52R SEP 2 2 5 A 2.0 0 WORKER S COMPENSATION DECLARATION 200026 DPW 9189 , APPLICATION FOR PLUMBING PERMIT l I hereby affirm that I have a certificate of consent to self insure 76A667A or a certificate of'Worker s Compensation Insurance or a certified - copy,thereof(Sec 3800 Lab C) - - Policy No Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV � -- z ❑ Certified copy is hereby furnished _ BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS l�w ❑ Certified copy is filed with the county building inspection l department nn NUMBER FIXTURE OR ITEM @ FEE s LOCALITY Date ``2 Applican � f p < < WATER CLOSET / Q NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST CAi� COMPENSATION INSURANCE I ASSESSOR OAL,`L (This section need not be completed if the work involved by the SHOWER MAP BOOK 5EsPAGE Qqq PARCEL permit is for one hundred dollars($100)or less) - OWNERS Wale" I certify that in the performance of the work for which this permit LAVATORY aG d .1 64ec is issued I shall not employ any person in any manner so as toMAIL SINK ADDRESS t 3 LI) T become subject to the Workers Compensation Laws v� I I DISWASHER CITY LA "1 t,()`� TEL NO - Date ' Applicant CLOTHES WASHER �, CONTRACTOR NOTICE TO APPLICANT If after making this Certificate of Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code you must forthwith comply with such ADDRESS LLl ti1�1/� N� provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM / LICENSED CONTRACTORS DECLARATION CITY TEL NO I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER - LIC (n� 1 Q. (commencing with Section 7000) of Division 3 of the Business and STATEGAS SYSTEM OUTLETS LICENSE NO ��L( CLASS vv 1 O Professions Code and my license is in full force and effect OUTLETS OVER DISTRICT NO PROCESSED BY Q License Number " ,�1 wtq 5 PER SYSTEM D Q Lic Class U FINAL DATE _ Z_ VALIDATION W a. Contractor Date _R L- FINALq CC 4 Z(n S A ° I am exempt under Sec gy � B&P C for this reason - 37,07 '`'°', Date Plan check fee ' Sgnatur ��-- �� �17�J PLUMBING PERMIT ISSUING FEE$ , ❑ TOTAL FEE 2 SINGLE FAMILY Plan check applicant 1 ITGM5 HOME OWNER BUILDER DECLARATION Name L ,%_ j 3111� ` �� ® �� I hereby affirm that I'am exempt from the Contractor s License Law for the following reason (Section 7031 5 Business and Professions Address S LkL E r C1 r.r,w�eSY\ CHECK fL,C�" `O � Code) y� L t ❑ 1 r�r �{t(Z-Z`T�oEI , I as owner of the property will do the work and the structure City Tel No i GE C,13 is not intended.or offered for sale (Section 7044 Business and Professions Code) , I i i CONSTRUCTION LENDING AGENCY 0009-0051 12/t0/9°- 1 hereby affirm that there is a construction lending agency for the 6��.r r c �`3�i`�°14 performance of the work for which this permit is issued (Sec 3097 - I Civ C) Lender s Name Lender s Address r 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 p y for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE �- q I, - S gnature of Permittee Date