HomeMy Public PortalAbout4934 KAUFFMAN AVE_Plumbing__ i
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.APPUCA-11 .I®N. FOO\ 'PL,U'tiv RING -P.ERWT -:
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING.AND SAFETY DIVISION BUILDING r
JOHN A.'LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS SUPT of BUILDING LOCALITY. -
FOR APPLICANT TO FILL IN (PR NT OR TYPE) CROSSSY
CROSS ST. �
NUMBER FIXTURE OR ITEM EACH FEE -
OWNER .
° WATER CLOSET,,, :• - 1.50 - -
MAIL _//��A��j
BATHTUB - 1:50 - ADDRESS 6Zr� -
'SHOWER .1.50: 'CITY. ,-'..' ,'� TEL. NO
LAVATORY -
CONTRACTOR.
SINK 1.,50 ADDRESS'.
DISHWASHER 1.50 "'- - 'CIT X r, EL. 140.0 61
'
CLOTHES WASHER - 1.50 - SATE LIC
L'ICENSE'N O. /X��� CLASS
° . SWIMMING POOL.RECEPTOR 1-:50
.. _ DISTRICT.NO GR UP' ESSED
BYZONE
_
'
LAWN SPRINKLER SYSTEM 2:00 '- � •
• WATER HEATER .1'.50. �- INDUSTRIAL - .
WASTE APPROVAL S
GAS'.SYSTEM- . OUTLETS 1:50 (,� - INSPECTION ! CORD
OUTLETS OVER .30
5 PER SYSTEM -
17
f z
PIa'n check fe-e,25%d.of?above. See reverse.,
PLUMBINGPERMITISSUING FEE 8 -2' 00
TOTAL FEE "d
APPROVALS DATE' - "'INSPECTOR'S SIGNATURE
Plan check applicant', - <. UNDER SLAB WORK -
:. Name 'L .>. . :. .ROUGH PLUMBING' - - -
AddressYAM GAS PIPING'
GAS VENT
Cit h_ ,Tel. Nof HOT WATER HEATER -
I, HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANDSTATETHAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES- d .
WITH ALL COUNTY ORDINANCES.AND STATE LAWS' REGULATING GAS TEST --
PLUMBING. - - 7�
I HEREBY-'CERTIFY THAT,I AM PROPERLY REGISTERED AND/OR- UTILITY CO. NOTIFIED.,
e' LICENSED.AS,REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIAIAM NAT I AM THE LEGAL OWNER OF,AND INTEND TO _
RESIDE IN,.TH B E D ED RESIDENTIAL PROPERTY. FINAL
SIGNATURE - JACK R. ALLEN, SUPERVISING HANICAL ENG'R.
OF
PERMI E - - -
_-
PERMIT VALIDA'T'ION
CK. M.O. CASH
.PLAN CHECK VA.LIIDA ON cK M o. CASH
- = SES o �Y8.2 5N
WORKERS'COMPENSATION DEe of
C A867A �P raj p �C A T�O N. FOR
PLUMB
L U M ��� P E R I�� �T
I hereby affirm that I have a certificate of consent to self ce est (z-so) low IIL= ��y�
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec. 3800,Lab.C.)
_ COUNTY OF LOS ANGELES / / �, BUILDING AND SAFETY, ,
Policy No. Company 3:
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING''G
F] NUMBER _FIXTURE OR ITEM FEE ADDRESS 7
Certified copy is filed with the county building inspection O J
LOCALITY
department. WATER CLOSET
Date Applicant NEAREST
.BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' 1
COMPENSATION INSURANCE SHOWER OWNER ��• _
(This section need not be completed if the work involved LAVATORY MAILADDRESS �j (i( �— }
by the permit is for one hundred dollars ($100) or less.)
SINK CITY TEL. NO. �•
I certify that in the performance of the work for which this DISHWASHER
permit is-issued, I shall not employ any person in any manner CONTRACTOR
so as to become subject to the orkers' Compensation Laws. CLOTHES WASHER0
Date Applicant /dn� ADDRESS �Z `t
/a��—� SWIMMING POOL RECEPTOR' U
NOTICE TO APPLICANTIf, after making this Certificate of. CITY I F C) TEL. NO. W
:
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE / LIC'. 2
Compensation provisions of the Labor Code, you must forth- LICENSE NO. (� CLASS
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. / GAS SYSTEM OUTLETS DISTRICT NO. P CESSED'BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL �� VALIDATION
`mess and Professions Code, and my license is in full force and DATE
'effect. /J
���� FINAL
License Number–.,�L � ! � Lic.Class a BY
Contract Date .�7' O Z �
I am exempt from the,licensing requirements as I am a Plan Check fee
licensed architect or'a registered professional engineer PLUMBING PERMIT ISSUING FEE$ �,� ✓ v d�
acting in my professional capacity (Section 7051, Bus- pf F
iness and Professions Code). TOTAL FEE
Lic,or Reg.No. Date Plan check a scant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's /address
License Law for the following reason (Section.7031.5, Busi- City T.I.No. Z
ness and Professions Code): / c 3 2 �.2 A
1, as owner of the property, am exclusively contracting #- 5
0 0 0 0 0
with licensed contractors to construct the project i I
(Section 7044,Business and Professions Code). 2 0 e 2 8 5 Q
CONSTRUCTION LENDING AGENCYo 2 8 5 5
I hereby affirm that there is a construction lending agency 0+0
for the performance of the work for which this permit is 0 3.0 9,-8,2
issued(Sec. 3097,Civ.C.).
Lender's Name
Lender's Address
1 certify that I have read this application and state that the
above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE.
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above entioned property for inspection purposes.
ignature o Permittee ate