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HomeMy Public PortalAbout6038 CLOVERLY AVE_Plumbing__ 761667 CE B17 BAPPLICATION FOR PLUMBING PERMIT 1 -BUILDING AND SAFETY DMSION Department of County Engineer County of Los Angeles BUILDING -', o rY JOHN A LAMBIE,COUNTY ENGINEER ADDRESS i O CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY FO PP T TO FILL IN NEAREST CROSS ST ^ OWNER DISTRICT NO GROUP I ZONE I READY FOR INSPECTION MAIL ,(- ADDRESS C/ Q" INDUSTRIAL CITY TEL NO WASTE APPROVAL PLUMBER INSPECTION RECORD ADDRESS CITY N�^ ,1' I/ ,/' LICENSE NO /�/ �/� c� GP' [ii ��h��� C��y //''!D/�,y��/7111r�/'_'_ NUMBER TYPE OF FIXTURE OR ITEM FEE /VD D�6= /-;kO1�'c — –'r- 7 1 WATER CLOSET (TOILET) @ $1 00 BATH TUB @ $1 00 SHOWER @ $100 LT/7�5,e-7'/I LAVATORY (WASH BASIN) @ $100 )) KITCHEN SINK @ $100 DISHWASHER @ $100 LAUNDRY TUB OR TRAY @ $100 CLOTHES WASHER @ $1 00 WATER HEATER @ $100 GAS SYSTEM @ $1 00 7 APPROVALS DATE INSPECTOR S SIGNATURE UNDER SLAB WORK PERMIT $ 1100 ROUGH PLUMBING J� GAS PIPING TOTAL FEE 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 pf UMBING FIXTURES PLUMBING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTab AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL 0 OF THEABOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTIAL PROPE SIGNATURE OF PERMITTEE FINAL - ��/ � r,r��/ 11C✓ ROBERT A'WOOD, JOHN A LAMBIE COUNTY ENGINEER �yALIDATION SUPERVISING MECHANICAL ENG R N 0 CASH AP- 2 7 3 OS sEP 2'7 3 2.00In 716AS67 17 6-50 (e 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 663z- PLUMBER NO py�� " -f- x- 1 `, 63z- PLUMBERJe� q ,� ! �,1 RECEIVED BY READY FOR DATTEISSUED pp�� cp1, FIRST INSPECTION ADDRESS �iiJ ! ,� // •J BUILDING CITY TEL NO ADDRESS �JJ/j/�/J� COUNTY,. LOCALITY LICENSE NO EXPIRES NEAREST PERMIT FEES CROSS ST �1 ✓ NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER �9� /V ann MAIL WATER CLOSET (TOILET) Q O 50 $ ADDRESS I BATH TUB © O 50 I CITY ` TEL NO SHOWER © O 50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND LAVATORY (WASH BASIN) Q O 50 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK Q O 50 STATE LAWS REGULATING PLUMBING 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY Q O 50 ANGELES COUNTY LICENSE OR I AM THE LEGAL OWNER OF THE RESIDENTIAL RfZOPERTY DESCRIBED ABOVE GAS SYSTEM OUTLETS @ O 50 SIGNATURE OF WATER HEATER Q O 50 PERMITTE= .ANAL SLOP SINK 0 O 501 INSPECTION RECORD � > FLOOR SINK Q 0 50 FLOOR DRAIN Q O 5011 1 DISHWASHER 0 O 501 1 DRINKING FOUNTAIN @ O Sol URINAL @ O 501 (,� A- J 1W)e,4 K -J dt I HOUSESEWER CQa O SOI S �� R �� �h / � c Z I MISCELLANEOUS ./ 2 / !V Lr- r p-p ►7 it APPROVALS 1 DATE INSPECTOR S NAME ROUGH PLUMBING 1 GAS PIPING GAS VENT /7�! CESSPOOL Q 1 00 1 CESSPOOL 44 - ' I SEPTIC TANK 1 SEPTIC TANK I DRAIN ( ) PIT ( ) (g) 1 00I SEWER PERMIT 1 00 GAS TEST $ �� TOTAL FEE UTILITY CO NOTIFIED FINAL �dK667 17 U-SO ID APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING I WILLIAM J FOX CHIEF ENGINEER �PORRA�PPPPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERMIT NO 1/1' PLUMBER C`-/� �'f�!/a / �Cs-v O RECEIVED BY READY FOR DATE ISS ED FIRST INSPECTION ADDRESSBUILDING CITY / TEL/NO I ADDRESS COUNTY, A® A ,/�,�� /Y' ��-��f�_i'f LOCALITY ,d (�� _ !n`s>_ LICENSE O /j // !t i ' EXPIRRCS !J V l NEAREST 1 P PERMIT FEES CROSS ST pp e NUMBER I TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET (TOILET) @ O 50 $ ADDRESS O r � � �.� 4°c"' A/•��P�+�'�""'' � BATH TUB @ O 50 I Y70 9 EL NO 4? SHOWER @ O 50 11 HER/Y ACKNOWiL,EDGE THAT I HAVE READ THIS i I APPLICATION AND �PQ7E THAT THE ABOVE IS CORRECT AND LAVATORY (WASH BASIN) @ O 50 I AGREE TO COMPLY/WITH ALL COUNTY ORDINANCES AND t 1 STATE LAWS REGULATING PLUMBING r KITCHEN SINK @ O 50 � 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB t ANGELES COUNTY LICENSE OR I AM THE LEGAL OWNER LAUNDRY TUB OR TRAY @ O 50 GAS SYSTEM OUTLETS @ O 501 OF THE RES IDENTIAV PROPERTY ,DD EESSSCj RI BED,ABOVE SIGNATURE OF t j WATER HEATER @ O 50 PERMITTEE_ SLOP SINK 0 o Sol I INSPECTION RECORD FLOOR SINK @ O 5 11 FLOOR DRAIN / @ O 5 DISHWASHER ` @X 5 DRINKING FOUNTAIN @ O. 1 URINAL @ O 501 ..1 HOUSE SEW ER @ O,5 Z I' MISCELLANEOUS o � 0 O APPROVALS DATE