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Home My Public Portal About6033 CLOVERLY AVE_Plumbing__ 1 76A667A (CE 817B) -4/77 C1 y or •/ y APPLICAT10FOR PLUMBING PERMIT'' RUM IJ6lTIL�NG FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM @ FEE ADDRESS WATER CLOSET LOCA TYjo NEAREST BATH TUB CROSS S . SHOWER OWNER s LAVATORY MAIL ADDRE SINK CITY TEL. �+— DISHWASHER MOM fl — CLOTHES WASHER SWIMMING POOL RECEPTOR Ir TEL.N LAWN SPRINKLER SYSTEM T ° LIC. WATER HEATER /J1� LICENSE NO. CLASS GAS SYSTEM OUTLETS (J DISTRICT NO. GROUP I ZONE P OCESSED BY / OUTLETS OVER 5 PER SYSTEM INDUSTRIAL C.;1 WASTE APPROVAL I= INSPECTION RECORD U r W a N Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE111/0100 Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING City Tel.No. GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE (_15,' � FINAL MEllEV81D' IEN)MPE1�8Sc� u �`a CASH PERMIT VALIDATION cK M.O. CASH ®LIC'Y 3 got_® �: �'�� s 4 O�JtJyd a .0 I -QE=V N1 iFir,RP . 7GA667 " PPLICATI®N FOR PLUMBING PERMIT .1 DBS-17'0-55 m DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles BUILDING l� JOHN A. LAMBIE, COUNTY ENGINEER CASSATT D,GRIFFIN,SUPT OF BUILDING OCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. OWNER /may DISTRICT f�Q GROUP ZONE I READY FOR INSPECTION MAIL /y ✓ ADDRESS Z (/ y�y INDUSTRIAL CIT TEL. N —/v P . WASTE APPROVAL PLUM ,�„t,?,/ INSPECTION RECORD ADDRESS CITY TEL, N LICEN E N � r NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET)- @ $1.00 BATH TUB @ :$1.00 SHOWER @ $1.00 LAVATORY (WASHBASIN) @ $1.00 n 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 ROUGH PLUMBING PERMIT $ .1 00 v 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 FIXTURES PLUMBING. 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 1THE EGAL O NER OL THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIAL OP Y. w 001-1 SIGNATURE OF PERMITTEE FINAL JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR CK. 61.0. ASH � � o o a JAN 9 3 2.0 a In s. a APPLICATION FOR PLUMBING PERMIT �-�s--�dVORKERS'COMPENSATION DECLARATION I hereby 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) TNEAREST Certified copy is filed with the cou y bduildig inspec- ti d part nt.s+ NUMBER FIXTURE OR ITEM FE Datefi&Y Applicant �' WATER CLOSET BATH TUBERTIFICATE OF EXEMPJN ! FROM WORKERS' COMPENSATIOURANCE OWNER 4 SHOWER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this 1 permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers Compensation Laws. DISHWASHER CONTRACTOI`jam ✓ �. Date Applicant CLOTHES WASHER JJ �� NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS v, Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY / r TEL. NOS] with comply with such provisions or this permit shall be STATE v+ UC. Cv7� deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRIC PROGESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER �� a and Professions Code, and my license is in full force and effect. 1 5 PER SYSTEM FINAL VALID TION DATE License Number Lic. Class / G S FINA Contractor Date BY 101— 17 ❑ I am exempt under Sec. 6 B.&P.C. for this reason 00. g Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ 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 2 2 I.5 A Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. # o o o o o 5 ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ° o 2 2 5 0 7044, Business and Professions Code). / o o - 22505 CONSTRUCTION LENDING AGENCY 0619-85 1 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 1 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 re sentatives of this County to enter upon the abovg- en oned prop y or inspection puo ,s. SEE REVERSE FOR EXPLANATORY LANGUAGE �i SignaSigno .14�'oT Perm itt a Dat T p� C PLUMBING PERMIT Cp�,A T WORKERS'COMPENSATION DECLARATION APPLICATION ION f®R ■ LU M BIND FERMI 1 I hereby,affirrit that I have;a certificate of consent to self 76A667A v insure, or a certificate of Workers' Compensation Insurance, CE 817(REV.8/86) or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. FOR APPLICANT TO FILL.IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY Date Appligant ' 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 - the permit is for one hundred dollars($100)or less.) LAVATORY MAIL � I certify that in the performance of the work for which this ADDRESS permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date �, Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making his Certificate of ADDRESS POY Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO. with comply with such provisions or this permit shall be . STATE LIC. deemed revoked. WATER HEATER LICENSE N/ CLASS LICENSED CONTRACTORS DECLARATION DISTRICJ_NOOL�r ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 1 GAS SYSTEM OUTLETS (commencing with Section 7000 of Division 3 of the Business L ( 9 ) OUTLETS OVER r� and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VA DATION DATE r� License Number Lic. Class FINAL 0 Contractor Date BY ❑ I am exempt under Sec. !y f� B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE s 6 6 4 A SINGLE FAMILY Plan check applicant # o 0 o 0 0 5 HOME OWNER-BUILDER DECLARATION Name ( o 2 a 5 0 1 hereby affirm that I am exempt from the Contractor's License Law for.the following reason (Section 7031.5, Business and Address o 0028,505 Professions Code): City Tel. No. O 1 2 - 87 1, 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 purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 3-I M Signature of Perrhittee Date r: WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT /7 I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company 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 (sr t tion department. NUMBER FIXTURE OR ITEM @ -r FEE LOCALITY C Date Applicant WATER CLOSET �jj -�/0 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' I BATH TUB ` 5' CROSS ST. Woodl COMPENSATION INSURANCE f SHOWER / OWNER (` (This section need not be completed if the work involved by MA the permit is for one hundred dollars ($100)or less.) LAVATORY r I certify that in the performance of the work for which this ADDRESS S permit is issued, I shall not employ any person in any manner SINK CITY �C/ TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL, NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER r /-J LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION / DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL n VALIDATION r DATE O License Number Lic. Class () FINAL Contractor Date p / BY 0 a / t - O I am exempt under Sec. () W B.&P.C. for this reason Plan check fee z Date: PLUMBING PERMIT ISSUING FEE$ A Signature TOTAL FEE �z 5 SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby a rm that I am exempt from the Contractor's License Address Law for a following reason (Section 7031.5, Business and Prof ions 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 , 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 purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE CIL— Signature of Permittee Date