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HomeMy Public PortalAbout5042 KAUFFMAN AVE_Plumbing__ 76A667A ICE 81713)- 11/76 , BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ' rADDRNUMBER FIXTURE OR ITEM, FEE ESS 5042 ,N. KAUE MAN AVE. . WATER CLOSET LOCALITY =LE CITY BATH TUB NEAREST ST. SHOWER OWNER ROMM, aiA Es MAIL LAVATORY ADDRESS SAME SINK CITY TEMPLE CITY TEL.NO. 286-4819 � DISHWASHER CONTRACTOR TRAM HCC `, CLOTHES WASHER ADDRESS 2034 N. PECK RD SWIMMING POOL RECEPTOR CITY SO. EL NDNTE TEL.No. 579-1982 LAWN SPRINKLER SYSTEM STATE LIC.G WATER HEATER LIC NSE NO. 265094 CLASS GAS SYSTEM OUTLETS DISTRICT NO. GRO P ZONE PROCESSED BY • 7 OUTLETS OVER �5 5 PER SYSTEM INDUSTRIAL. WASTE APPROVAL INSPECTION RECORD 09 u 0, Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING City Tel.No. GAS PIPING- �7 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING.FIXTURES ...a. REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST ��PeY LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL , PROPERTY. UTILITY CO.NOTIFIED SIGNATURE _ OF PERMITTEE 7 FINAL t � PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.0. CASH 5, 4. 7 r•SEP 1 -7.5 Q , ' ©5 D.S.S.17 23M SETS -1-48. DEPARTMENT OF BUILDING AND SAFEW APPLICATION ®R DRgp - `. COUNTY OF LOS ANGELES WM.J. FOX.CHIEF ENGINEER PLUMBING NATURE OF INSTALLATION DISTRICT NO. 6 OUP o PERMIT NO. ROUGH FIXTURES COMPLETE B READY FOR DATE ISSUED HEATER CESSPOOL -�SEPTIC TANK RECEIVED FIRST INSPECTION AS MISCELLANEOUS APPLICANT .FILL IN HEAVILY OUTLINED p�PORTION ONLY JOB NAME_ n e A L ADDRESS g ADDRESS /�C LOCALITY 40 �C r NEAREST > d • d CITY . TEL.No. CROSS ST. 1 4 �6! ev meq. _ COUNTY. CERT.No. EXPIRES 09.. NAME LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL NORTH 3: ADDRESS �9 s Petr[. ' CITY �.�E6 ��a EJ TEL.No. I AM THE LZdAL POSS=SOE R OF THABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. n PLUMSQR I AM THE LEGAL OWNERR OP THE/PROPERTY DESCRI?BE/D�' ABOVB. c; CORRECTIONS SOUTH J (DESCRIPTION OF WORK a z_ _BATH TUB FURNACE 6 SHOWER DISHWASHER 0 LAVATORY hhj REFRIGERATOR L KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN tL WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE IwaPECToe's wnaae _WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I I METER-GAS SODA FOUNTAIN GAS PIPING OUTL At GAS VENT I Py EI`Y CESSPOOL I I T6OTAL NUMBER OF FIXTURES SEPTIC TANK I I o ' CESSPOOL SEPTIC TANK .:� if 10 SEWER I I UTILITY CO.NOTIFIED TOTAL FEE / 100 FINAL 6rA667 s-so 0 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMMAW I WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. PLUMBER .Revere Service Corp, RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS 11811 ,Teale St CITY Culver City TEL. NO. /C-'721'51 ADDRESS 802 Sa Kauffman Ave. —LICENSE COUNTY NO. O/ )O IVI EXPIRES O��O�)1 LOCALITY 77T11,P,,,m�le City CNEAREST ROSS ST. T a ROSES Dr. PERMIT FEES �r n NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER HA O B. M.itchell MAIL ] WATER CLOSET (TOILET) @ 0.50 EA $ I ADDRESS Same S above BATH TUB a O.50 I I CITY TEL. NO. ' SHOWER @ 0.501 1 HEREBY ACKNOWLEDGE' THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.501 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE. TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK L 0.50 1 STATE LAWS REGULATING PLUMBING. - 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LIG OR I AM THE LEGAL OWNER OF THE RESIDENTA: PROP RTY DESCE BOVE. GAS SYSTEM OUTLETS n 0.501 WATER HEATER @ 0.501 I SIGNATURE O PERMITTE 1 SLOP SINK @ 0.501INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 1 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 1 URINAL @ 0.50 •,J IHOUSESEWER @ 0.501 1 Q _Z MISCELLANEOUS U� n I� 0 o I APPROVALS 1 DATE INSPECTOR'S NAME 1 ROUGH PLUMBING GAS PIPING GAS VENT I CESSPOOL @ 7.00 I CESSPOOL SEPTIC TANK: 1 SEPTIC TANK I DRAIN ( ) PIT ( ) @ 1.001 SEWER PERMIT . I 1.00 GAS TEST TOTAL FEE UTILITY CO. NOTIFIED �. I 1 I5� FINAL 76A667A ICE 61713)- 1 1/76 -KPPL0C:AT0OILEI. GOR pLUMBONca pERMO1[ db BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS WATER CLOSET LOCALITY BATHTUB NEAREST / CROSS ST. / j SHOWER OWNER LAVATORY MAIL ADDRESS SINK CITY TEL.NO. r DISHWASHER CONTRACTOR r �' CLOTHES WASHER ADDRESS o SWIMMING POOL RECEPTOR CITY ! !