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HomeMy Public PortalAbout4918 KAUFFMAN AVE_Plumbing__ "A-GOT 11 946 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WBIN WILLIAM J. FOX, CHIEF ENGINEER ff� LW FOR'APPLICANT TO FILL IN DISTRICf NO. GROUP I ZONE PERMIT NO. J/�� PLUMBER ,A 2 /J e-o 1' Ly M 13 i N G RECEIVED QY READY FOR DATE ISSUED p� q � / FIRST INSPECTION " ADDRESS 7� ,p. � Wt .�3 �•Pa.9O'� 'C I.Y L!✓� lJ g� AA '` n� IYAyJ 6�A ,p py /� /� BUILDING 4Fq q Sc). � q N p'Fr` �i CITY /V0 hI ELam, N TfWACTEL. NO. ATS'*{T.4 31 ADDRESS -} O'er ,p COUNTY ^7 LOCALITY l r-M ! L- IS c I r�C LICENSE NO. / 0 Y Fes' EXPIRES C 10 A Q CROSS ST. L 0 W �S)Z, PERMIT FEES NUMBER TYPE OF FIXTURE OR ITEM - FEE OWNER � MAIL A/1/WATER CLOSET (TOILET) @ O.50 I S I ADDRESS —�—I BATH TUB _ @ 0.501 1 CITY TEL. NO. II ''SHOWER @ 0.501 1 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS /LAVATORY (WASH BASIN) @ 0.50 I1 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND �I KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING. II � I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS _____J,-LAUNDRY TUB OR TRAY @ 0.501 ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. / I GAS SYSTEM--!—OUTLETS @ 0.501 SIGNATURE OF �I WATER HEATER @ 0.501 1 PERMITTEE e SLOPSINK @ 0.501 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.501 DRINKING FOUNTAIN @ 0.501 URINAL @ O.SOI _I I HOUSESEWER @ 0.501 1 Q Z MISCELLANEOUS 1 I U' o I APPROVALS DATE INSPECTOR'SyJI KWI E' ROUGH PLUMBING I .4 1 E GAS PIPING GAS VENT CESSPOOL @ 1.00 I CESSPOOL SEPTIC TANK: II SEPTIC TANK I DRAIN ( ) PIT ( ) @ 1.001 I SEWER PERMIT • I 1,00 GAS TEST i UTILITY CO. NOTIFIED TOTAL FEE I $l>`m FINAL G4 /1 •�` WOthat I S COMPENSATION DECLARATION 20-0026 DPW PW 9189 ^ PPUCAMN F®R' Pn n nM IG PERS T Thereby affirm that I have a certificate of consent to self insure, �U (�U u�u �J or.aiiificate 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. FOR APPLICANT TO FILL IN(PRINT OR TYPE) /�} L 11�711 ❑ Certified copy is filed with the county building inspection . - ADDR SS�r ! 11i �j- department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY /r6,j. / •�. ' Date Applicant / WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' / CROSS ST. BATH TUB COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER - MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER ) / I certify that in the.performancetof the work for which this permit LAVATORY (/ •T (/ is issued, I shall not employ any person in any manner so as to MAIL. become subject to the Workers' Compensation Laws. SINK _ ADDRESS DISWASHER CITY. /bq TEL.NO. Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such I IIADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM' LICENSED CONTRACTORS DECLARATION / CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER 13- (commencing with Section 7000) of Division'3 of the Business and STATE LIC. O LICENSE NO. CLASS Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS V OUTLETS OVER DISTRICT.NO. PROCESSED.BY ; O 5 PER SYSTEM License Number Lic.Class _ FINAL U DATE _ VALIDATION d Contractor Date U) ❑ I am exempt under Sec. * FINAL z B.&P.C.for this reason Plan check fee D Date: Signature PLUMBING PERMIT ISSUING FEE$ 76 _ ❑ TOTAL FEE Plan check applicant - SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address C )• ~_ City Tel.No. f � a-;•''-'i I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). ;w .••: : 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 t I certify that I have read this application and state that the above D information is correct. I agree to complywith all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purpose SEE REVERSE FOR EXPLANATORY LANGUAGE i nature of Permittee Date Q WORKERS' COMPENSATION DECLARATION �. APPLOCnR T8©N FOR PLUA Q NG PERMT T I hereby affirm that I have a certificate of consent to self 76A667A ins,40, or a certificate of W6.rkers' Compensation Insurance, CE 817(REV. 10/81.) or.a certified copy the eof (Sec. 3800, Lab, C.) COUNTY OF LOS ANGELES BUILDING ARID SAFETY Policy No. Company Certified copy is hereby furnishe FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant/ (f WATER CLOSET NEAREST E IFICATE OF EXEMPTIG7 FROM WORKERS' BATH TUB CROSS ST. COMPENSATIO NSURANCE SHOWER OWNER !' (This section need not be completed if the work involved by MAIL the permit is for one hundred.dollais ($100)or less.) LAVATORY ADDRESS I'certify that in the performance of the work for which this permit is issued; I shall not employ any person in any manner SINK c1 U CITY TEL. NO. so as to become subject-to the Workers'Compensation Laws. DISHWASHER CONTRACTOR , Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of r 2. Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPCITY TEL. NO. V-1 - G RINKLER SYSTEM with comply with such provisions or this permit shall be STATErd �22�� CIC. !` deemed revoked. WATER HEATER LICENSE NO. Y3 8:52= CLASS - LICENSED CONTRACTORS DECLARATIONDISTRICT O. _ �/ ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS S UQx (commencing,with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALI ATION DATE, CLI License Number Lic. Class FINAL U. Contractor Date BY lY ❑ O I Of exempt and Sec. U B. C. for this reason D W Plan check fee a' Date: PLUMBING PERMIT ISSUING FEE$ :966 3 3A Z Signature �' TOTAL FEE e # 0'0,0, o to 5 Plan check applicant SINGLE FAMILY 1 '° ° 2 2 5 HOME OWNER-BUILDER DECLARATION- Name 0 1.0 09 9 v I hereby affirm that I am exempt from the Contractor's License Address w Law for the following reason (Section 7031.5, Business and 60 Professions Code): City p Tel. No. ?7 ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 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 I have read this application and state that the above information is correct. I agree to comply with all County A,gnotur nd State laws regulating Plumbing, and hereby presentatives of this County to enter upon the nned ro erty r inspection purpx- Iv--.- osSEE REVERSE FOR EXPLANATORY LANGUAGE P mite Da