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Home My Public Portal About6042 CLOVERLY AVE_Plumbing__ 76A 687 -CE9817 10-82 APPLICATION FOR PLUMBING PERMIT I� COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER FNEAREST G BUILDING AND SAFETY DIVISION S 6042 N. Cloverly JOHN A LAMBIE COUNTY ENGINEER WILLIAM A JENSEN SUP T OF BUILDING TY Temple lty FOR APPLICANT TO FILL IN r ,! NUMBER FIXTURE OR ITEM EACH FEE CROSS OWNER Miller WATER CLOSET $125 MAIL BATH TUB 1 25 ADDRESS / CITY TEL/NO SHOWER 125 LAVATORY 125 CONTRACTOR Van Curen Plumbing Inc. SINK 125 ADDRESS 425 W. Chestnut S t. DISHWASHER 125 CITY Monrovia TEL NO 359 7134 LAUNDRY fUB 1 25 R GINSTTRAT ON NO 191691 COUIINTY p ATE CLOTHES WASHER 125 DISTRICT GROUP ZONE P CESSED BY WATER HEATER 1 50 t GAS SYSTEM OUTLETS 1 50 INDUSTRIAL d WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V 0 1,11ater Service1 U W a H Z APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING yam^"-' TOTAL FEE GIIS PIPING U/gC.&a/ jn/01:15 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER I 1 PLUMBING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES t LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE SCRIBED RESIDE TIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE i OF PERMITTEE FINAL / VALIDATION ROBERT A WOOD I CK M O CASH SUPERVISING MECHANICAL ENG R i ,mac 8 6 8 jUL 2 3 5 D 3 5 G z , S 76A667-CE81712/59 TEMPLE CITY APPLICATION FOR PLUMPING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING ANP SAFETY QIVISION BUILDING 5/'� (�/� JOHN A LAM IE, COUNTY NGINEER s ADDRESS '+ /� y WILLIAM A JENSEN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL /`/ /U• Y((• _ ADDRESS BATH TUB CITY Tri 1- 'I �� TEL 1� SHOWER LAVATORY CONTRACTOR j/ SINK ADDRESS DISHWASHER CITY TEL NO CONTRACTORS STATE ❑ LAUNDRY TUB REGISTRATION NO COUNTY ❑ CLOTHES WASHER DIST�t.ICT NO GR"O.�lp ZONE! ROCE F- Y WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL / INSPECTION RECORDI y F $1 00 PER ITEM OR IrIXTURE $ !� APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ JJ 2100 UNDER SLAB WORK---b { I / yyJ1 d�f/1 TOTALFEE Fr9 I GROUGH AS PIPING MBI�/ d I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT A AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOYE DESCRIBED RESIDEN TIA PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE ' �/�/'� FINAL OF VALIDATIROBERT A WOOD CK m O Z!sH) SUPERVISING MECHANICAL ENG R m if 8 3 5 71"10 FEB 14 5 D 6.0 0 M 76A667C (CE-6178) -9/75 APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO 77 07"IPRINT OR TYPE) BUILDING /I NUMBER FIXTURE OR ITEM @ FEE ADDRESS V WATER CLOSET LOC NEARE46T BATH TUB CROSS ST SHOWER OWNER LAVATORY MAIL ADDRESS SINK CITY TEL Nf DISHWASHER CONTRAC CLOTHES WASHER ADDRE � r SWIMMING POOL RECEPTOR 019 T LAWN SPRINKLER SYSTEM TATE LIC /� WATE EA r7 LICEN ENO CLASS C. y c3 a DISTRICT NO GROUP ZONE1 OC S ED BY CD GAS SY M OUTLETS OUTLETS OVER V K- 5 PER SYSTEM V INDUSTRIAL WASTE APPROVAL �y INSPECTION RECORD Cn Plan check fee PLUMBING PERMIT ISSUING FEE $ TOTAL FEE 7 SV Plan check applicant Name APPROVALS DATE INSPECTOR 5 SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel No GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND :TATE 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 I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REOUI RED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIA PROPERTY UTILITY CO NOTIFIED SIGNATU RE / OF PERMITTE FINAL PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION 0-1 M 0 CASH 0 4 6-,JAN 5 5 0 ! 7.5 0 � s WORKERS'COMPENSATION DECLARATION � `� � APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate o,"'consent-`to self 76A66?A1 r 4 insure or a certificate of Workers' Compensation Insurance CE 817(REV 10/81) or a certified copy7 thereof (Sec 38000 Lob C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No�_ _Company ,r7pk F Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with t cou y buil nspec- ADDRESS tion department NUMBER FIXTURE OR ITEM Q FEE LOCALITI'�^ WATER CLOSET Date _ Appltc n NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE ' OWNER ` (This section need not be completed if the work involved by SHOWER - t�` \ the permit is for one hundred dollars ($100)or less ) MAIL I LAVATORY ADDRESS `C51CAV I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner SINK �, CIT`_ .� TEL NO so as to become subjt?ct to the Workers Compensation Laws_ DISHWASHER >L �r CONTRACTOR Date Applicant ' CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after, making this Certificate of Exemption you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL NO ///111 Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATERLICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT N } OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS - (commenting with Section 7000) of Division 3 of the Business OUTLETS OVER _ � 0.and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINALO VALIDATION DATE V �—� �/� License N er Lic Class pa- Contractor Date B N 4) LU ❑ I am exempt under Sec T y B&P C for this reason Plan check fee _ Date O PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check p lica t SINGLE FAMILY ;-9,4 2 7,8 A HOME OWNER-BUILDER DECLARATION Nam ' I hereby affirm that I am exempt from the Contractor s License Address # e''o 0 oA o 5 Law for the following reason (Section 7031 5, Business and 1 0 a Professions Code) City Tel No �' a _ ❑ 1, as owner of the property, will do the work and the _ o,o o fi 3I5 o n structure is not intended or offered for sale (Section 7044 Business and Professions Code) p19-84 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for r the performance of the work for which this permit is issued 4 (Sec 3097, Civ C ) 6 t Lender s Name Lender s Address c ` I c t I have read this application and state that the Jvom on is correct I agree to comply with all County and tate laws regulating Plumbing and hereby epres nCis hisCounty to enter upon the do inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE m Signature of Permittee Date '