HomeMy Public PortalAbout6229 CLOVERLY AVE_Plumbing__ 76A667 17 B-so ® APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
IG1"IBOTCO f{d9 BROS., INC.
PLUMBER RECEIVED BY READY FOR DATE ISSUED
HIP VE i t I 7 P y FIRST INSPECTION
ADDRESS Al HAMBRA,,_CAI IF NIA
BUILDING ' i
CITY TEL. NO. ADDRESS _6229- CLOVERLY AVE.,
COUNTY LOCALITY
LICENSE NO. (I A EXPIRES NEAREST
PERMIT FEES
CROSSST. fir ,��c, k;
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
1 WATER CLOSET (TOILET) @ 0.50 MAIL$ I (',. ADDRESS
BATH TUB a 0.50 '� _
p CITY :'MC.,rQtoYo '1s ffl( �PN TEL. NO.
sV SHOWER @ 0.501 c1r) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
Y I LAVATORY (WASH BASIN) Q 0.50 {.»:- APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK Q 0.50 �t STATE LAWS REGULATING PLUMBING.
of -� I .;: RTIFY THAT 1 POSSESS THE ABOVE VALID LOS
Q I LAUNDRY TUB OR TRAY @ 0.501 ANGEL �Y LI SE. R I AM �EL�/E�,OGAL OWNER
pp OF T TIA OP Y D EV
Y 1 GAS SYSTEM_ @ 0.501 q:7
A F
1 WATER HEATER I I oe
SLOP SINK @ 0.501 NSPECTION RECORD
1 FLOOR SINK @ 0.50 I I
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.501
l
DRINKING FOUNTAIN Q 0.501
1 URINAL @ 0.501 ,J
I HOUSESEWER @ 0.501 Q
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1 MISCELLANEOUS 1 I D
1 I i °
I-1
II
I
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT - -[1-2e?
CESSPOOL Q 1.00I CESSPOOL
SEPTIC TANK: I SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.001 SEWER / ry
GAS TEST e=/vk, 4
PERMIT I 1.00
ti$rv't UTILITY CO. NOTIFIED I
TOTAL FEE I $ IM `- I
FINAL
ti�
WORKERS'COMPENSATION DECLARATION 76A667A
I hereby affirm that I have a' certificate of consent to self ce 617 (z-e0) APPLICATION FOR PLUMBING PERMIT
`fl
insure,or a certificate of Workers'Co nsation Insurance,or
c t•fi d copy thereof Sec. 3800,L
COUNTY OF LOS ANGELES BUI LD1 NG AND SAFETY
oli NO-.
�[�__] Cerffied copy is hereby furnished. '. �j FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING /J^� ADDRESS _2 �9 ell Veified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEELOCALITY
rtment. WATER CLOSET %
Date Applicant I NEAREST / Q
BATH TUB CROSS ST. �o .Zl t�Gr✓
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER
LAVATORY MAIL >_
(This section need not be completed if the work involved ADDRESS . r o.
by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.NO. OU
I certify that in the performance of the work for which this DISHWASHER 'ys
permit is issued, I shall not employ any person in any manner CONTRACTOR / n"W"4",i4,e� ,Q�10
so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER I /
Date Applicant ADDRESS��r � W
SWIMMING POOL RECEPTOR iL
g CITY ✓_ TEL.NO.
NOTICE TO APPLICANT: If, after making this Certificate of � - V)
subject Exemption, you should become ect to the Workers' LAWN SPRINKLER SYSTEM STATE L
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P J _ .+,
Compensation provisions of the Labor Code, you must forth- LICENSE NO. —`?a �-� CLASSIC. r�
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM / OUTLETS DISTRICT NO. SED BY
LICENSED CONTRACTORS DECLARATION
OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATI N
ness and Professions Code, and my license is in full force and DATE l-
effect.
FINAL
License
License Number ` 3// � Lic.Class r BY
ContractoWlge C�Gc/a//7/l'r15(a/te
I am exempt from the licensing requirements as I am a
Plan check fee <
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE Ci
Lic.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name ;20829A
I hereby affirm that I am exempt from the Contractor's Address
X000005 ,
License Law for the following reason (Section.7031.5, Busi- City Tel.No.
ness and Professions Code): 2 c o 1. 0.0 0
O1, as owner of the property, am exclusively contracting
with licensed contractors to construct the project 10 e e 1 00 0'�
(Section 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY 08,2',0-8 1
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
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
authori presentatives of this County to enter upon the
above- ent ned property for inspection purposes.
Signature of Permittee Date