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HomeMy Public PortalAbout6028 CLOVERLY AVE_Plumbing__ 76A667-CE#617 4-67I APPLICATION��F ` R PeLU INC PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING (� 'BUILDING AND SAFETY DIVISION ADDRESS rJ JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY , FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS CITY TEL O. SHOWER 1.25 LAVATORY 1.25 CONTRACTOR;V ' SINK1.25 ADDRESS DISHWASHER .1.2S CITYSTATE LAUNDRY TUB 1.25 LICENSE NO. me�gg,, / LIC �pi C� �P � CLASS CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCESSED BY WATER HEATER 1.50 d 1.50 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS CD OUTLETS OVER 5 PER'SYSTM .30 AN)37ECTION RECORD O H O_ PfnAk N AA Vlog Gt Ill c +'I ` APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK �� ROUGH PLUMBING TOTAL FEE �� GAS PIPING 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 LHE ' CERTIFY,THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES S REQUIRED BY LOS ANGELES COUNTY AND'STATE OF OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST HE ABOVE DESCRIBED RESIDENTI PROPERTY. UTILITY CO. NOTIFIED IT �� FINAL LIDATION JACK R. ALLEN CK. M.O. CASH SUPERVISING MECHANICAL ENG'R. t_ACC 4 0 9 8�2 APH 4 5 D 35 0 IT LUM NG DEPARTMENT OF COUNTY ENGINEEit � ' 7 '/v DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING / D WILLIAM J. FOX, COUNTY ENGINEER ADDRESSBUILD NG P _ FOR APPLICANT TO FILL INLOCALITY .t� NEAREST d ADDRESS 6028 Cloverly CROSS ST DI NO GROUP ION PERMIT NO LOCALITY Tem le Cit J (� NEAREST CROSS ST RECEI ED BY Ready for Inspection DATE ISSUED OWNER Ellen Johnson MAIL INDUSTRIAL ADDRESS WASTE APPROVAL CITY TEL No INSPECTION RECORD PLUMBER Belvedere Plumbing Co. ADDRESS 11900 E .Garvey Blvd • CITY El Monte TEL NO FO 89836 3A ru i D w—r7lmvor LICENSE NO 54932 o TWT Illi A b �J a 11 S,01Z, L) l: PERMIT FEES p I/�-6LJ !�F' ldUGl� /3IClYlc f Q JUMSER TYPE OF FIXTURE OR ITEM FEE v//��D�x? 'P/ 1-3g /J 2 WATER CLOSET(TOILET) @ 080 S�.• O �/��/v!` ti�y✓ O BATH TUB @ 080 . O SHOWER @ 080 2 LAVATORY(WASH BASIN) @ 0 80 1• O ��-1 (F is 8�C�f� �1 �% 1` 1 KITCHEN SINK @ 0 80 • 0 � n a —?4 1 LAUNDRY TUB OR TRAY @ 0 80 .80 I SLOP SINK @ 080 FLOOR SINK @ 080 FLOOR DRAIN @ 080 DISHWASHER @ 0 80 DRINKING FOUNTAIN @ 080 URINAL @ 080 1 GAS SYSTEM 4. OUTLETS @ 1 00 1•UO 1 WATER HEATER @ 1 00 1.00 MISCELLANEOUS disposal 0 - APPROVALS ° DATE INSPECTOR'S SIGNATURE UNDERSLAB WORK PERMIT $ 1 00 ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GAS VENT 12 -2- r CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS HOT WATER HEATER ` REGULATING PLUMBING PLUMBING FIXTURESIHEREBY CERTp�2� p� ¢yam_/✓ REGISTERED AND/OR LACE SED TFY HAT R QUIREDABYPROPERLY LOS ANGELES COUNTY GASTEST P-10(I,'Ot, 117- C�tOC'f>uY�� AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDFATIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE rd OF PERMITTEE FINAL L�C3 - 7bA067 DBS 17 CAb 12-53 166 WORKERS'COMPENSATION DECLARATION 81 A APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a' certificate of consent to self CE cE e» (z-eo) insure,•or a certificate of Workers'Compensation Insurance,or a c rtified co y.thereof(Sec.3800,Lab.C.) v'F 0 5 317 COUNTY OF LOS ANGELES �i - 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 inspection NUMBER FIXTURE OR ITEM • FEE ADDRESS lle artment. WATER CLOSET LOCALIT Date 8-A ✓- pplicant `'"r '/`` NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER ry� (This section need not be completed if the work involved LAVATORY MAIL �GaQ ADDRESS by the permit is for one hundred dollars ($100) or less.) a SINK CITY / �' TEL.NO 7,.' O I certify that in the performance of the work for which this DISHWASHER � U permit is issued, I shall not employ any person in any manner CONTRACTO " ^1C so as to become subject to the Workers' Compensation Laws. CLOTHES WASHERQ ADDRESS? 9 Date Applicant SWIMMING POOL RECEPTOR / tU NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. NO. Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM /d� �7 N Compensation provisions of the Labor Code, you must forth- STATE �) 7�/8[fj©' CLASS with comply with such provisions or this permit shall be WATER HEATER LICENSE NO. O� 7 P - deemed revoked. DISTRICT NO PRO ESSED BY GAS SYSTEM OUTLETS 6 p LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINA- ' VALIDATION ness and Professions Code, and my license is in full force and DATE effect. C--16 FINAL License Numb er �i� Lic.Class FFI Contractor Date _? dtl I /�3�/ 0 I am exempt from the licensing requirements as 1 am a Plan check fee {O J licensed architect or a registered professional engineer acting in my professional capacity (Section 705.1, Bus- iness and Professions Code). /p TO0 [TOTAL FEE (f Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm.that I am exempt from the Contractor's Address f5-;P3 7 License Law for the following reason (Section.7031.5, Busi- City Tel. No. ness and Professions Code): 1 9 0 34�7 A 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project #:0 o,0 0 o 5 (Section 7044, Business and Professions Code). 