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Home My Public Portal About5628 CLOVERLY AVE_Plumbing__ c 76A667-CM17-8-'8 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE, Count)r Engxaeer ADDRESS _ :0 L/ G, CASSATT D GRIFFIN.Supt of Buildmg LOCALITY 9 FOR APPLICANT TO FILL IN NEAREST 'NUMBER FIXTURE OR ITEM CROSS ST WATER CLOSET OWNERMAIL "O IfU BATH TUB ADDRESS SHOWER CITY TEL NO LAVATORY CONTRACTOR o SINS ADDRESS DISHWASHER CITY t TEL NO CONTRACTORS p STATE LAUNDRY TUB REGISTRATION NO COUNTY CLOTHES WASHER DISTRIFLNO OUP N P SSE D BY WATER HEATER i GAS SYSTEM INDUSTRIAL WASTE APPROVAL Tr � INSPECTION RECORD lt-/ .7E'2 aZ 17-7-1? :/'4 / -7- APPROVALS O8 O P ITEM FIXTURE DATE INSPECTOR S SIGNATURE UNDER SLAB WORK PERMIT $ 2 00 ROUGH PLUMBING TOTAL FEE GAS PIPING - I HEREBY ACKNOWLEDGE THAT I 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 OF THE ABOVE UTILITYCO NOTIFIED DESCRIBED RESIDENTIAL PROPE SIGNATURE OFPERFINAL OF PERMITTEE ROBERT A WOOD OF VALIDATION SUPERVISING MECHANICAL ENG R CR m O CASH I Lt1C,0 5 4 7 3 APR 21 5 A 5.0'0 N �J 17 10 SS DBS APPLICATION FOR PLUMBING PERMIT DBS t7 DIVISION OF BUILDING AND SAFETY Department-of County Engmeer County of Los Angeles BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS J s CASSATT D GRIFFIN, SUP T OF BUILDING r IJ LOCALITY �* + FOR APP CANT TO FILL NEAREST CROSS ST � r OWNER b 7/ /trb� DISTRICT NO GROUP h ZONE READ R INSPECTION MAILWdR ADDRESS INDUSTRIAL CITY L. TEL NO WASTE APPROVAL PLUMBER '- INSPECTION RECORD ADDRESS �L CITY !3 TEL NIU LICENSE NO //J-/ ,5 �3 NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1 00 $ BATH TUB @ $1 00 SHOWER @ $1 00 LAVATORY (WASH BASIN) @ V 00 KITCHEN SINK @ $1 00 DISHWASHER @ $1 00 LAUNDRY TUB OR TRAY @ $1 00 CLOTHES WASHER @ $1 00 WATER HEATER @ $1 00 GAS SYSTEM @ $1 00 APPROVALS DATE INSPECTOR S SIGNATURE UNDER SLAB WORK PERMIT $ LA 00 ROUGH PLUMBING GAS PIPING TOTAL FEE GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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 LEGALOWNER OF THE ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTIAL PROPERTY i SIGNATURE OF PERMITTEE '✓� FINAL JOHN A LAMBIE COUNTY ENGINEER ALIDATION ROBERT A WOOD,CHIEF PLBG INSPECTOR CH d 0 CASH E ACo,7 0 4 3 c'AY ?6 5 A 3.00 D 17 12 84 DBS APPLICATION Y ®R PLUMBING ■ ` ■ \M I T BS 17 _ DIVISION OF BUILDING AND SAFETY �$3 Z S�"��, �,4�'�� I 1, Department of County Engmeer County of LOS Angeles BUILDING WM J FOX, COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN SUP T OF BUILDING FLOCALITY OR APPLICANT TO FILL IN CNEAREST ROSS ST OWNER DISTRICT NO GR OyP I READY FOR INSPECTION MAIL 1 ADDRESS ' INDUSTRIAL CITY ` TEL NO WASTE APPROVAL PLUMBER s INSPECTION RECORD ADDRESS ♦ � y0AJI6 CITY 420 LU Ar TEL NOWO LICENSE NO NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) BATH TUB SHOWER 3 LAVATORY (WASH BASIN) KITCHEN SINK DISHWASHER LAUNDRY TUB OR TRAY CLOTHES WASHER TOTAL NO @ o s0 fD APPROVALS -7 - DATE INSPECTOR S SIGNATURE GAS SYSTEM----f OUTLETS @ 100 WATER HEATER @ 1 00 Q UNDER SLAB WORK ROUGH PLUMBING PgRMIT S I I `I OO GAS PIPING ZI TOTAL FEE GAS VENT 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER _ AND STATE THAT THE ABOVE IS CORRECT AND AGPEE TO COMPLY 11 WITH ALL COUNTY ORDINANCES AND STALE LAWS REGULATING PLUMBING FIXTURES 1 PLUMBING GAS TEST 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AN STATE OF UTILITY CO NOTIFIED K 9. CALIFORNIA OR T4AT 1 AM THE LEGAL OWNER OF HE ABOVE DESCRIBED RESIDENTIAL PROPERTY SIGNATURE OF PERMITTEE FINAL WILLIAM J FOX. COUNTY ENGINEER VALIDATION _C,01 7 5 31R M21 3 1 4 A 0 m BY SIcE �h DEPUTY', WORKERS'CC»AFENS1 C%ti cafePECLARATIONAPPLICATION FOR PLUMBING PERMIT 4.. %L-hereby,affirm that I have a cd►itificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817 (REV. 8/86) or a certified1.1p t reoZc. 3800, La-- (�Cj �(�J — "7/ COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS PolicyNo. an ❑ Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS l tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date --Z6Applicant ' WATER CLOSET 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 the permit is for one hundred dollars($100)or less.) LAVATORY r ADDRESS -0 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY "` c c�� L TEL. NO. 2-1 ' so as to become subject to the Workers'Compensation Laws. DISHWASHER �bf CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS -7�G NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' / � �.—/14� Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM 41�CITY !/ TEL. NO. with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. SS A LICENSED CONTRACTORS DECLARATION DISTRI NO. ROCESSfD BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �} (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER :01,VALIDe4T1 and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL 0 0 License Number 5�6�7 Lic. Class DATE FI ,Q � fo Contractor//_44 �� Date ❑ I am exempt under Sec. @mss f� B.&P.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature 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 ® 7 3 Q,•L A 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY # 0 0 0 9,0 5 I hereby affirm that there is a construction lending agency for 0 0 3 IL 5 0 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). 0 0,0 3(j,5 0= v Lender's Name 0 626-87 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 repr entatives of this County to enter upon the above- t' a roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu of Permittee Date