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Home My Public Portal About5702 KAUFFMAN AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 7PW a/90 6A667A sure,or o'certificate of Workers'Compensation Insurance,or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS 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 deportment. NUMBER FIXTURE OR ITEM @ FEE z 3 ( ) LOCALIT �.. WATER ,TOILET Date Applicant BATH TUB CROSS NEAREST . �I�� D CERTIFICATE OF EXEMPTION FROM WO ERS' �� At COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL //yy n ,{ the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS S5 0 1 1 I certify that in the performance of the work for which this per- SINK � te��iid�rr mit is issued, I shall not employ any person in any manner so CITY /6M C.fTEL. NO)gy/j„ as to become subject to the Workers'Compensation Laws. _ DISHWASHER CONTRACTOR ;Q -- toeo __L_�G Date Applicant CLOTHES WASHER ` / _ NOTICE TO APPLICANT: If, after making this Certificate of Ex_ ADDRESS J'-CJ��--�- em tion, ou should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR P Y I P CITY , ) /,4 TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS N ly with such provisions or this permit shall be deemed revok- STATE125F /� UC. ed. WATER HEATER LICENSE NO. (,�g CLASS LS ed. -C� LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY GES SYSTEM OUTLETS I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL fect. HOSE BIB DATE ..VAUDiATION ( c� �j / -, License Num er r/-✓SS A Lic. Class GV -c-f6 1FIN .�`Y/r1� BY AL`�-1 I—OL4 T?`IAL 2 m G 1 Contractor Date El I am exempt under Sec. .HE4 tt ''-'fj i s B.&P.C. for this reason CH ANGEPlan check fee ► `` Date: PLUMBING PERMIT ISSUING FEE$ p _ Signature i_% Si g TOTAL FEE � 4� SINGLE FAMILY tact $ #=rl 1 HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address ❑ 1, as owner of the property, will do the work and the City. Tel. No. structure 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 �bove-_,entionqjproperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r Si nature o Per jlee Date WORKERS'COMPENSATION DECLARATION 76A667A' I hereby affirm that I have a' certificate of consent to self cE e1 7 (z-60) APPLICATION FOR PLUMBING PERMIT insure, or a certificate of Workers'Compensation Insurance,or ~ '� a certified copy thereof(Sec. 3800,Lab.C.) u COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING r ADDRESS S ?�O� t Certified copy is filed with the co my b it g' spection NUMBER FIXTURE OR ITEM • FEE { LOCALITY de (�� ^ Date a tine �pplicant WATER CLOSET NEAREST of BATH TUB CROSS ST. ✓` CERTIFICATE OF EXEM O FROM WORKERS' AIRN ASHOWER d COMPENSATIJ ML S'S O (This section need not be 'om eted if the work involved LAVATORY ADDRESS O by the permit is for one h red dollars ($100) or less.) SIN K CITY TEL. NO. U I certify that in the performance of the work for which this DISHWASHER r permit is issued, I shall not emW erso i any mariner CONTRACTOR Cj J Cz O so aAnAPKICANT ubject to theCo sation Laws. CLOTHES WASHER ADDRESSt{ pplicant ! SWIMMING POOL RECEPTOR af CL GT : If, a ter making this Certificate of CITY ` Of rr TEL. NO. F5^ LAWN SPRINKLER SYSTEM STATE LIC. Exemption, you should be a subject to the Workers' _ Compensation provisions A e Labor Code, you must forth- LICENSE NO CLASS with comply withsuch provisions or this permit shall be WATER HEATER deemed revoked. DISTRICT NO. PROCESSED BY GAS SYSTEM OUTLETS Y LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM �E9 (commencing with Section 7000) of Division 3 of the Busi- FINAL4-��q VALIDATION ness and Professions Code, and my license is in full force and �f4i S e7p,V L' DATE s effect. FINAL License Numbe Lic. Class �+ Ls,NT BY ContractIlki 11dte I am exempt f om the licensing req-_ nts as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEES �',1 O acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE t (y �j�i e' Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the followingreason Section.7031.5, Busi- 0 0 0 0 ( City Tel.No. 