�� 3 -,>� LAWN SPRINKLER SYSTEM TEL.NO.3 • STATE /�j•�f� ry LIC. WATER HEATER LICENSE NOC / CLASS GAS SYSTEM OUTLETS DISTRICT NO. GROUP ZONE RO ED BY OUTLETS OVER I© e S PER SYSTEM INDUSTRIAL WASTE APPROVAL. INSPECTION RECORD 6� Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE 0 Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING City Tel.No. GAS PIPING . I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES -10 AND STATE LAWS REGULATING PLUMBING. - HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES -7 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST 2 /•-A j 17 LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE - OFPERMITTEE FINAL 2-771 PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATION CK. M.0. s� 5OAJUL 12 2 � 1 0.5 0 m WOhItVL� .RS'COMPENSATION DECLARATION 7ea667A I hereby a'Mrtn that I have-n certifipate of consent to self ce e17 (2-90) P L IC��®N FOR- PLUMBING PERMIT insure, ora certificate of Workers'Compensation Insurance,or a certified copy 04reof(Za 380 b:C — CO TY OF.L ANGELES BUILDING AND SAFETY Policy N� � ny 9A Certified copy is,hereby furnished. �� FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified copy.is filed with the county building inspection NUMBER FIXTURE OR ITEM O 'FEE ADDRESS department. WATER CLOSET LOCALITY __11 C Date ApplicantNEAREST BATH TUB-' CROSS ST. - Ulf CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER Qyri e�Q LAVATORY MAIL (This section need not be completed if the work'involved ADDRESS aH.,.9& } by the permit is for.one hundred dollars ($100) or less.) SINK, — CITY � TEL. NO. aO I certify that in the performance of'the work for which this DISHWASHER * F R.IU permit is issued I shall not employ any person in any manner CONTRACTOR cc so as to become subject to the Workers' Compensation Laws. ADDRESS CLOTHES WASHER 0 2 ,33 Date Applicant SWIMMING POOL RECEPTOR U NOTICE TO APPLICANT:-If, after making this.`Certificate of CITY TEL.N / � LL Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM �T d STATE LIC. Compensation provisions of the Labor Code;you must forth- LICENSE NO CLASS / Z with comply with such provisions or this permit shall be WATER HEATER c� deemed revoked. GAS SYSTEM ` OUTLETS ( DISTRICT NO. C SED BY LICENSED CONTRACTORS.DECLARATION : OUTLETS OVER l� - I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi-• FINAL /� VALIDATION •ness-and Professions Code, and my license is in full force•and DATE �Q -a�d� effect. 1 6 7 � �{L / FINAL License Number tic.Glass ®V BY .C_4"� t x Contractor�� �' ' ' Date /v �.I am exempt from the licensing requirements as I am a Plan Check fee licensed architect or a registered professional engineer. PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity-(Section 7051, Bus- iness and Professions Code), TOTAL FEE Lic,or Reg.No. Date Plan check applicant t 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 ness and Professions.Code): I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code). } �•0 0'°b CONSTRUCTION LENDING AGENCY 2.0 - 2200 I he affirm that there is a construction lending agency , for the performance of the work for which this permit is o 0 0 220 0 issued(Sec. 3097,Civ.C.). Lender's Name 0 7, 1 6—B 0 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon -the above- ntioned property-for ins a tion purposes. " Signature of PeAnittee Date ' W11, ERS'COMPENSATION DECLARATION p nn p p �p 'I hereby affirm that I have a certificate of consent to self 76A667A QI�I!-L��CQ��OII�.I FOP PLUM .NG PERMN insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certifi d cop there (Sec. 3800, Lab. C ) � /�� COUNTY OF LOS ANGELES BUILDING ARID SAFETY Policy No lQr� ompany!7`[J�rl� •�-_u /7V 3 Certif ed copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS �d 7� 2 (�{ NUMBER FIXTURE OR ITEM LOCALITY ! L 1° r FM _42 tion department C� FEE Date — Applicant = �r!�� WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE. SHOWER OWNER �Y S DbG<_e yl (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL ADDRESS sD 92- Q I certify that in the performance of the work for which this / permit is issued, I shall not employ any person in any manner SINK CITY �� Le CL TEL. NO.2 so as to become subject to the Workers Compensation Laws. DISHWASHER [• / CONTRACTOR_ (-�Qe vWl 1 AC Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY 1 TEL. NO. cc Compensation provisions of the Labor Code, you must forth- G1( T _a7 LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE / �iC LIC. deemed revoked. WATER HEATER LICENSE NO.C3CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER (� and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL,? VALID ION 0 License Number Lic. Class 3-6Ce.+;1c rf /L DATE Contractor Skiti Qv cQ /�i Date s l !C—/`Z- �l/lL4S(/ 4r B 10— O ❑ I am exempt under Sec. t I y 107 B.&P.C. for this reason Plan check fee D te: vBU D .21 0 9, 0 A PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE 0 # o 0 o o o 5 SINGLE FAMILY Plan check applicant I -,o30.50 HOME OWNER-BUILDER DECLARATION Name o 0 P30,506 I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and ( 1, 19-84 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 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 f r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign ture of Permitt Date