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Home My Public Portal About5719 KAUFFMAN AVE_Plumbing__ 76A667 (CE-817) - 5/73 • APPLICATION_ F PLUM NG PERMIT ,' . COUNTY OF LOS ANGELES n. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FADDRESS G MAKE CHECKS PAYABLE TO: ��s•. /. 'HARVEY T.. BRANDT, COUNTY ENGINEER',r_ TYFOR APPLICANT TO FILL IN.(PRINT OR TYPE) TT. NUMBER FIXTURE OR ITEM @ FEE ,OWNER .1 •. .,. , WATER CLOSET 1.75' BATH TUB -1�' 1.75 ADDRESS' SHOWER 1.75 CITY TEL.'NO.. LAVATORY 1,75 CONTRACTOR e+ . SINK 1.75 - ADDRESS DISHWASHER 1.75 ii5 CI TEL. N0. CLOTH ES-WAS HER 1.75 STATE ,J LIC LICENSE NO+.+% CLASS .1 SWIMMING POOL RECEPTOR. 1,75 DIST�T NO. GR F OI, � � F CESS '-BY LAWN SPRINKLER SYSTEM 1;75 ` WAVER HEATER 1.75 INDUSTRIAL WASTE AP,PROVAV d GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD Ov OUTLETS OVER =1 -/ 5 PER SYSTEM 30 � r/ �� Off/✓ ��✓.l .�Lli,C,Di p ' Cn Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 ' 00 TOTAL FEE 4 APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant +UNDERISLAB WORK Name ROUGH PLUMBING Address GAS'PIPING City• Tel. No. GAS VENT HOT WATER HEATER - . I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND' STATETHAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL ,COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. . GAS TEST I HEREBY CERTIFY-THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED ` a LICENSE DAS EOUI RED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR AT I AM THE LEGAL OWNER OF, AND INTEND TO 0 OL 6- rD �!I-7c,/ IV-,-19!P9 �•�,.yw� RESIDE IN THE AB RESIDENTIAL PROPERTY. FINAL' SIGNATURE , OF PERMI TEE PERMIT VALIDATION CK. :0. CASH PLAN CHECK VALIDATION CK. M.0. CASH 7 4 2"�'JUN 27 5 0 6.5 0 eyo — - 76A667 -CE#8172-62 ' TEMPLE CITY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DNISION BUILDING 5— - It - / JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS of WILLIAM A. JENSEN, SUPT OF BUILDING ,LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE 1 OWNER WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS �j ) SHOWER 1.25 :CITY_ O.2-ft-2, LAVATORY 1.25 'CONTRACTOR SINK 1.25 ADDRESS S DISHWASHER 1.25 CITY . N LAUNDRY SUB 1.25 :CONTRACTOR'S STATE ❑ REGISTRATION NO. COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT No. GR Z E Pkto_r-ssspoBY WATER HEATER 1.50 ~^ GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL _ OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD) / o A* 7 v � a Vf z APPROVALS DATE INSPECTORjS SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A PLICATION GAS VENT ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. , I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS'TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO n RESIDE IN,THE ABOVE DESCRIBED RES ENTIAL PROPERTY. UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE FINAL OCKM o LIDATION ROBERT A. WOOD CASH SUPERVISING MECHANICAL ENG'R ltlLo 0 8 3 71 SEP 3 0 5. D 4.50 a � - • -.. .- �.. ' - _to l `"�=1 Vr�:trip�j L•� WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 FOR - �•.�,-• - '�-ll';: I he;ebyraffirm that I have a certificate of consent to self'insure, r76A667A APPLICATION .� ,,PLUMBING PERMIT/,• �,•s, • br a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec 3800 Lab C) •�� •�- •' ``='� •^ '`• • ', COUNTY OF LOS ANGELES DEPT.:OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. i Policy No. Company , Certified copy is hereby furnished. a L /it ,n FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ ADDRESS" 1 Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM FEE LOCALITY �,{f Date Applicant WATER CLOSETNEAREST t CROSS ST • CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE , ASSESSOR - , PAGE PARCE& , (This section need not be completed If the work involved by the SHOWER MAP BOOK O permit,is for one hundred dollars($100)or less.) LAVATORY OWNER l`��VL 4 I certify that in the performance of the work for which this permit 5 'MAIL 'A ' is issued, I shall not employ any person in any manner so as to SINK' ADDRESS MAk— become subject to the Workers' Compensation Laws. \\// DISWASHER CITY TEL.NO. Date X `' Applicant X CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATIONCITY TEL.NO. a I hereby affirm that I am licensed'under provisions of Chapter 9 WATER HEATER commencin with Section 7000 of Division 3'of the Business and STATE LIC. ( 9 ) LICENSE NO. CLASS Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS V OUTLETS OVER DISTRICT NO PROCESSED BY cr 5 PER SYSTEM License Number Lic.Class, (/ V FINAL _z DATE - VALIDATION LU Contractor Date l _I _; U) ❑ FINAL i Z I am exempt under Sec BY. B.