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). c 0 1. �j. j 0 17 CONSTRUCTION LENDING AGENCY o ;i I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is ? 17— ?L 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and(St, laws regulating Plumbing, and hereby authorize reprves of this County to enter upon the above- tionerty fo ection purposes. Signa u of Permittee D to COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1301220023 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 6561 LT: 100 5702 KAUFFMAN AV I .1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917802505 (ASSESSOR INFORMATION NUMBER: 1 1 NEAREST CROSS STREET: 18587-023-026 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: S97 GRID: A3 LOCALITY: TEMPLE CITY CAI 1 163 WATER PIPING BR/FIX 10.00 FIX 68.00 1 1 ITENANT: 1 TOTAL FEES 95.80 11SSUED ON: PROCESSED BY: PLAN BY: 1 1 1 101/22./13 SR I 1 1 1 I (OWNER: TEL. NO: I 1F NAL DATE F BY: CODE: I 1ADAMS, KATHY (626) 451-0512- 1 1 1 15702 KAUFFMAN AV ITEMP 917802505 1 ID C IPT ON OF WORK 1 1 IREPIPE ENTIRE HOUSE WITH PEX 10 FIXTURES 1 I i I I (APPLICANT: TEL. NO: 1 1 1 1KINGSLAND, JONATHAN (818) 426-2947- 1 1 114724 VENTURA BLVD 1 1SPECIAL CONDITIONS: 1 1SHERMAN OAKS 91403 1 1 1 I I I I I I I I 1CONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE 1 1ULTIMATE BUILDERS (818) 981-5016- 1 1 1 114724 VENTURA BLVD #307 LIC. NO 1 1UNDER SLAB WORK 1SHERMAN OAKS CA 91404 927892 1 1 I 1WATER SERVICE 1 1 1 I 1PLASTIC Y/N METAL Y/N 1 1 (ARCHITECT OR ENGINEER: TEL. NO: 1 1 1 1 IROUGH PLUMBING 1 1 1 LIC. NO: I I IGAS PIPING 1 1 1 I I I I I I 1 1 1GAS VENT 1 I 1 I 11 I I 1 1HOT WATER HEATER I 1 1 1PLUMBING FIXTURES 1 I 1LAWN SPRINKLERS I I I I I I 1 1 1GAS TEST I I I 1-1 I I (UTILITY COMPANY NOTIFIED( 1 1 I I 1-1 I 1 1Cwv i I I 1 1 I I I 1 1 1GRAY WATER SYSTEM 1 1 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 1REPORT ID: DPR263 ROUTE TO: BSO508 1 1 1 1 1_ I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT- DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 9901270026 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 6561 LT: 100 5702 KAUFFMAN- AU FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP-CA-917802505 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8587-023-026 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY 47 WATER HEATER(S) 1.00 WTH 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 01/27/99 UT 01/27/00 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: SALVO ALBERT P;MICHELENE r�C� 5702 KAUFFMAN AV TEMP 917802505 DESCRIPTION OF WORK "") CHANGE OUT OF WATER HEATERI APPLICANT: TEL. NO: MR ROOTER PASADENA (626) 445-8203- 25 WHEELER ST. #L SPECIAL CONDITIONS: ARCADIA, CA Epp MRNR OTERROF PASADENA (626)N445-8203- d®� APPROVALS DATE INSPECTOR SIGNATURE 25 WHEELER #L LIC. NO UNDER SLAB WORK P 0 BOX 661843 706307 C36 ARCADIA CA 91006 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING LIC. N0: / - 1111111 IL GAS PIPING �] GAS VENT �� L \��/ O� HOT WATER HEATER �-� V PLUMBING FIXTURES 12 LAWN SPRINKLERS O ❑ �' L= GAS TEST n IJP UTILITY COMPANY NOTIFIED 9®¢0� CWV4Q1� GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508