HomeMy Public PortalAbout6032 CLOVERLY AVE_Plumbing__ 76A667 Des 17 7-s1 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
DI R •
FOR,,APPLICANT T❑ FILL IN if-/
4 T/ /O
PLUMBE RECEIVED BY READY FOR / DATE ISSUED
!1/Y11lL�/�
FIRST INSPECTION
ADDRESS � "�.•
BUILDING A0 1 i9
CITY ,r TEL.No ADDRESSIle
G
COUN—
N NO f EXPIRES �J�J LOCALITY _
NEAREST
PERMIT FEES CROSS BT
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNS
FtIVAW
MAIL ff��
WATER CLOSET(TOILET) O 90 !B 'ADDRESS V�f-
BATH TUB O SO DITY TEL o
SHOWER O 50 1 HER ACKNO 13E THAT I HAVE READ THIS
LAVATORY (WASH BASIN) O 59 APPLICA ON AND E THAT THE ABOVE IS CORRECT
AND AGREE TO COMPL WITH ALL COUNTY ORDINANCES
KITCHEN SINK O 50 AND STATE LAW13 REGU TING PLUMBING
I CERTIFY THAT I OBSESS THE ABO5CK
LAUNDRY TUB OR TRAY Q 050 ANGELES COUNTY LI NSE, M THEOF THE RESIDENTIA R RTY DE IB
OAS SYSTEM OUTLETS 0 O 90
SIGNATURE OF
WATER HEATER @ 050 PERMITTE
SLOP BINK O 90 INSPECTION RECORD
FLOOR SINK 0913
FLOOR DRAIN ® 0513
DISHWASHER it 050
DRINKING FOUWrAIN 050
URINAL O 50 J
Q
HOUSE SEWER O BO Z
MISCEL NEO S
J
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAB PIPING
GAB VENT
CESSPOOL @ IGo CESSPOOL
SEPTIC TANK. SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1 OO SEWER
PERMIT 1 00 GAS TEST
UTILITY CO NOTIFIED
TOTAL FEE
FINAL
1
76A667 CE98 17 6-65
APPLICATION FOR PLUMBING PERM
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS (/
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $125
BATH TUB 125 ADDRESS O
SHOWER 125 CITY � NO
LAVATORY 175 CONTRACTOR
SINK 125 ADDRESS
It
DISHWASHER 125 CITY TEL N
LAUNDRY TUB i 1� J LTCENATE LIC
N CLASS
CLOTHES WASHER 125 DISTRICT NO GROUP ZONE PROCESSED BY
WATER HEATER 150
GAS SYSTEM OUTLETS 150 INDUSTRIAL d
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD /J V
W
a
Lo
z
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK _
ROUGH PLUMBING Z-$ep7jj �r
TOTAL FEE 3 j
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I 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
PLUMBING
I HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED B OS ELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 TH EGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE 6C Ep RESI NTIAL PRO RTY UTILITY CO NOTIFIED
SIGNATURE I i
OF PERM ITTE
FINAL /y
VALID
CK M 0 O CASH
iso 1 ; y 9-0 DEC 4 5 Q 3.50— Q
il t , ,
4 E YVORKERS COM?ENSATION DECLARATION
260026 DPW 4/87
APPLICATION FOR�PLUMBIN}G PERMIT
y
• I hereey af�rfm Nave that ave a certrfiwte of consent to self m- 76A667A
k"
sure or'a certificate of Workers Compensation Insurance or a CE 817(REV 8/86)
trfied copy ther
ceieof (Sec 3800 Lab C )
- COUNTY OF LOS ANGELES DEPT OF,PUBLIC WORKS
Policy No Company
❑ Certified` `,' _
copy is`hereby furnished
,, FOR APPLICANT TO FILL,INr(PRINT OR TYPE) BUILDING
❑ Certified copy is`filed with the county budclA'inspection 5 ADDRESS 'Yr 0 3
' depahmen,t t Si r' NUMBER 'FIXTURE OR ITEM @ FEE , LOCALITY
WATER CLOSET(TOILET) < OV 9cr
Date v t Applicant ro y + NEAREST
f r' _ a CROSS ST
' CERTIFICrATE OF EXEMPTION FROM WORKERS
BATH TUB R
COMPENSATION INSURANCE '
Y Y Y SHOWER OWNER, , i,
(This section need not be completed if the work involved by' MAIL ^ �,
h the permit is for one'hundred dollars ($100)or less ) vLAVATORY i ` } ADDRESS
_ I certify thawh the performance of the work for which this per- r
mit is issued I shall not employ any person'in any ma finer so SINK CITY ���'� TEL NO
as to become sublect to the WorkeFs+Compensation Laws DISHWASHER < t /
CONTRACTOR r ++
Date- y�adiaApplicant �dr✓ y CLOTHES WASHER ~4i ADDRESS `
NCTICEITO APPLICANT 'If t.bfter making ihi" ertificate of Ex SWIMMING POOL RECEPTOR
-,emption you should become subject to the orkers Compen- - s - CITY T L NO
"sahon provisions of the Labor Code you must forthwitl comp ;r LgWN SPRINKLER SYSTEM,
' ly with,such provisions or this permit shall be deemed revok- STATE LIC w "
ed _ I WATER HEATER / �( LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION : r 5 t7 U DISTRICT NO ��� PROCESSED BY -`
GAS SYSTEM OUTLETS �) 4
I hereby affirm that I am licensed under provisions`of Chapter c Cl d
,9(commencing with,Section 7000)of Division 3 of the Business, a A OUTLETS OVER r
" and Professions Code and ny license is in full force and of 5 PER SYSTEM FINAL VA ATION+ y,
4 feetd
F / -G� >
a '�,` DATE
License Number �} Lic Class _ V`
11 jFINAL
Contractor Date ` 7 BY, '
` I am exempt under Sec_' * U
CL
B&P C for this reason s - ► t 9 4'7,8 A z
'r Plan check fee° -
Date PLUMBING PERMIT ISSUING FEE $ " d
5
Signature TOTAL FEE 4'
y ` SINGLE FAMILY~ +I' ' ° 40 50
HOME OWNER-BUILDER DECLARATION'.' t �, Plan check applicant r*'
"I hereby affirm that I am exempt from the Contractor s License Name q. ®4 Q 5 0 c��i
`r,Law for the following reason (Section 7031 5, Business and '` ^
Professions Code) - a i Address,+ ,B" y. '" y° °Y - _ 04,28 -88 `
a 1, as owner of the,properaty, will-do the work and the, C ty} p Tel No y
structure is not intended or offered for sale(Section 7044, _ ,/ ,
f Business and,erofessions Code)
`CONSTRUCTION LENDING AGENCY
` I hereby affirm that there is a construction lending'agency for ° c _
the performance-of the work+for,`which this,permii ispissued 4
(Sec 3097 Civ C )
+J r -
y Lender s,Nome
Lender s Address
I certify that I have read this application ond.`state that the
above information�,is correct I agree to comply with all County
ordinances and State laws regulating Plumbing and hereby
ri
authoze representatives of this County-to enter upon the
above-mentioned pr perty for inspection purposes
,1 SEE REVERSE FOR EXPLANATORY LANGUAGE f
k , Y
Signa ure,a Permittee o' Date - r