2 ° ° 1Q00 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency ° ° ° 1 0 0 0 3: for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). 071 5-81 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. Signature of Permittee Date WORKER'S COMPENSATION certificate of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I hereby affirm what I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. El Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Dl Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @a FEE LOCALITY 1 /� Date Applicant WATER CLOSETt� NEAREST CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE ASSESSOR MAP BOOK PAGE PARCEL (This section need not be completed if the work involved by the SHOWER permit is for one hundred dollars($100)or less.) OWNER LAVATORY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to SINK MAIL d� p� ) become subject to the Workers' Compensation Laws. ADDRESS DISWASHER CITY1 V TEL.NO. �^1 Date Applicant CLOTHES WASHERe� NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. d I hereby affirm that I am licensed under provisions of Chapter 9 , WATER HEATER (commencing with Section 7000 of Division 3 of the Business and STATE LIC. ( g ) GAS SYSTEM OUTLETS LICENSE NO. GLASS V Professions Code, and my license is in full force and effect. OUTLETS OVER DISTRICT NO. P CESSED BY 5 PER SYSTEM >�^© -_' i,7 - Q License Number Lic.Class V FINAL VALIµ, T�• fps- LLl DATE _ .- Contractor Date (/ T;•.",.' �' CD ❑ t under Sec. d �1 FFIINAL s•'•3- = =-:.f = =-•-}' I am exempt t•.-HL.t_.K ;-E-o"18. �. B.&P.C.for this reason ,- Plan check fee , f HNGE _DIt - Date: Signature PLUMBING PERMIT ISSUING FEE$ TOTAL FEE 1,,;3 i I,-11 it,i 1 :;' -14- ❑ tr: Plan check applicant t X-D 3 -- SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name G I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address ©X GL O Kk 611-0— Code): El 1, _� C Tel.No. 02 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 urposes. 1, 1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu�dPiwirnittee Date f WORKERS' Mhave a, ION DECLARATION CE 81 A APPLICATION FOR PLUMBING PERMIT I hereby affirm tha I have a' certificate of consent to self ce en (z-ao) insure, or a certificate of Workers'Compensation Insurance,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 ADDRESS O Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE department. LOCALITY WATER CLOSET Date 'Applicant NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER LAVATORY MAIL (This section need not be completed if the work involved ADDRESS by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL. NO. I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS g Date Applicant SWIMMING POOL RECEPTOR cc NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. NO. 0 Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. C" ` Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be WATER HEATER LICENSE NO. CLASS PJI deemed revoked. DISTRICT NO. PROCESSED BY GAS SYSTEM OUTLETS LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code, and my license is in full force and DATE effect. FINAL License Number Lie.Class BY Contractor Date I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lie.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 7031.5, Busi- City Tel. No. ness and Professions Code): 7 n, 1, as owner of the property, am,exclusively contracting with licensed contractors to construct the project " • • • • • c (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.). ry 1 Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC-WORKS 9701 LAS TUNAS PL 0508 0105140021 BUILDING AND SAFETY'/-LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGALFEES PAID BUILDING ADDRESS TR 6561 LT 304 6028 CLOVERLY AV FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917802025 ASSESSORIRFORMATION NUMBER NEAREST CROSS STREET LAS TUNAS 5385-007-019 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID J2 LOCALITY TEMPLE CITY 07 BATHTUBS/SHOWERS 1 00 FIX 16 20 TENANTTOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY EXPIRESON 05/14/01 UT 11/10/01 OWNER TEL NO FINAL DATE FINAL BY CODE TRUONG, THOMAS (626) 675-9189- ��/� / Ti(�Gl 6028 CLOVERLY AV 4�j- TEMP 917802025 DESCRIPTION OF WORK PLUMBING PERMIT FOR BATHROOM REMODEL IN AM N-HOUSE mo-z ) APPLICANT TEL NO SAME AS OWNER - SPECIAL CONDITIONS CONTRACTOR TEL NO ®� ��� ®� f� APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - d LIC NO UNDER SLAB WORK WATER SERVICE y PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEERTEL NO ROUGH PLUMBING LIC NO ] 1111111 L GAS PIPING r- — - GAS VENT G�� O II (c w(a�K�) HOTWAT TER LLL��� PLUMBING FIXTURES O 0 e AWN SPRINKLERS 0 , � GAS TEST Q ° sy UTILITY COMPANY NOTIFIED Q�® 4 WvGRAY WATER SYSTEM 1 " REPORT ID DPR263 ROUTE TO BS0508