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Home My Public Portal About6048 CLOVERLY AVE_Plumbing__ 76A667-CE817- 11-57 v r APPLICATION FOR PLUMBING PERMIT 4 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS CASSATT D. GRIFFIN, Sup't of Building LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS SHOWER CITY . TEL. NO. LAVATORY CONTRACTOR-,,_-!'�_' SINK ADDRESS �. DISHWASHER CITYLiO� CONTRACTOR'S STATE ❑ LAUNDRY TUB REGISTRATION NO. G� �/ COUNTY ❑ CLOTHES WASHER DISTRICT NO. I GROUP ZONE NE I READY FOR INSPECTION WATER HEATER GAS INDUSTRIAL WASTE APPROVAL INSPECTION RECORD APPROVALS @ $1.00 PER ITEM __ DATE INSPECTOR'S SIGNATURE OR FIXTURE $ / UNDER SLAB WORK PERMIT $ 00 ROUGH PLUMBING TOTAL FEE - j GAS PIPING 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, PLUMBING FIXTURES 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE OF PERMITTEE FINAL ROBERT A.WOOD. ®F ALIDATION SUPERVISING MECHANICAL ENG'R CK. M.O. CASH 76A667-CE�817 6-65 APPLICATION FOR , PLUMBING PERMIT COUNTY OF LOS ANGELES C9C/ p DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS LU •fi/�L COLEMAN W JENKINS SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST c� NUMBER FIXE TUROR ITEM EACH FEE WATER CLOSET $1.25 OWNER p4W.1, y,,o' /f /ar77 s MAIL BATH TUB 1 25 ADDRESS fU�i�� v� SHOWER 1 2S CITY i , TEL. NO Zrg;; LAVATORY 125 .S CONTRACTOR SINS 125 25 ADDRESS DISHWASHER 1 25 LZa CSATEITY q��/r TEL NO a LAUNDRY TUB 125 LICENSE NO CLASS CLOTHES WASHER - 1.25 DISTRICT NO GROUP Z E PROCESSED BY WATER HEATER 1.50 GAS SYSTEM OUTLETS 1 W J S� INDUSTRIAL d WASTE APPROVAL 0 OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V v � O H V Lu D_ N Z APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING 7, .� TOTAL FEE GAS,PIPING 117- 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 I AM PROPERLY GIS RED ND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY ANGELE O NTY A D 5 TE OF GAS TEST .-- CALIFORNIA R THAT I LEGAL W O D I END TO RESIDE IN, T RIBED RES E AL PR P RTY UTILITY CO NOTIFIED SIGNATUR - OF PER ITT FINAL ALIDATION CK "M O CASH LAL,03 6 4 4'l-3 XL21 5 D 1`1.25 n WORKERS'COMPENSATION DECLARATION 7GA667A I hereby affirm that I have a' certificate of consent to self CE 617 (2-60) APPLICATION FOR PLUMBING PERMIT insure, or a certificate of Workers'Compensation Insurance,o a certified copy thereof(Sec. 3800,Lab. .) COUNTY OF LOS ANGELES BUI Lr _7 y Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS Certified copy is filed with the c untyuildi g inspection NUMBER FIXTURE OR ITEM FEE LOCALITY departm n WATER CLOSET Date Applicant NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKS COMPENSATION INSURANCE SHOWER OWNERAl r. LAVATORY MAIL (This section need not be completed if the work involved ADDRESS/ y �• 0 by the permit is for one hundred dollars ($100) or less.) SINK CITY Z_JTEL. NO )„ I certify that in the performance of the work for which this DISHWASHERcc permit is issued, I shall not employ any person in any manner CONTRALTO 0 so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS �Q IJI CJ Date Applicant SWIMMING POOL RECEPTOR � TEL.NO. NOTICE TO APPLICANT: If, after making this Certificate of CITY subject Exemption, you should become ect to the Workers' LAWN SPRINKLER SYSTEM p J STATE LIC. p Compensation provisions of the Labor Code, you must forth- l LICENSE NO. CLASS ✓ with comply with such provisions or this permit shall be WATER HEATER Gy deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. OCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER o I hereby affirm that I am licensed under provisions of Chapter 5 PE R SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL ( f� � VALIDATION ness and Professions Code, and my license is in full force and DATE effect. FINAL License Num r�� Lic.Class v BY Contractor�romE te J��/ ! — El I am exeng requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE �{ S 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 Fx, a. License Law for the followingreason Section 7031.5, Busi- ( City Tel.No. ness and Professions Code): I, as owner of the property, am exclusively contracting ;285IL0A with licensed contractors to construct the project } (Section 7044, Business and Professions Code). . 0 0 0 0 o 5 CONSTRUCTION LENDING AGENCY 2001250 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is o I o 0 1 2 5 0 6) issued (Sec. 3097,Civ.C.). 2 2 3—8 2 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 his County to enter upon the above-mentioned proper for inspection purposes. Signa a of Permittee Date