HomeMy Public PortalAbout6223 CLOVERLY AVE_Plumbing__ e
76A6(f,-CE8?7 10-60APPLICATION FOR PLUMBING PERMIT,,'
COUNTY OF LOS ANGELES
'DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING Y'Y
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
-.aLOCALITY
FOR APPLICANT.TO FILL IN NEAREST
CROSS ST, u
NUMBER FIXTURE OR ITEM OWNER _
WATER CLOSET MAIL
BATH TUB ADDRESS
CITY TEL. NO.
SHOWER .
CONTRACTOR _
LAVATORY
SINK ADDRESS, ocl
DISHWASHER CITY. TEL.NTRACON
TATE
LAUNDRY TUB REGISTRAATIION NO. COUNTY ❑
CLOTHES WASHER f 2 DISTRICT NO. GROUP /ZZOONE PROCESSED
—�BB�Y
• WATER HEATER � `. /I �a INDUSTRIAL
4 GAS SYSTEM V
WASTE APPROVAL }
dINSPECTION RECORD O
$1.00 PER ITEM
OR FIXTURE $ APPROVALS DA/TE INSPECTOR'S SIGNATURE
PERMIT -s 2160 UNDER SLAB WORK y [,r( ,� �/f
TOTAL FEE . ROUGH PLUMBING
} GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE ,READ THIS APPLICATION y -
AND STATE THAT THE ABOVE IS CORRECT AND,AGREE TO COMPLY GAS VENT
WITH,ALL COUNTY ORDINANCES AND -STATE LAWS REGULATING
PLUMBING. - HOT WATER HEATER ,1rYV`
I HEREBY CERTIFY THAT I PROPERLY- REGISTERED AND/OR '� PLUMBING FIXTURES
A LICENSED AS REQUIRED BY S ANGELES UNTY AND STATE OF '
- CALIFORNIA OR THAT 1 SYS
LEGA O NGAS TEST
E OF THE ABOVE ( {rl
DESCRIBED RESIDENTI PR PERTY. / .r UTILITY CO. NOTIFIED
SIGNATURE r'1...yj J/l� �4
OF PERMITTEE FINAI1V lL � bd. -� 1 ^'
\TALIDATION ROBERT�A�WOOD
CK. - M.O. CASH SUPERVISING MECHANICAL ENG'R'
LAP � I � 3:o` MIAR 5 5 D- `] 2 5 ''
> 7eaee7 17 8-150 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
'COUNTY OF LOS ANGELES p L u m 13 N
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT
cNO.
WIN L' S INC. , m�-)�T
O I fCi�'1 BROS., ItlliRECEIVED BY READY FOR DATE ISSUED
PLUMBER ., i` FIRST INSPECTION
ADDRESS ALHAMBRA, CALIFORNIABUILD - n - a
CITY TEL. NO. ADD EISS Ej223_M nvFRLY .AVF.--i�—
COUNTY LOCALITY
LICENSE NO. EXPIRES Iris'ZM_(Z
NEAREST
PERMIT FEES CROSS ST. Ttrramr Ic• t`p Ya Ri tie
OWNER �:iF`FtZ C?f? ACIP)
NUMBER I TYPE OF FIXTURE OR ITEM FEE
MAIL ee�
i I WATER CLOSET (TOILET) Q 0.50 S I n ADDRESS 3619 E. LIVE- OAPL Ayr.
f I BATH TUB Q 0.50 911� p CALIF.4 CITY 63t3GAf?ItJ,� 4TEL. NO.
1 I SHOWER Q 0.501 140 tHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Q 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
1 I
KITCHEN SINK Q 0.50 STATE LAWS REGULATING PLUMBING.
ppi 9 1 CERTIFY THAT 1 PVRIJ
SSESS THE ABOVE VALID LOS
.y 1 LAUNDRY'TUB OR TRAY Q 0.50 ;a ANG CO TY LOR 1 AM E LEGAL OWNER
1 OF ENTITY�� OV
1 I GAS SYSTEM— Q 0.501 Fn SIJ/•/)
SI UR OF
B I WATER HEATER Q 0.501 PERMITTEE
SLOP SINK Q 0.50 I INSPECTION RECORD
FLOOR SINK Q 0.50 I
FLOOR DRAIN Q 0.501
IDISHWASHER Q 0.501 (� ^ �r
DRINKING FOUNTAIN Q 0.501 U h J 1 l 1.t'!:l 1�1;170 N !-/ o r,
URINAL Q 0.50 J
IHOUSE SEWER Q 0.501 Z
IMISCELLANEOUS
0.'
I� O
I�
i
I
APPROVALS
DATE g INSPECTOR'S NAME
ROUGH PLUMBING /I I
GAS PIPING t /a��'q f%' !
GAS VENT .
