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Home My Public Portal About4846 KAUFFMAN AVE_Plumbing__ DEPARTMENT OF COUNTY ENGINEER DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING 1 J Q �/ WILLIAM J. FOX, COUNTY ENGINEER ADDRESS oo ``YY llOD e1eL�Ii7/t � FOR APPLICANT TO FILL IN LOCALITY _ BUILDING NEAREST ADDRESS CROSS ST. ,/p,,,, _�,�/ ,///t �� DISTRICT NO. GROUP ZONE PERMIT NO. LOCALITY'—/E/�?/�,L ��J T '711, / NEAREST _ 6 CROSS ST. 4,4 J/ O.SA RECEIVED BY Ready for Inspection DATE ISSUED OWNER ��O —, MAIL INDUSTRIAL ADDRESS WASTE APPROVAL CITY EL.NO. INSPECTION RECORD PLUMB 1rK E ADDRESS /(1 CITY TEL NO. �" "o /AJ S ❑STATE �//Gl 3 y/.Ce a/.aa fZ D �m.a7 LICENSE NO. 7Z/' COUNTY PERMIT FEES L/-°"'$ I/J47^� - a i:MSER TYPE OF FIXTURE OR ITEM FEE "� Z [7 WATER CLOSET(TOILET) @ 0.80 S Q /?X/ A O BATH TU B @ 0.80 G SHOWER @ 0.80 O :L4 LAVATORY(WASH BASIN) @ 0.80 KITCHEN SINK @ 0.80 ^n_ LAUNDRY TUB OR TRAY @ 0.80 t� SLOP SINK @ 0.80 FLOOR SINK @ 0.80 FLOOR DRAIN @ 0.80 DISHWASHER @ 0.80 DRINKING FOUNTAIN @ 0.80 URINAL @ 0.80 GASSYSTEM..... .....--OUTLETS @ 1.00 QG WATER HEATER @ 1.00 �/ O MISCELLANEOU clTd f4 S O APPROVALS D, INSPECTOR'S SIGNATURE. UNDERSLAB WORK PERMIT $ 1 00 ROUGH PLUMBING GAS PIPING TOTAL FEE & I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- GAS VENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS S f REGULATING PLUMBING. PLUMBING FIXTURES ✓ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ER OF THE ABOVE DESCRIBED RE ROPE Y. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE--- .... ..--.- _..-+ FINAL 76A667 DBS 17 1/53 WORKERS COMPENSATION DECLARATION � . - r'•.. self 20;0026DPW'4/87 (�"�'!Ilt�'O pp pp ppI1L7❑B��pp(�`� nn n(n��p� .;f herebyi.affirm.that:l have a;certificate:of.consent to•se i f ^�'�� ? 9 �, ®� �L�V U`�l' I�. 'll�ll�J1111 sure or;',6 certrf{'cate of^Wotk-6rs',•Compensation Insurance,or 8 C, /8' (REV•:"8/86) r Certificopy ted hereof (Seow 3800Lab' Policy,No'. Company„ COUNTY OF L O77 S ANGELES DEPT OF•PUBLIC WORKS Cettified cop-y is hereby furnished { , v FOR APPLICANT,TO FILL'1N(PR(NT OR;TYPE) BUILDING- ��• p ' DCertified copy is filed'with;the.county'building'inspection., ADDRESS NUMBER ,FIXTURE'6R ITEM - FEE depayt ent. LOCALITy .: " Date ;Applicant' NEAREST. , WA TER CLOSET(TOILET S BATH'TUg CROSS T, 41✓ d g 9 CERTIFICATE 0F'EXEMPTION FROM WORKERS- :':. - _ }" COMPENSATION INSURAN -E SHOWER OWNER (This sectionAneed'riof be'c`ompleted if the work m"volved'by, s's I` the permit(is for•one hun8red"dollars`($100)_or less.) ' - LAVATORY ADDRESS e CAv I certify"that in'the_performance-of+the work for which this per.' tSIN CITY" TEL m,t•,s,issued, Lshall,not employ any penner.so rson„in any;ma . ^ `'as to be"co'me subject'to'the:Workers' Compensotion,Laws .; „ DISHWASHER CONTRACTOR, Date Applicant' ° CLOTHES';WASHER ;' l n a. NOTICE,TO APPLICAN .:"If'after making,thi-sCectficate of Ex Y �.; 1/l�\ .14 ;. SWIMMING POOL•,RECEPTOR ..`., ''emption, you'should become subject to th-e;WorkersComperr — . ADDRESS Sidon provisi'ons,of ihe'.Labor Code,'you,must,foithwith comp, ;l L"AWN'SPRINKCER`SYSTEM TEL NO 'ly With such%pr6visions or:this permit.,shall be"deemed revok:">"; / t` STATE t. UC ed" ?' LICENSE NO CLASS WATER•H' TER "'LICENSED`CONTRACTORS^,DECLARATION ,; N. s DISTRICT NO -PROCESSED'8Y .' GASSYSTEM OUTLETS I_hereb^y affirm=th"at I am••lic-ensed'un•der piovision's of Chdpter ire - y1 9:(comme`ncing with Section 7000)of Division' of the Business .OUTLETS OVER and-Professions Code, and m license is,n'full'force,and ef- 5;PER.SYSTEM. Y FINAVia. feet i. f A^ �.