INSPECTOR S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1 001 CESSPOOL SEPTIC TANK I SEPTIC TANK DRAIN ( ) PIT ( ) @ 1 001 SEWER PERMIT I 1 00 GAS TEST TOTAL FEE $ UTILITY CO NOTIFIED FINAL - r^' WORKERS'COMPENSATION DECLARATION 76A667A I hereby affirm that I have a ce,tificate of consent to self CE en (z-ao) APPLICATION FOR PLUMBING PERMIT insure, or a certificate of Workers'f03-mpensation Insurance,or a certified copy thereof(Sec 3800,Lab C) COUNTY OF LOS ANGE ES BUILDING AND SAFETY Policy No Company / Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS Certified copy is filed with the county building inspection NUMBERI FIXTURE OR ITEM • FEE department LOCALITY p WATER CLOSET Date Applicant NEAREST BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved LAVATORY ADDRESS by the permit is for one hundred dollars ($100) or less) SINK CITY TWL NO _ I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR O so as to become subject to the Workers' Compensation Laws CLOTHES WASHER ADDRESS U Date Applicant ISWIMMING POOL RECEPTOR tL CL NOTICE TO APPLICANT If, after making this Certificate of CITY TEL NO U) Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC Z Compensation provisions of the Labor Code, you must forth LICENSE NO CLASS with comply, with such provisions or this permit shall be WATER HEATER deemed revokedD CTNO C SSED Y GAS SYSTEM OUTLETS LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Bust FINAL 9 VALIDA ON ness and Professions Code, and my license is in full force and DATE effect FINAL License Number Lic Class BY Contractor Date I fee I am exempt from the licensing requirements as I am a Plan check � licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus l � mess and'Professions Code) TOTAL FEE)/ Ltc 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, Bust City Tel No ness and Professions Code) I, as owner of the property, am exclusively contracting 3 8 7,4 A with licensed contractors to construct the project (Section 7044, Business and Professions Code) # 0 0 o 0 o 5 CONSTRUCTION LENDING AGENCY _ 2 ° ° 3 Q Q I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is -- - 1300F_1 issued(Sec 3097,Civ C) Lender's Name 0 t26-8 1 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 1 authorize representatives of this County to enter upon the abov mentioned property for inspection purposes / G \� Signature of Permtttee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMING PERMIT 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) BUILDING { Certified copy is filed with the county building inspec- ADDRESS A, Cw i - ' kk tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY T �"` WATER CLOSET Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER fl' (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less ) MAIL a LAVATORY ADDRESS I certify that in the performance of the work for which this - permit is issued, I shall not employ any person in any manner ! SINK CITY _ ` ML NO so as to become subject to the Workers Compensation Laws DISHWASHER / CONTRACTOR Date Applicant lJ27cr1_ CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificatefof ADDRESS Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL NO LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO r--)PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 % GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL / DATE `/ VALIDATION u License Number Lic Class 119 FIN O Contractor Date BY V ❑ 2 W I am exempt under Sec fL t/f B&P C for this reason Plan check fee ► Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE h = (j 1,4 A SINGLE FAMILY Plan check applicant 11 Q o 0 0 t ' HOME OWNER-BUILDER DECLARATION Name - 12'o o -8 2 5 b 1 hereby affirm that I am exempt from the Contractor s License Address o io n 5 Q Law for the following reason (Section 7031 5 Business and Professions Code) Cit Tel No C0. 2 G r 8 3 ProY M 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 �� e Lender s Address 40 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 jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the above mentioned property for rection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signa ure of ermittee Date