HomeMy Public PortalAbout4925 KAUFFMAN AVE_Plumbing__ 76A667-CE#6I7 6-65
APPUCATON FORPLL=U�fllBPSIC PERK _
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER /
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEARESY
CROSS ST. "> '
NUMBER FIXTURE OR ITEM EACH 'FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
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LAVATORY 1.25 CONTRACTOR n
SINK 1.25 ADDRESS G_24ST` /
DISHWASHER 1.25 CITY "/o%'TEL. NO.
`
LAUNDRY TUB 1.25 aZJ STATE LICLICENSE NO. 1p CLASS
CLOTHES WASHER 1.25 DRICT 70NP O BY
WATER HEATER 1.50
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL O
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
C w
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 106 GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AFOLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY .REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF r
CALIFORNIA OR THAT AM TME LEGAL OWN LF,AND INTEND TO GAS TEST
RESIDE IN,THE ABOV SCRIBED RESIOENT.A PROP-'ERTY. UTILITY CO. NOTIFIED
SIGNATURE f �/�
OF PERMITTEE t
FINAL
�ALIDATIOIV
CK. M.O. CASH
L.r'is,0 4 7 5 0 SEP 1 J5. 5 p
� KER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 FOR
n n
I hereby, affirm that I have a certificate of consent to self insure,
or a 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.
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspection ADDRESS
department. NUMBER FIXTURE OR ITEM (off FEE LOCALITY t
Date Applicant WATER CLOSET NEAREST �yl�/��J T A?V� T
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
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($100)or less.) LAVATORY OWNER -7,
I certify that in the performance of the work for which this permit f—�
is issued, I shall.not employ any person in any manner so as to SINK, ADDRESS
become subject to the Workers'Compensation Laws. p �y
DISWASHER - - ,�../1 TEL.NO.SIC, 7F
O�a
Date Applican ' CLOTHES WASHER dj v v CONTRACTOR e�
NOTIOZ-0-44kPfICANT: If, after making this Cert�cateof
,..f
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code;you must forthwith comply with such ADDRESQ,7/p S,
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM �f
LICENSED CONTRACTORS DECLARATION CITY ` TEL.NO. Z
gq
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER -
commencin with Section 7000 of Division 3 of the Business and STATE y pp (f LIC. Q
(commencing ) LICENSE NO. / 1� CLASS *� -
Professions Code, and my license is in full force and effect. GAS SYSTEM / OUTLETS �-�Q / V
OUTLETS OVER DISTRICT NO. PROCESSED BY BY 0
5 PER SYSTEM Q
License Number 3`4 ,��Lic.Class SN �(aelv
ID
NAL V
�/ ` , ATE �a _( LWATION d
)IF]
ontractor � i- /"t ",f0ADate Ir I 1 s (A
❑ INAL j yf.�.i o g
I am exempt under Sec. Y 5� Lr
BAP.C.for this reason _S o T.I
E Plan check fee € "��cEM
- -�- Date: _ TTEMS
`•
PLUMBING PERMIT ISSUING FEE$
Signature / TOTAL 55- 65
TOTAL FEE - cc
SINGLE FAMILY Plan check applicant CHANGEa�_I0
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
Code): 1�E1 h f—i E 4�J t•_�
City Tel. No. 51.4�tr
❑ A ,+,t
1
I,as owner of the property,will do the work and the structure 7�_ti.L` 1 AN So
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 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
Signature of Permilfee Date