• g J/' VALIDATION ®, x 1fV ci /! DATE / G L'icense•Number Lic Class (� Contractor. Date �� 0` BY tr am•exempt'underSec f LU _. . ' B'&P'C for`this reason 00 Plan check fee g Date =' PLUMBING PERMIT ISSUING F R r Signature `1 TOTAL FEE mSINGLE FAMILY :r HOME'OWNER- BUILDER DECLARATION Plan cheek applicant I hereby,offirm3hot l'om exempt from the:Contractor.s,L'icense , No r e ' Law for the following 'reason (Sect;ion"7031,5;'BusiYiess and`, o Professions Code)`:' ZCi I;s I, as'owner-of the:?property,,wilh;do the v o&k•:and th'e City Tel No. a a;t t structure is',not intended or offered for sale.(Seetion 7044;,' „^. t ' ' _ Business and',Professions-Code) u,• ^ a" ( mA CONSTRUCTION LENDING AGENCY jLr I•hereby affirm"tF dt there.is.a construction lending agency for, ` the perfo;mance..of the work for which tl is.permif is issued`, (Sec.`3097; CGv C;. le'der s'Name ''Il :f a x ` • Lende'r's: Addressr J yiy9 + 1-certify,that I 'have read`this application'and.state that the ' aboJe information is'correct. I agree'to'comply with all County ordinances and State Paws regulating Plumbing, and hereby = D authorizerepresentatives of this•County to'enter upon the above-mentioned prope�ty'f nspection purposes. ' SEE REVERSE FOR EXPLANATORY LA14GUAGE ; Signature of Permute Date WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 �nn p /� �p I'heteby affirm that I have a certificate of,consent to self insure, 76A667A AP1!✓L��CG=,1T0®N FOR PLUMBPNG PERMT ora certificate of Worker's Compensation Insurance, or a certified 'copy thereof(Sec.3800 Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF.PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. BUILDING f/ /'''` FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS L� .b (�t1�1 ❑ Certified copy is filed with the county building inspection department. 'NUMBER FIXTURE OR ITEM FEE LOCALITY g� Date Applicant WATER CLOSET T J NEAREST CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB POM PENSATION.INSURANCE I ASSESSOR (This section need not be completed if the workinvolvedby the f SHOWER' 7.5-0 MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) � OQ OWNER �� I certify that in the performance of the work for which this permit LAVATORY MAIL W r .is issued, I shall not employ any person in any manner so as to, SINK Q ADDRESS 4 (- become subject to the Workers'Compensation Laws. DISWASHER 7 CITY I e/ t TEL.NO.��'1 Date Applicant j CLOTHES WASHER l•, NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS i provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION ` CITY TEL.NO. d I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000) of Division 3 of the Business and LICENSE NO. CLASS ST�TE LIC. O Professions Code, and my license is in full force and effect. GAS SYSTEM S OUTLETS OUTLETS OVER DISTRICT NO. PROCESSED BY, 5 PER SYSTEMD D Q License Number Lic.Class �' �� Q� d U FINAL VALIDATION W DATE 0- Contractor Contractor Date W EJI am exempt under Sec. BY 1 Z B.&P.C.for this reason tV� L Date: Plan check fee Signature PLUMBING PERMIT ISSUING FEE$ /3 0 ❑ TOTAL FEE d310 p Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name �C I hereby affirm that I am exempt from the Contractor's License Law s` '�I = for the following reason (Section 7031.5, Business and Professions Address (_li Code): City Tel.No. 1.9--fir, 1,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business 1 _ . 03 - 00 and Professions Code). 111N I CONSTRUCTION LENDING AGENCY CHECK I hereby affirm that there is a construction lending agency for the (,1i4'— performance of the work for which this permit is issued (Sec. 3097, Civ.C.) j71/ iYwj Lender's Name q 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE