HomeMy Public PortalAbout6217 CLOVERLY AVE_Plumbing__ 76ASS7 17 S-BO 0 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING I
WILLIAM J FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRI NO GROUP I ZONE PERMIT NO
WINTERBOTTOM BROS 1 INC, RECEIVED BY READY FOR DATE ISSUED
PLUMBER L ` FIRST INSPECTION
4AVE
ADDRESSAi HAUE3RA GA 1�FOR lam_
BUILDING A
CITY TEL NO ADDRESS CLOV_E,R
COUNTY LOCALITY
LICENSE NO I I IS EXPIRES
NEAREST
PERMIT FEES CROSS ST
NUMBER TYPE OF FIXTURE OR ITEM FEE
OWNER MEEKER LAND CO.,
MAIL
I WATER CLOSET (TOILET) Q O Sol$ I_ ADDRESS 3612 E. LIVE OAK AVE.
BATH TUB Q O 501 I SO _CITY ARCAD I A, CALIF• TEL NO
SHOWER Q O 501 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
I LAVATORY (WASH BASIN) Q O 50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUN'"Y ORDINANCES AND
KITCHEN SINK Q O 50 STATE LAWS REGULATING PLUMBING
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY Q O 50 ANGEL COU Y LI SR 1 AM E LEGAL OWNER
OF T NTIA O�PXWDMD A OV
GAS SYSTEM OUTLETS Q O 50
SI OF
WATER HEATER Q O 501
PERMITTE
SLOPSINK Q o 50IINSPECTION RECORD
FLOOR SINK Q O 50
FLOOR DRAIN Q O 501
DISHWASHER Q O 501 f ,,,
DRINKING FOUNTAIN Q O 501 a �� �7f U 9V 1= 1"'-
v
IURINAL Q 0 50I .J
HOUSE SEWER Q O 50 I1 Q
Z
MISCELLANEOUS
O
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I
I
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING �f t Y '�" I /V
GAS PIPING
GAS VENT !/ ��/✓ �� .°j�'
CESSPOOL Q 1 00 CESSPOOL f
SEPTIC TANK I SEPTIC TANK
DRAIN ( ) PIT ( ) Q 1 00 SEWER
PERMIT 1 00 �IA/� lo-14
GAS TEST ! s.d his
UTILITY CO NOTIFIED 1A
TOTAL FEE I $ 5I00 �/� ac d. T„'Y ;✓
FINAL
t WORKERS' COMPENSATION DECLARATION 7�� 4� APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate oftirnsent to-self 76A6679
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81)
or a certified copy thereof (Sec 3800, LabC ��/ COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No7Company�`r2 o Nl
❑ Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING � �r �/ `
91 Certified copy is filed with the county building inspec- ADDRESS A 0 U n_
tion department /�M�7� ry�/¢ NUMBER FIXTURE OR ITEM @ FEE LOCALITY
e V
Date "/ ( Applicant v!w WATER CLOSET NEAREST P/d7 �c �r�
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST �f2 7
COMPENSATION INSURANCE SHOWER OWNER 2 Liel
(This section need not be completed if the work involved by MAILf
the permit is for one hundred dollars (;100)or less ) LAVATORY ADDRESS 7 /✓ CloVe21
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINKCITY �
70^01e / .0 TEL NOZJS�I�l
so as to become subject to the Workers'Compensation Laws DISHWASHER C / n d
CONTRACTOR �'NNo C K t Qr� /VC
Date Applicant CLOTHES WASHER ADDRESS [fp
NOTICE TO APPLICANT If, after making this Certificate of ( !�� N —NCi•N;fA
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR c,
Compensation provisions of the Labor Code, you must forth- CITY �7 TEL NO (7/k LAWN SPRINKLER SYSTEMwith comply with such provisions or this permit shall be STATE 7 LIC deem /ed revoked WATER HEATER LICENSE NO V03 CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO GAS SYSTEM OUTLETS '400P ESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 � � �
(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 ALIDATION I2.U L 3X s,0 DATE"/ O
License Number /o37J S Lic Class SCy V
/� / FINALV C9Contractor� A11.10 Z !//C Date 6 BY G
t—
❑ V
I am exempt under Sec I1L
B 8P C for this reason H
Date
Plan check fee ► Z
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 3 5 4 4 A
Law for the following reason (Section 7031 5, Business and Address
Professions Code) City Tel No ft 0 0 0 O io 5
❑ I, as owner of the property, will do the work and the + o+oG O
structure is not intended or offered for sale (Section ) ti
7044, Business and Professions Code) , 0 10 o '6 5 0 cz.
CONSTRUCTION LENDING AGENCY t
I hereby affirm that there is a construction lending agency for 08116-84
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 entioned roperty for insppa4pri purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signatui4 of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1205210029
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
ILEGAL ID I FEES PAID BUILDING ADDRESS
ITR 17179 LT 17 I 6217 CLOVERLY AV I
I IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917801602 1
(ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET WENDON 1
15385-010-017 101 PERMIT ISSUANCE FEE 27 80 I THOMAS PAGE 596 GRID J2 LOCALITY TEMPLE CITY, Cl
1 107 BATHTUBS/SHOWERS 2 00 FIX 32 40 I I
ITENANT 125 LAVATORIES/SINKS 2 00 FIX 32 40 (ISSUED ON PROCESSED BY PLAN BY 1
I 145 WATER CLOSET/URINAL 1 00 FIX 16 20 105/21/12 SR
I
TOTAL FEES 108 80 1
(OWNER TEL NO IFINAL DATE F BY CODE 1
ILEE, HUANLING (626) 456-0716- 1 I
19615 GARIBALDI AVE 1 I 7 /
ITEMP 917801602 1 ID CRIPTION OF WORK 1
1 1PLUMBING FOR BATHROOMS AND KITCHEN REMODEL 1
(APPLICANT TEL NO 1 I I
SAME AS OWNER - I
I ISPECIAL CONDITIONS I
I (APPROVALS DATE INSPECTOR SIGNATURE
(CONTRACTOR TEL NO 1 I I
ISAME AS OWNER - 1 I I
I LIC NO 1 (UNDER SLAB WORK I
IWATER SERVICE I I
1 1 IPLASTIC YIN METAL YIN 1 I
1ARCHITECT OR ENGINEER TEL NO 1 I I I
1 - IROUGH PLUMBING I / I
1 LIC NO 1 I_ 1
I
1 1 IGAS PIPING
GAS VENT
I I
I IHOT WATER HEATER
I IPLUMBING FIXTURES 1 I
1 1 (LAWN SPRINKLERS 1 1
1 1 IGAS TEST I I
I 1UTILITY COMPANY NOTIFIEDI
I ICWv I I
I IGRAY WATER SYSTEM 1 1 1
I I I I I 1
1 1 I I I I
1 1 I I I I
I I I I I I
I I I I I I
1 IREPORT ID DPR263 ROUTE TO BS0508 1 I I I
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