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Home My Public Portal About5808 CLOVERLY AVE_Plumbing__ "wImey rr +a-gig APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND,SAFETY COUNTY OF LOS ANGELES WILLIAM J FOX CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERM17 NO PLUMBER RECEIVED BY READY FOR DATE ICSH ZD /,Q _ _ FIRST INSPECTION /;7 ADDRESS t � 1 BUILDING CITY TEL N ADDRESS ' COUNTY a OCALITY LICENSE NO EXPIRES NEAREST CROSS ST �e P MIT FEES NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER Z /U IMAIL WATER CLOSET (TOILET) 1 0 50 I S I ADDRESS Q / BATH TUB Q O 50 I _ I - -CITY TEL NO ' SHOWER n O 501 I 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND LAVATORY (WASHBASIN) Q O 50 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK Q O Sol STATE LAWS REGULATING PLUMBING 1 CERTIF HAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB,OR TRAY @ O 501 ANGELES C UNTY LQICENSE OR 1 AMS THE LEGAL OWNER OF THE RESID NTIAL PROP EF DESCRIBED ABOVE GAS SYSTEM OUTLETS �+L O 50 SIGNATURE OF �' WATCR HEATER Q O Sol PERMITTEE SLOP SINK @ O $01 I PECTION REC&D FLOOR SINK Q O 50 FLOOR DRAIN Q O 501 IDISHWASHER Q O 50I DRINKING FOUNTAIN Q O 501 URINAL Q O 501 I J HOUSE SEWER @ O Sol I Q Z MISCELLANEOUS A.(! I-4v,1 I 1506 0 II I I APPROVALS DATE INSPECTORS NAME ROUGH PLUMBING I� GAS PIPING IGAS VENT CESSPOOL Q 1 00 I� CESSPOOL SEPTIC TANK I SEPTIC TANK DRAIN ( ) PIT ( ) Q 1 00I I SEWER PERMIT I 1 00 GAS TEST TOTAL FEE UTILITY CO NOTIFIED I� // (� FINAL / `/( ✓ .� RKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT ereb m that I have a certificate of consent to self 76A667A V.sure, or,a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) ora certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAM Policy ompany CNA F•. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING a Certified copy is filed with the county building inspec- ADDRESS 5806 CLOVERLY AVE. tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY TEMPLE CITY Date 12-1-88 Applicant OWEN PLUMBING CO. 6 WATER CLOSET 3600 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' 6 BATH TUB 3600 CROSS ST. COMPENSATION INSURANCE SHOWER OWNER TRI TECH DEVELOPMENT (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars (:100)or less.) 6 LAVATORY 736 00 ADDRESS 735 W. 'IMERSON AVE. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner 2 SINK CITYMONT TEL. so as to become subject to the Workers Compensation Laws. DISHWASHER 2 12 00 CONTRACTOR OWEN PLUMBING Date Applicant 2 CLOTHES WASHER 12 00 ADDRESS 2019 SANTA ANITA AVE. 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 �7 1O CITY S. EL MONTE CA. TEL41 443-3384 with comply with such provisions or this permit shall be STATE 451(733 LIC. `+- 36 deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION P 12DISTRICT NO. PR SSED BY I hereby affirm that I am licensed under provisions of Chapter 9 2 GAS SYSTEM OUTLETS 1.2 00 (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 VAL1061ON DATE �y r , License Number +51933 Lic. Class 0-36 ' 6� n' 1+ ROOF DRAINS 24100 FIN 1/51 I 0 OWEN PLUMBING 12-1-88 e / Q. Contractor Date ❑ I am exempt under Sec. O B.BP.C. for this reason Plan check fee0_ ® Date. PLUMBING PERMIT ISSUING FEE$ 10 0 TOTAL FEE 2O2 5O Z Signature Plan check applicant #9 1 2 3.4 A5 SINGLE FAMILY 1 2 0 2 5 0 HOME OWNER-BUILDER DECLARATION Name ° 1 hereby affirm that I am exempt from the Contractor's License Address o .2 02. 5 0 5 Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No.❑ 1201 -88 I, as owner of the property, will do the work and the 0 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 Pool ordinances and State laws regulating Plumbing, and hereby. authorize representatives f this County to enter upon the abov -me oned ro ty or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 43 0nature of Permittee Date RKERS' COMPENSATION'DECLARATION APPLICATION FOR PLUMBING PERMIT '1 rm that I have a certificate of consent to self 76A667A rt sure, c�a certificate of Workers' Compensation Insurance, CE 817(REV. 10/811 �J or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy NC �S��SQ�mpany CNA " Certified copy,is hereby furnished. BUILDING 4 — A & ❑ PC] FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING HO CLOVERLY AVE. Certified copy,is filed with the county building inspec- NADDRESS 5 tion department. UMBER FIXTURE OR ITEM @ FEE LOCALITY TEMPLE CITY Date 11�_1_8R Applicant 6 WATER CLOSET 6 00 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' 6 BATH TUB 36 OO CROSS ST. COMPENSATION INSURANCE SHOWER OWNER TRI TECH DEVELOPMENT (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY 36 OO ADDRESS W. EKERSQN AVE I certify that in the performance of the work for which this 12 00 permit is issued, I shall not employ any person in any manner 2 SINK CITY MONTEREY PARK,CA• TEL.8�18)289-0204 so as to become subject to the Workers'Compensation Laws. DISHWASHER 12 QQ CONTRACTORQW'� PLUMBING Co. Date Applicant 2 CLOTHES WASHER 12 00 ADDRESS @ 2019 .SANTA ANITA AVE. NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR M)443-3384 1 p Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY S MONTE CA. TEL.M 44 — 4 with comply with such provisions or this permit shall be STATE 451933 LIC. O`.— deemed revoked. 2 WATER HEATER LICENSE NO. CLASS 3 12 100 LICENSED CONTRACTORS DECLARATION DISTRI!7 P CESSED Y I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 12 00 (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALI TION License Number 451933 Lic. Class C+ 36 ROOF DRAINS 24 00 DATE �� .� I w OWEN PLUMBING 12-1-88 FINA / (,. Contractor Date � fY ❑ I am exempt under Sec, 0 B.BP.C. for this reason W Plan check fee p. Date: Signature 2020 PLUMBING PERMIT ISSUING FEE$ 10 50 Z TOTAL FEE 5 SINGLE FAMILY Plan check applicant ;21 2 3 3 A HOME OWNER-BUILDER DECLARATION Name # 0 0 0 0.0 5 1 hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and 1 0 2 0 2 5 0 Professions Code): City Tel. No. 0 ° 2 0 2 5 O v El1, 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). 1201 -88 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 lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned prop for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE .. — !p�--� Si lure of Permit ee - Date