HomeMy Public PortalAbout4911 KAUFFMAN AVE_Plumbing__ 76A667 OBS 17 11-50 �t APPLICATION FOR PERMIT
DEPARTMENT. OF BUILDING AND SAFETY
COtigTY OF LAS ANGELES
WILLIAM J. FDX, CHIEF ENGINEER PLUMBING 1
D[STRtCT O. ROUP ZONE .
yFOR APPLICANT TO FILL IN f— I I
r l
PLUMBER / 4 ( i•• f / �.� RECEIVED BY - READ-( FOR DATE ISSUED
FIRST INSPECTION
ADDRESS
BUILDINGq I' U d IV
CITY ,c.> t1-1 ('b (� 4 'I!" TEL NC. ADDRESS I
COUNTY J — l � LOCALITY T@-Pl P10- if,
LICENSE NO. �O EXPIRES ml NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE
OWNER 'v.
MAIL t
WATER CLOSET(TOILET) @ 0.50 1 O ADDRESS y 10 B P'd.® t411
BATH TUB - @ 0.50 d CITY N r ow i d. TEL.. Na. fr s
SHOWER @ 0.513 1 HEREBY ACKNOWLEDGE THAT Z1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 d APPLICATION AND STATE THAT THE-ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 Q AND STATE LAWS REGULATING PLUMBING.
- I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE,
OORR I AM THE LEGAL OWNER
THE RESIDNTIAL A ECi�/C DESCRMED.. ABOVE.
GAS SYSTEM--'j-OUTLETS @ O.SO
SIGNATURE
SIGNATURE OF
WATER HEATER @ 0.50 � PERMITTEE.—
SLOP SINK @ O.SO INSPECTION RECORD
FLOORSINK @ 0.50
FLOOR DRAIN @ 0.513-
DISHWASHER @ 0.50
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50 J
Q
HOUSE SEWER @ 0.SO Z
MISCELLANEOUS E9
� c
o
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.00 CESSPOOL C/
SEPTIC TANK: SEPTIC TANK
DRAIN ) PIT ) @ 1.00 SEWER
PERMIT .
. . I 1.013 GAS TEST
A UTILITY CO.NOTIFIED g1
TOTAL FEE $
7 FINAL
7.6A667-CE#817 2-66 - -
APPLICATION FOR PLUMBAG PERMI
COUNTY OF LOS ANGELES
'DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN.W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE C
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
CIT
SHOWER 1.25 Y TEL. NO.
CONTRACTOR
LAVATORY 1.25
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO. @ _
STATE LIC,
LAUNDRY TUB 1.25 LICENSE NO. 6 CLASS
0
CLOTHES WASHER 1.25DISTRICT h10 G Z E P S By
WATER HEATER 1.50 Q
GAS SYSTEM OUTLETS LSO INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD c
CD
H
' v
w
CL.
' Z
APPROVALS ATE INSPECT .�&PNATURE
PERMIT $ 2 OQ UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 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 - r
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES - -�
LICENSED AS REQUIRED BY LOS A ELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM HE AL OWNER OF,AND INTEND TO GAS TEST
®-
RESIDE IN, THE ABOVE DES 1 SI DENT I AL PROPERTY. UTILITY CO. NOTIFIED ,
SIGNATURE
OF PERMITTEE
FINAL 1
VALIDATION ,JACK R. ALLEN
(SCK./
M.0. CASH SUPERVISING MECHANICAL ENG'R.
/WORKERS' COMPENSATION DECLARATION A pMOU ON FOR PLUMMNG NG PERWr
I hereby affirm that I have a certificate of consent to self '76A667A
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81)
or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No.511350company State, Compensation a>&zXKXX2� 4709
Certified copy is hereby furnished.
® FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 4911
Certified copy is filed with the'county building inspec- ADDRESS Kauffman Ave.
tion department. NUMBER FIXTURE OR ITEM @ FEE
LOCAUTYTem le City-
Date
it -Date Jan. 30/84plicant Terry Tile WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB _ CROSSsTLower Zuza O '
COMPENSATION INSURANCE 1 SHOWER Pan Replaceme t 6 00 OWNER
(This section need not be completed if the work involved by
the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL
ADDRESS
I certify that in the performance of the work for which this .91-1 Kauffman :Avea
permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO:
Temple Cit
so as to become subject to the Workers Compensation.Laws. DISHWASHER
CONTRACTORTerry Tile
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS 200 W Wawhhin ton Blvd.
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- - LAWN SPRINKLER SYSTEM CITY 0016 TEL. N 1F
with comply with such .provisions or this permit shall be STATE 10 264 LIC. C5
deemed revoked. WATER HEATER LICENSE NO. 5 CLASS
LICENSED CONTRACTORS DECLARATION DISTRLGT NO. OCESSED BY
I hereby affirm that I am licgnsed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000 of Division 3 of the Business t
( 9 ) OUTLETS OVER y,
and Professions Code, and my licerise,is in full force and effect. 15 PER SYSTEM FINAL _ VALI TION �^
O
License Number 105264 DATE Lic. Class C54 �� U
FINAL/^/ ills
Y Ti1/30/85 BY ;21 446A 0
Contractor Terr �-e Date
I am exempt under Sec. ` L, 3 # o o o o o5
B:BP.C. for this reason
Plan check fee D ,I 0'o 1 6,50
ate: PLUMBING PERMIT ISSUING FEE$
Signature - - O o o 1 65060
TOTAL FEE 1• 0
Plan check applicant 0 1.30-785
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Address
Law for the following 'reason (Section 7031.5, Business and
Professions Code): City Tel. No.
❑ I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section D
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
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 1 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 purpos s.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee bate