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Home My Public Portal About6002 CLOVERLY AVE_Plumbing__ �1 76A6167 7' APPLICATION ,I'OR PLUMBING PERMIT .1 DBS DIVISION OF BUILDING AND SAFETY Deportment of County Engmeer County of Los Angeles BUILDING i4A �f JOHN A LAMBIE COUNTY ENGINEER CASSATT D GRIFFIN,SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST ` CROSS ST OWNE DISTRICT NO GROUP ZONE I READY FOR INSPECTION MAIL As 2 ADDRESS !� ✓� --gyp q INDUSTRIAL CITY TEL N sN h` WASTE APPROVAL PLUMBE INSPECTION RECORD G ADDRESS CITY TEL NO LICENS NO I/f Z2 NUMBER TYPE OF FIXTUREf OR ITEM FEE WATER CLOSET (TOILET) @ $1 00 $ BATH TUB @ $100 SHOWER @ $1 00 LAVATORY (WASH BASIN) @ $1 00 &0-7— KITCHEN KITCHEN SINK @ $1 00 (�U, DISHWASHER @ $100 LAUNDRY TUB OR TRAY @ $100 �/�/�/ •� /lT!/fjS .f3!� 'IV CLOTHES WASHER @ $1 00 (IV 12S,5 � p �/�,f7 pS / WATER HEATER @ $1 00 � /� , GAS SYSTEM @ 5100 P r171c /S 0 V1 7-,,C- /'/'1/)/ lir 7/)(1 -77;4,r// N FI/ G>> rH -r lllJ OIVZ- APPROVALS DATE INSPECTOR S SIGNATURE UNDER SLAB WORK PERMIT S 1 00 ROUGH PLUMBING ry v GAS PIPING TOTAL FEE z GAS VENT 1 HEREBY ACKNOWLEDGE THAT 1 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 PLUMBING FIXTURES 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 T EGAL OWNER--PF TH.9 ABOVE -LITILITY CO NOTIFIED DESCRIBED RESIDENTIA RO RTY SIGNATURE OF PERMITTEE Av IL. FINAL JOHN A LAMBIE COUNTY ENGINEER VALIDAT BERT A WOOD CHIEF PLBG INSPECTOR CK d 0 CASH L01-3 m 18 3 n 2.00 M I >j WORKERS CQMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hiareby affirm that I have a certificate of consent to self 76A667A ensureq or,a-cienhficate of Workers' Compensation Insurance CE 817(REV 10/81) or d,certified`copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company aye ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑J Certified copy is filed with the county building inspec- ADDRESS tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST Q� CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST 99 COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed rf the work involved by MAIL the permit is for one hundred dollars($100)or less ) LAVATORY ADDRESS I� I certify that in the performance of the wor _for_w this permit is issued I shall not employ a erson in any mann } SINK CITY ,w TEL NO 3 so as to become subject to the rkers'Compensat a , DISHWASHER v� CONTRACTOR Date App can CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after making this C tificate of SWIMMING POOL RECEPTOR Exemption you should become subject to the Workers' CITY TEL NO Compensation provisions of the Labor Code you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO,,,V PROCESS BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER >_ and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL V I ATION CL DATE License Number Lic Class 1 V FINAL f t1 �� IM O Contractor Date r} I am exempt under Sec J CL B 8P C for this reason '7�, �^ �� Z Plan check fee -9 0 0 6-6 A - Date PLUMBING PERMIT ISSUING FEE$ Signature # 0 0 0 0 0 5 TOTAL FEE I1650 Plan check applicant SINGLE FAMILY 0 0 0 1 6 5 0 6 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor s License Address Law fo the following reason (Section 7031 5 Business and Prof Bions Code) City Tel No 0 7.0 1 8 8 j 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 authorizere r of this County to enter upon the above- oned 7pert inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Fiermittee Date 1 �. WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT hert;,by 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 certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. 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 G� ` tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY I WATER CLOSET t4 Date Applicant CROSS NEARESTT . ��(/K✓di8' / CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE SHOWER OWNER �/F✓r �/�� (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL '�/ I certify that in the performance of the c or w is ADDRESS ��c'✓ Com'��'��/�'�� permit is issued, I shall not employ a person in any manner SINK CITY TEL. NO. �� ?-y so as to become subject to the Wo ers'Compensation Laws. /G' �✓ �-^ c� �/ /ff DISHWASHER CONTRACTOR Dat. Applica t CLOTHES WASHER NOTIC TO APPLICANT: If, a r ma ing this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY /� _ TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION GAS SYSTEM OUTLETS DIDISTRICTNp. N R ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL VALID ION DATE License Number Lic. Class rr U FIN 99 Contractor Date 11rz b I am exempt under Sec. � B.&P.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ 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 Law,f6r the following reason (Section 7031.5, Business and Address ;23323A Prof4ssions Code): City Tel. No. # o o o o o rj ® I, as owner of the property, will do the work and the JJ structure is not intended or offered for sale (SectionPilo8 0 0 x U 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for I 0.29-85 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address Ale? 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 authorizg_;;eptesentative b this County to enter upon the abpvd'7�entioned property fbr inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date