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Home My Public Portal About4919 KAUFFMAN AVE_Plumbing__ 76A667 05S 17 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY % COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER ZONE FOR APPLICANT TD FILL IN S R fZ0 P JERMIT NO X336 . PLUMBER RE IVED Y– READY FOR DATE ISSUED FIRST INSPECTION ADDRESS BUILDING CITY TEL No. ADDRESS ,jam COUNTY LOCALITY LICENRE NO. EXPIRES ' NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER ` MAIL rV WATER CLOSET(TOILET) !� 0.50 III ADDRESS BATHTUB @ 0.50 ® `--- CITY TEL. N0. SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS VATORY (WASH BASIN) @ 0.50 `� APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALLCOUNTY ORDINANCES KITCHEN SINK @ 0.50 'O' AND STATE LAWS REGULATING PLUMBING. I CERTIFY -THAT .1. POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 S� ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM.—OUTLETS @ O.SO gA 810NATU OF � /es 'G✓� �' WATER HEATER @ 0.50 PERMITTEE �a� SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 - DISHWASHER @ 0.50 - DRINKING FOUNTAIN 0.50 URINAL 0.50 J HOUSE SEWER 0.50 Z MISCELLANEOUS O O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING // GAS PIPING /A z1*11S3 GAS VENT CESSPOOL 1;00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT . I 1.00 GAS TEST t UTILITY CO.NOTIFIED TOTAL FEE $ �(� FINAL ,,;YNORKERS' COMPENSATION DECLARATION I hereb , affirm that have a certifiate ofr consent to.self in- c 20-0026 DPW„4/87 sure, or a certificate of Workers'Compensation Insurarice orIa . CE'8117(REV 8/86), certified copy.thereof`�Sec. 3800;.,16b. t ... a A IV D ,Policy No:, Company. a P C ,. ES EPT O BLft WORKS � ` OUiVTY LO GEL Certified copy is hereby furnished.' 'FOR APPLICANT:TO FILCIN:(PRINT OR'TYPE) ' BUILDING.• "a Certified copy is filed'.with-the'couniy building inspection -- ` `, ' ADDRESS AN department :.- Y @.” NUMBER FIXTURE OR ITEM FEE `' s ..: LOCALITYTp;` p�� jlc. • _ - C Date Applicant ` WATER CLOSET(TOILET) NEAREST%,, CROSS STJ 4.L •`. r1 Z�IS .I BATH TUB::. _`} lJ ^ CERTIFI�COMPENSATIONOINSURANEORKERS y. c z C-ir1 `•. ' r! SHOWER., y This section need'not be com leted ! th'e.work'involved b OWN ....,(': - ,�..•..- .,..P -:.,r -*.. y's. - J. MAILER osc dh ^^ the permit is for one hundred dollars ($l00)or less.) LAVATORY.. ADDRESS I'certify thbt+n the performance of-the'work for which this p'er-' trait is issued;-fshpll noi'em' loy'any'pers n'�-in an manner so -'� }SINK 'y'kj CITY;, ;TEL NO`_:��i•S-� `V , P y as to become subject to the;Workers C ensV�,on",,, ws[. t ;o > CONTRACTOR ISHWASHERDate t- Applicant sCLgTHES'WASHER -~NO TO,'APP,LICANT �If; after;ma' ng,lhisCerti re%of Ex ,...'»SWIMMING POOL,RECEPTOR. ADDRESS , emptwn;-.you sho.uld:becq'me;subje .to the:Work Com en-- .. TEL NO CITY., ,' sot+on,prov+s+ons o,the;Labor-Code,-;you must,forthwitli comp,,,: „ ;,:LAWN,-SPRINKLER SYSTEM •._; ly".with; W6RKEIZS'COMPENSATION DECLARATION �p I0P UC6r'HON FOR [PLU Ifo IG pERIffi.f f I,hereby affirm that I have a certificate of consent to self - 20-0026 DPW 6/87 insure, or ci certificate of Workers' Compensation Insurance, 76A667A or a certifidd copy thereof (Sec. 3800, Lab. C COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS PolicyNo.a.2 —Cokpnnf �fA�q fLinj ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ��CI ��j Certified copy is filed with the county building inspec- ADDRESS ` f ''I(/�/1 tion depart enL NUMBER FIXTURE OR ITEM FEE LOCALITY mfg' Date ZZ Applicant �� Vf� WATER CLOSET NEAREST. CERTIFICATE OF EXEMPTION FR6M WORKERS' BATH TUB d CROSS ST. COMPENSATION INSURANCEOWNER �- (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars($100)or less.) i LAVATORY O MAIL ADDRESS I certify that in the performance of the.work for which this TEL. NO. �'� permit is issued, I shall not employ any person in any manner SINK CITY - � so as to become subject to the Workers'Compensation Laws. DISHWASHER r CONTRACTOR �, j f i a F,• `lfrq& ll Date Applicant CLOTHES WASHER ADDRESSZ. V�(� ALV NOTICE TO APPLICANT: If,.after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY a�� TEL. NOI/ 14,0 6V1zM Compensation provisions of the Labor Code, you must forth- LAWN,SPRINKLER SYSTEM with comply with such provisions or'this permit shall be STATE D LIC. ,mayfJ deemed revoked. WATER HEATER LICENSE NO. " -Q V CLASS J/ LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing.with Section 7000) of Division 3 of the Business OUTLETS OVER O y� and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION 0..l 2' '*&,1 $`,0 ', DATE ri-tet-9� o License Number J' Lic. Class 2 FINAL Contractor 1 Date BY 0. ❑ I am exempt under Sec. a 60 B.BP.C. for this reason Plan check fee CO Date: PLUMB ING•PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name ��j,� yw t I hereby affirm that I am exempt from the Contractor's License'(-I .'s' Law for the following•reason (Section 7031.5, Business and Address yt91 D{ 91 Jd . 4'1 _ Professions Code): City Tel. No.' 7 _ ❑ "I, as owner of the property, will do the work and the .L t t F— 5•, structure is not intended or offered for sale (Section D x, - 7044, Business and Professions Code). I 1-I l iN -� _ 5 CONSTRUCTION LENDING AGENCY HECK. r.S,a1_1 I hereby affirm that there is a construction lending agency for - - the performance of the work for which this permit is issued i'H�NGIE =U1 (Sec. 3097, Civ. C.). lily t t+ Lender's Name i-!I _,ij-i((:� _• _,• i i Lender's Address AN >w 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 80-0-2 � ignatur of Permittee Date °r. WORKERS' COMPENSATION DECLARATION AIf"PUCAMN FOR PLUMENG NG 'PERNT J7 I 'hereby affirm that I have o certificate of consent to self 20-0026 DPW 6/87 `,insure, or a certificate of Workers' Compensation Insurance, 76A667A or a 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 q /1� Certified copy is filed with the county building inspec- ADDRESS 9 / r1 /� tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY lei lZ Date Appligant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS`ST. LOWer AZGL54 S ✓�� ' COMPENSATION INSURANCE W ONER (This section need not bo completed if the work Involved by SHOWER s`7 - t►?1 Hsi the-permit Is for one hundred dollars ($100)or less.) LAVATORY MAIL ADDRESS 4`.N•r e ' I certify that'in. the performance of the work for which this `.va -. g2 permit is issued, I shall not employ any person in any manner i SINK,. (, CITY TEL. NO. 4_$y_O so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER Q ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become'subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such, provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �Q �� ^ n (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER �/tJ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM =' DA EL VALIDATION o: O, License Number Lic. Class 0, FINAL X Contractor Date BY O, ❑ I'am exempt under Sec. W B.&P.C. for this reason N! Plan check fee Date: o z. PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE �p Q SINGLE FAMILY Plan check applicant ' HOME OWNER-BUILDER DECLARATION Name f"`-' _'T I hereby affirm that I am exempt from the Contractor's License Law for the following reason.(Section 7031.5, Business and Address `t• _'� Professions Code): City Tel. No. M/I as owner of the property,,will do the work and the e'} =,f structure is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY _t. I hereby affirm that there is a construction lending agency for 1i nN''='-the performance of the woik 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 ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned' roperty for inspection purposes. � - SEE REVERSE FOR EXPLANATORY LANGUAGE � Signature of ermitte Date