&P C for this reason -Plan check fee , Date: PLUMBING PERMIT ISSUING FEE$ Signature Z TOTAL FEE /, a` ❑ SINGLE FAMILY Plan check applicant Jp�T V � HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address Code): City Tel. No. / I,as owner of the property,will do the work and the structure 9(p is not intended or offered for sale (Section 7044, Business and Professions Code). , . I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the r - 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 nter upon the above-mentioned prope o ecti n ur es SEE REVERSE FOR EXPLANATORY LANGUAGE l Wiz- 9� Signatu of Permittee Date WORKERS'COMPENSATION DECLARATION G -� 30��APPLICATION FOR PLUMBING-PERMIT I�eFeey`.affvm that I have a ceLrhficate of consent to self _ 76A667A _ irrurcJ, or a certificate o4'WOrkers" Compensation Insurance, CE 817(REV 10/B1) of o certified copy thereof (Sec. 3800, Lab;,C ) M COUNTY OF LOS ANGELES _• 1--_,-_ _BUILDING AN_D SAFETY _ 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 inspec- ADDRESS CC,14 tion department. NUMBER 'FIXTURE OR ITEM @ - - FEE-•'^ LOCALITY Date Applicant _ WATER CLOSET NEAREST--.. -- _ CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER -(This section'need not be completed if the work Involved by MAIL `� /�// the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRE / /�_�CJ I certify that in the performance of the work for which this l permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO� �- Ze- 'SO as to become subject to the Workers'Compensation Laws DISHWASHER . CONTRACTOR V 4)Z) / �O Date Applicant CLOTHES WASHER NOTICE'TO APPLICANT If, after making this Certificate of _...._ _ ADDRESS, - 33., Exemption, you should become subject to the ,Workers' SWIMMING POOL RECEPTOR CITY �� TEL. NO. Compensafion provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM' with comply with such provisions or this permit'sholl be STATE;__.... //�!s LIC deemed revoked. WATER HEATER LICENSE NO !C ( CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY I hereby affirm that 1 am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER U' and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL L/yd CDATE a� License Number ?!/ Lic. Class FINA - O BY U. Contractor Date' I am exempt under Sec. B i3P C for this reason ,r Plan check fee pW Date- /&_Xl �b M PLUMBING PERMIT ISSUING FEE$ ........... .,..: . � TOTAL FEE Plan-check applicant - - SINGLE FAMILY HOME OWNER-BUILDER DECLARATION'' Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031 5, Business and Professions'Code): , - • ' City Tel. No. ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sole•(Section , 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY _ � IQti�> I�•�,c=� 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 ) ^7� Lender's Name - ✓�j�j�a " 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 jaws regulating Plumbing, and hereby authorize representatives of this County, to enter upon the - ••I' �' a �S,g ve-mentioned propert for inspection pure es SEE REVERSE FOR EXPLANATORY LANGUAGE nature o Permittee Date . WORKERS'COMPENSATION DECLARATION 76A887A APPLICATION FOR P L U M B•I N G .P E R M I T I hereby affirm, that I have a' certificate of consent to self ce a» (z-so) 5 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 Q Certified copy is hereby furnished. FOR APPLICANT TO FI LL IN (PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM • FEE ADDRESS ��z! �/iWN Certified copy is filed with the county,building inspection department. / f LOCALITY Date Applicant WATER CLOSET NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' n��Go �x COMPENSATION INSURANCE /• SHOWE-R y 'OWNER ' MAIL � -(This 'section need not be completed if the work involved LAVATORY ADDRESS �' a by the permit is for one hundred dollars ($100) or less.) SINK Q CITY TEL: NO. U I certify that in the performance of the work for which this DISHWASHER CONTRACTOR / perma is issued, I shall not employ any person i any manner G�v e+f �// G—,' Q so as to become subject to the Workers!/omp at• aws. CLOTHES WASHER ADDRESS L� / • ` U DatX_ z —� Applicant `' L / r� W SWIMMING POOL RECEPTOR d NOTICE TO APPLICANT;"If, after making this 'ertificate of CITY ' TEL. NO.'&,-23 (q Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE ! LIC. /J Z Compensation provisions of the Labor Code, you,must forth- LICENSE NO.ZZ5'a36 CLASS v � with comply with such provisions or this permit shall be WATER HEATERr deemed revoked. �' GAS SYSTEM ♦ OUTLETS �_ DIST ICT NO. PROCES D BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER. / O t� 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 '7r//�� VALIDATION Hess and Professions Code, and my license is in full force and DATE ,�' effect. FINAL License Number Lia Class _ � BY V y" Contractor Date )_4-el� /f�"r� I am exempt from the licensing requirements as I am a Plan check fee I� I licensed architect or a registered professional engineer acting in my professional capacity (Section 7051, Bus- iness and Professions Code). 4 TOTAL FEE 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 following reason (Section 7031.5, Busi- City Tel�No, ness and Professions Code): I, as owner of the property, am exclusively contracting with licensed contractors to construct the project 3 0 4,8 A (Section 7044, Business and Professions Code). #l0000a5 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 2"o o4 a'5`0 for the performance of the.work for which this permit is issued(Sec. 3097,Civ.C.). ;`o o t04$5 Ox Lender's Name • - • "' Lender's Address 0 2 123— ,82 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 a la regulating Plumbing, and hereby authorize represe ativ of this County to enter upon the above-mention drop y for in ection purposes. ry y Signature of Permittee ate