HomeMy Public PortalAbout5121 KAUFFMAN AVE_Plumbing__ 76A667-CE#817 10-62
APPLICATION FOR PLU eM'NC PERMIT
COUNTY OF LOS ANGELES Y
DEPARTMENT OF COUNTY- ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �T
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 121 N. Kauffman
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY T e C
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER Jo Ciochetts
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS same
SHOWER 1.25 CITY TEL. NO. At.7363
LAVATORY 1.25 CONTRACTOR Pacific Installers
SINK 1.25 ADDRESS 10920 Eo Grand
DISHWASHER 1.25 CITY Te le City TEL. NO. 442-1234
CONTRACTOR'S STATE (4�
LAUNDRY TUB 1.25 REGISTRATION NO. 211898 COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO GROU Z NE ESSED BY
1 WATER HEATER 1.50 l 50 V
50 INDUSTRIAL d
GAS SYSTEM OUTLETS 1. WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD u
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 c
UNDER SLAB WORK
_
'ROUGH PLUMBING •� y
TOTAL FEE 3 5Q GAS PIPING I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND 'STATE LAWS REGULATING HOT WATER HEATER /ff4/1���3 1:1 �• ",r„+.
PLUMBING. _
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
4'
° LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THATGAS TEST 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE-IN,THE.ABOVE DES PI ED RESIDENTIAL ROPER v. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL fY.`_ 1.�%'P�y "Y •.''�+•/"`'r t'�
(✓.•ALIDATION ROBERT A. WOOD
CK. M.O. • CASH SUPERVISING MECHANICAL ENG'R
LAGo 1 9 :9 3I'D OCT 29 5 D 3.50-
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r76A667--CE617-11-57,
APPLICATION FOR 'PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE gin County Engineer eer A
DDRESS
CASSATT D. GRIFFIN Sup t of Building
_ LOCALITY r �Y
FOR APPLICANT TO FILL IN NEAREST ,
NUMBER FIXTURE OR ITEM CROSS ST. W
WATER CLOSET OWNER 0 A �
BATH TOB
ADDRESS �1 i.� Aj
SHOWER CITY TEL. NO.
LAVATORY CONTRACTOR-
SINK
ONTRACTORSINS ESS €.s,��✓•
DISHWASHERC TEL. N
s LAUNDRY TUB CO CTOR' / ST�STE
REGISTRATIO O. COUNTY ❑
CLOTHES WASHER y DISTRICT NO., GROUP ZONE READY FOINSPECTION -
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD r /i
.. `1-lve.rS � Jfi '^-c.-.+.�-��_ e�,,..dL-t•a_CZF— 1--,�/ t-Cr� .
APPROVALS
@ $L00 PER ITEM DATE INSPECTOR'S SIGNATURE
OR FIXTURE $
_ - UNDER SLAB WORK
PER $ O ROUGH PLUMBING ..-'�'S�1 �.o •,c�-- f. ,_ _
TOTAL FEEGAS PIPING _f
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM'PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED .BY LOS ANG S COUNTY AND STATE OF
CALIFORNIA OR THAT IA HE G OWNE OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED SID TIAL PERTY
C c z
SIGNATU FINAL
OFPERM
ROBERT A.WOOD.
®F VALIDATION SUPERVISING MECHANICAL ENG'R
CK. M.0. CASH
LA AC,0 1 3 3 °; JuPJ 7 5 R 5.0 0
-WORKERS'COMPENSATION DECLARATION ` ��(p� //U�� p
r r 20 Q026'DPW 4%87 !i �YII �!J 11 ll ll
I.here'lo'Tian that I have*a'ceetificaie:of'consent to self an- j6A667A
sure,or'a ceriificate'of blockers'Compensation Insurance',ora a CE'817'(REV. 8/86)
Beatified`copy thereof (Sec, 3800; Lab C )
F,
>. . .
Poli No.` q` Com an. VV
COUNTY OF LOS Ai�lGELES -DEPT OF.PUBLIC ORKS
Certified copy.is'hereby furnished
(PRINT OR dYPE) BUILDING', >' •.y
Certified copy is flied with;the cou4 ty building inspection FOR AP.P,LICANT.TO FILL.IN ADDRESS
department` ,
c ..� LOCALITY
NUMBER, FIXTURE OR ITEM
WATER.GLOSET(TOILET)
Date' Applicant `` NEAREST
CROSS ST L� 4 's
CERTIFICATE OF,EXEMPTION FROM; ORKERS'• BATH TUB A
? 'x COMPENSATION INSURANCE' N• , OWNER66
i (This section need'not be:compl'eted�f e,work involved by SH MAIL
OWER (1-S,
,,..ry,4„ F µ
•
alie`permit'is for one hundred dollars ($100),or less)I LAVATORY ADDRESS S E.