CESSPOOL Q 1.00 I CESSPOOL
SEPTIC TANK: I SEPTIC TANK
I DRAIN ( ) PIT ( ) Q 1.00 11111 SEWER 1
PERMIT 1.00 GAS TEST �F4/a;� a �� `' �] t?i
UTILITY CO. NOTIFIED JA n.on
TOTAL FEE I S 5 00 � I "i —J-w6 's;t s✓,
FINAL
WORKERS'COMPENSATION DECLARATION 20-0026 APPLICATION
/� TION FOR PLUMBING
PERMIT
`--I hereby, affirm that I have,a certificate of consent to self in- 76A667A PW a/87 11r r J`1 1 1r r R ,Y,v 1r r LR,Y1
sure, or a certificate of Workers'Compensatiori'Insurance,or.a CE 817(REV.{8/86)
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 7 /® J� L
Certified copy,is filed with the count y'building inspection ADDRESS G L U
department: NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Ddte Applicant WATER CLOSET(TOILET) NEAREST
(/L.I �-
CERTIFICATE OF'EXEMPTION FROM WORKERS' 'BAT.H,TUB CROSS ST. A4 (J 5C—-
COMPENSATION INSURANCE. SHOWER - OWNER
' (This section need not be completed'if the work involved by MAIL '
the permit is for one hundred dollars ($100)or less:) LAVATORY ADDRESS
I certify that in the performance of the work for which t is per-
r. SINK Q CITY TEL. N�
mit is issued, shall not em any pers y nner so �7�8
os�o become subject to the Workers'Co" e Laws. DISHWASHER
` :f � CONTRACTOR
Dat ApplicanT CLOTHES WASHER ADDRESS )Z ��^���
NOTICE TO"APPLICANT: If, after m" ing this Certific' e of Ex- �'�
em tion,you should become sub' ct to the Workers'Com en- SWIMMING POOL RECEPTOR
sat on provisions of the Labor Code you must forthwith'comp- LAWN SPRINKLER SYSTEM CITY�&�d�01T�1C a.Z T
ly with such provisions or this"permit shall be deemed revok- STATE a LIC.
SS,
WATER HEATER LICENSE NO. S CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. P CESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM. OUTLETS O (�
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �J
fed Professions Code, and my license is in full force and ef- SPER SYSTEM FINAL VALIDATION
DATE �'
License Number Lic. Class �+
FINAL �. U
Contractor Date O
BY
f
am exempt under Sec. 11 qfl � d LU
B.&P.C. for this reasone. N
Plan check fee
Date:' PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE
SINGLE FAMILY '
HOME OWNER-BUILDER DECLARATION Plan check applicant " I
I hereby affirm that I am exemptfrom-the"Contractor's License Name c
Low for the following reason_ (Section 7031.5, Business and
Professions Code):" Address r' C Y1CIrl as
I, as owner of the property, will do the work and the City Tel. No. 3307
structure isnot intended or offered for sale(Section 7044; 1 T M
Business and Professions Code). `
� tiF
CONSTRUCTION LENDING AGENCY Tit 1 `L 2-.s a
I hereby affirm that there is a construction lending agency for CHECK
the performance of the work for which this permit is issued s> t}I.
(Sec. 3097, Civ. C.). t:�IAINGE at:
Lender's Name
Lender's Address .
36
1 AN 33
I.certify that I have read this application and state that the 18"39 .-
above information is correct. I agree to comply with all County ►
ordinances and State laws regulating Plumbing, and hereby
outhorirepr se tatives of this County to enter upon the'
above- a roperty for inspection purposes.
SEE REVERSE FOR',EXPLANATORY LANGUAGE
gnature of P rmit ee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS -TUNAS PL 0508 0210290042'
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 17179 LT: 18 6223 CLOVERLY AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801602
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: WENDON
5385-010-018 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY
47 WATER HEATER(S) 1.00 WTH 16.20
TENANT: TOTAL FEES 43.95 ISSUEC ON: PROCESSED BY: PLAN BY: EXPIRES ON:
10/29/02 JK 04/27/03
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
LEUNG;MAN (626) 285-4570-
6223
85-4570 6223 CLOVERLY AV ��'
TEMP 917801602 DESCRIPTION OF WORK
C/O WATER HEATER
APPLICANT: TEL. NO:
ACTION CONTRACTORS (310) 515-1311-
17111 S BROADWAY SPECIAL CONDITIONS:
GARDENA 91248
CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE
ACTION CONTRACTORS (310) 515-1311
\ LAB WORK
17111 SOUTH BROADWAY LIC. NO UNDER.S
�j Or ,✓ ���.
GARDENA CA 90248 B/L 27953
WATER;SERVICE
PLASTIC YIN METAL YIN
ARCHITECT OR ENGINEER: TEL. N0:
[ t ROUGH iPL MBING
LIC. N01� "�llllllll 'it GAS PIPING
- - - -- --� - --- - -- -... GAS VENT
HOT WATER HEATER n Tj
-- PLUMBING FIXTURES
LAWN SPRINKLERS
/�� GAS TEST
�� UTILITY COMPANY NOTIFIED
V���➢G �- @y y� CWV
GRAY WATER SYSTEM
* ADDITIONAL DATA ON FILE
REPORT ID: DPR263 ROUTE TO: BS0508