HomeMy Public PortalAbout5120 KAUFFMAN AVE_Plumbing__ DS-17 10.55 FOR OR tl PERMIT
L� RMIT
BS-17
DIVISION OF BUILDING AND SAFETY
'Deportment of County, En4ineer. "
County.of Los Angeles BU]L-.NG
•e
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN,SUe'T OF BUILDING
LOCALITY ,
FOR APPLICAqU TO FILL IN . NNEARESST.
OWNE + - DISTRICT_LL0. "GROUP ZONE READY FOR INSPECTION
MAIL S j� J
_- ADDRES Jam'
r„ INDUSTRIAL
CIT . NO r WASTE APPROVAL
PLUM R INSPECTION RECORD
ADDRES
CIT �`'�¢�L TEL. N C�/�
r LICEN NO.n /_71-cE /®-2 / 1 - -
NUMBER TYPE OF FIXTURE OR IT M FEE
WATER CLOSET (TOILET) @ '$1.00 $
BATH TUB @ $1.00 - -
SHOWER @ $1.00
LAVATORY (WASH BASIN) -@ $1.00 _
KITCHEN SINK. @ $1.00 —
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY, @ $1.00 -
CLOTHES WASHER @ $1.00 - •� -
WATER HEATER @ $1.00 ® ,
GAS SYSTEM @ P.00
1
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
_
GAS PIPING
TOTAL FEE GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT. AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING.
-
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS 'REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA ORTHAT ] M TUE LEGAL OWNER OF THE ABO UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIA ROP TY• -
SIGNATURE
OF PERMITTE FINAL
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATI(w<) ROBERT A:WOOD, CHrEF PL CTOR
CK. M.G. CASH
.5°4.fl=OR- MAY 5 3 �.. 3 00.0
WORKERS' COMPENSATION DECLARATION o 0 5� N 0 n0 p 0 M 0 n0 /� 5�
I hereby affirm that I have 0 certificdte of consent to self 76A667A ������� U �OUV FOR I�L�MGI�/11��11VC� ��l1�SUVLI� Il
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81)
or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
P❑olicyNo.p ComponyS2,Aio lui_t-f�
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspec- ADDRESS
E tion department. � NUMBER FIXTURE OR ITEM � FEE
t k � WATER CLOSET � LOCALITY'T,C ,
Q� L e
Date I �"+ Applican � � 4 NEAREST
C RTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST:
COMPENSATION INSURANCE OWNER
(This section need not be completed if the work involved by SHOWER
the permit is for one hundred dollars ($100)or less.) ; LAVATORY MAIL �,��
ADDRESS -0 PVJ
I certify that in the performance of the work for which this `
permit is issued, I shall not employ any person in any manner SINK CITY , C.. TEL. NO2'3—oU 4--
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of.
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY CC). 0 J a(`f! TEL. NO. f
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM V e
with comply with such provisions 'or this permit shall be STATELIC.
^� ] 2�
deemed revoked. WATER HEATER �� LICENSE NO. ✓ �°'� CLASS III
LICENSED CONTRACTORS DECLARATION 61 1 DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER v 0 9
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL
DATE VALIDATION
License Number�7Lic. Class
cf FINAL O
Contractor ' 7 *f ' Date 'f O BY
❑ 1 am exempt under Sec.
B.&P.C. for this reason D z
Plan check fee
Date: PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE
Plan check applicant
SINGLE FAMILY
_ r
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm•thot I am exempt from the Contractor's License Address
Law for the following reason (Section 7031.5, Business and
17
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
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
1 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 certifyth I have read this application and state that the D
above in ,
i
on
is correct. I agree to comply with all County
ordinanc and State laws regulating Plumbing, and hereby
outhorizrepresentative of this County to enter upon the
7.be-1 ntioned pro e y for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
nature of ermittee J Dot