('certify that in the'perforrfmance,of tFie woik'for which`this pec= N
., ,SINK z• TEL NO.- .
mit is•'issued 1.shall,not employ,a_ny person'in any manner so 649,7_ 1
O CITY; "
as to become subject to the Workers' Compensation:Laws DISHWASHER.
"
,r
CONTRACTOR '' ^AcYf
Date JFA
Applicant' :CLOTHES'WASHER ` Dj
-NO TICE'TO APPLICANT. If'`5fter making this Certificate of Ex- ;" ADDRESS W , ��
m :''•' SWIMMING POOL RECEPTOR:`
14'
e`mption;you sF ould Liecome,sublectio•the'Workers Com pen.-, --
a - CITY:' T L., NO..t,. a...
ati'on provisions,of the Lal or CodeCyo,u most;forthWrfh com a:: [{, 6��,Z%47
e, LAWN SPRINKLER SYSTEM
ly with:such provisions or this pe mit shall.'be deemed revok= STATE` :kx L Li C!, "
ed. -`, .V. , .._ t'ICENSE NO:._•?'•� CLASS
�j
WATER HEATER " `fid �✓
LICENSED CONTRACTORS DECLARATION; 1 TRIC OC SSE BY
GAS SYSTEM " -OUTLETS-
. ,
Thereby affirm that I amtlieensed;un'der provisions p,.Chapter
9'(commenang wi:th,Section 7000)of'Division''3 of'the Business-'
OUTLETS OVER
and Profe'ssions-Code,and=m license is_'in'full forc'e,''and of- 5 PER SYSTEM,' )
Y
fect i
y��3.9,
71, FINAL :-
License Number_ Lic. Class_
0.
_
FINA .
Contractor Date' BY O'
r
I am;exem under)Sec ,r' _ ' LAJ
V
B &P.0 for this reason. :W
s_.
s e
Y
Plari ch ck fee D ; ,
Date PLUMBING PERMIT ISSUING;FEE$ '
t
Signature
TOTAL'fEE
SINGLE FAMILY
HOME'OWNER,-BUILDER,DECLARATION Plan check applicant: _
'Thereby affirm that[a ezempt'from the.Contmctor s.License Name _
Law for;the following reason (Section 7031-:5 Business and -
P,rofess'ions Code) Adcless
:r t >.�30
• I,,.as owner'of the+ ro ert";=will, do the'work.:and the
` City Tel No
7
p..P Y, .. , �
structure is not'intended or;offered for'sale(Section 7044', . E
`Business a rd'Prafessians Code). ��
�
CONSTRUCTION LENDING AGENCY cc ; f '
r � EU, °-
I hereby'affirm that,there'is a construction'lending agency for ^
the performance,of:the work fo�'which this permit_is:`issued, s ':HANGE•' °:00,-
(Sec. 3097, Gv. C.).
Lender's Name T/ilii'
r .
Lender's Address -
..r. '.
893 AM 12
I certif `that I,have:read this application nnd'state.'that the
above information,is correct<'I agree to comply with all County
ordinances'and State-l6ws regulating-Plumbing,.and hereby. "
authorize representatives.of this-.County to enter,upon the
above-mentio dproperty for inspection purposes:
S
EE -(REVERSE FOR EXPLANATORY LANGUAGE'Lurk ,
Signature of`Permit a Date'
COUNTY OF LOS ANGELES' - TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0511010006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA. 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: - FEES PAID BUILDING ADDRESS:
TR: 15683 LT: 39 5121 KAUFFMAN AV
FEE DESCRIPTION: QUANTITY: Uom: AMOUNT: TEMP CA 917803946
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
8589-011-011 - 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C
07 BATHTUBS/SHOWERS 1.00 FIX 16.20
TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
45 WATER CLOSET/URINAL 1.00 FIX 16.20 11/01/05 JK 04/30/06
TOTAL FEES 76.35
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
TAKEDA NORMAN L;SUZANNE (626) 287-8771-
5121 KAUFFMAN AV
TEMP 917803946 DESCRIPTION OF WORK
PLUMBING FOR BATH REMODEL
APPLICANT: TEL. NO:. '
TOM O'LEARY (626) 287-0927-
5823 AGNES AVE _ _ SPECIAL CONDITIONS:
TEMPLE CITY CA 91780 -
CONTRACTOR: TEL. NO: i '� APPROVALS DATE INSPECTOR SIGNATURE
TOM O'LEARY CONSTRUCTION (626) 287-0927-
5823 AGNES AVENUE LIC. NO _ - UNDER SLAB WORK
TEMPLE CITY, CA 91780 '489354 B-1
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
ROUGH PLUMBING
` LIC. NO:
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
' I UTILITY COMPANY NOTIFIED
CWV
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508 '