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HomeMy Public PortalAbout5725 KAUFFMAN AVE_Plumbing__ 76 A 667•-- CE 817 7-69 APPLICATION' FOR. PLUMBING -_FE_ RM 4 COUNTY-OF LOS ANGELES, DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY'DIVISION - BUILDING 2� " �L�i - JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS J , COLEMAN W. JENKINS. SUPT OF BUILDING' LOCALITY D' FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST- CROSS'ST. i NUMBER, FI XTU•RE OR ITEM EACH FEE "i - OWNER WATER CLOSET ' 1.50 I4111n2. J ` BATH TUB',, 1.50 ADDRESS SHOWER 1.50 CITY TEL. N LAVATORY - 1.50 CONTRACTOR IYVIS I . SINK - ' P.50 ADD - DISHWASHER •1.50, CITY'-, �l _TEL.'NO.� `CLOTHES WASHER - 1,:50 •'STATE"• �� LIC, 'LICENSE NO. CLASS y SWIMMING POOL RECEPTOR, 1.50 - 'DI STRICT'N CRO_ ZONE r RJRC�5E `LAWN SPRINKLER SYSTEM :2.00' ' •WATER HEATER 1.50 'INDUSTRIAL^ , WASTE APPROVAL ' GAS SYSTEM - 'OUTLETS 1.50 l _ INSPECTION RECORD ' OUTLETS OVER- 5 VER .30 - - - 5 PER-SYST-EM , Plan check fee 2576,of above.-See reverse: PLUMBING.PERMIT ISSUING FEE S 2 00''. - - TOTAL FEE 'APPROVALS DATE.. INSPECTOR'S SIGNATURE'a , Plan check;applicant ' UNDER SLAB WORK Name^ • - '{ • ^ ROUGH PLUMBING !� r Address" •- � - ' GAS PIPING v •• ' 'GAS VENT •.City• Tel. No. 'HOT.WATER HEATER • ' 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS,APPLICATION , AND STATE THAT THE_ABOVE IS CORRECT'AND AGREE-TO COMPLY-" 'PLUMBING FIXTURES WITH BALL-COUNTY ORDINANCES AND STATE LAWS REGULATING'- GAS TEST d'+ PLUMBING: - - - - - I HEREBY CERTIFY THAT 1 1.AM,PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED - LICENSED AS REQUIRED BY-.LOS ANGELES COUNTY AND� STATE ,OF CALIFORNIA OR,THAT I AM THE LEGAL OWNER OF,AND INTEND TO a! •d' , RESIDE IN,THE A VE DEGCRIBEO RESIDENTIAL 4, 1P T FINAL SIGNATURE �t-I � - ,JACK R. ALLEN, SUPERVISING MECHANICAL R. •- OF PERMITTEE- _ - , PERMIT VALIDATION cK. m'.0'. CASH PLAN CHECK-V ALIDATIOV CK M O. CASH y A127 5 '0; 3;5;gN;�a WORKER'S COMPENSFtiTIONDECARATION ( 76A667DPW,9/69 APPLICATION FOR PLUMBING PERMIT 76A667A I hereby affirm that I have avcertific4ats of,consent to self insure; b or a-certificate of Worker's Compensation Insurance, or a certified copy,thereof sec 3800 Lab.-C. � �- ® 5 / v� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS; DEPT. OF PUBLIC WORKS DIV. Policy No/ p Company I I I ❑ Certified coPY is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE), _. BUILDING Certified copy is filed with the county building inspection '`} ADDRESS department /( NUMBER FIXTURE OR ITEM i FEE LOCALITY aL � /} Date L v Applicant 1`,G�.=� WATER CLOSET NEAREST !> © Lf�T/t� CROSS ST.. V C CERTIFICATE OF EXEMPTION ROM WORKERS' BATH TUB J COMPENSATION INSURANCE ASSESSOR (This section need not be completed If the work Involved by the �^ SHOWER 5-0 MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) LAVATORY OWNER Y 1' Ae- 1 certify that In the performance of the work for which this permit MAIL person is issued, I shall not employ any person in any manner so as to 1 SINK ADDRESS �•� 02�' become'subject to the Workers' Compensation Laws DISWASHER CITY '1 P TEL NO. Date Applicant CLOTHES WASHERCONTRACTOR- I t NOTICE TO•APPLICANT: If, after making this Certificate,-of _ Exemption,you should become subject to the-Workers'Compensation SWIMMING POOL RECEPTOR ' provisions of the Labor Code, you must forthwith comply with such ADDRESS .��� Aqi ��� provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY s7(� 6/f s' (P L_ TEL NO ��5 'S/a 7 d I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER /' 'f STATELIC (commencing with Section 7000) of Division 3 of the Business and � 7 �-C CLASS C �� O GASLICENSE NO. Professions Code,and my license is in full force and effect. ,SYSTEM 3 OUTLETS - OUTLETS OVER DIT CT NO/� ROC D BY a:5 PER SYSTEM J(' 00 License Number Sa -.5(94( Lic.Class U \ FINAL V 1 p�J .� Q DATE VALID TION a Contractor t Date Z CO FINAL GIyU r• ❑ I am exempt under Sec. i - BY BAP.C.for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY Plan check applicant c _ HOME OWNER-BUILDER DECLARATION Nameti r r•f y a I hereby affirm that I am exempt from the Contractor's License Law t•t•i es ; for the following reason (Section 7031.5, Business and Professions - Address _ = 117 3131.It`D Code) City Tel. No. ❑ T- I,as owner of the property,will do the work and the structure 1 ITEC hi`IO is not intended or offered for sale (Section 70441"Business TOTAL 30 - 65 and Professions Code). ► CONSTRUCTION LENDING AGENCY CHE; j�) I hereby affirm that there is a construction lending agency for the CHANGE ,Iii f performance of the-work-for which this permit is issued (Sec. 3097, Civ C) tt 4 Lender's Name 00co—[I[Iftl i j{{�r{�q�j�51/I •• ` - - 252( 1 AM 10:24 Lender's Address I certify that I have read this application and state that the above , y 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 for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0904070015 BUILDING AND SAFETY'/ LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT ILEGAL ID- - _ FEES PAID BUILDING ADDRESS: ' - ITR: 6561 LT: 508 UN: .002 5725 KAUFFMAN AV I I _ IFEE DESCRIPTION: - QUANTITY: UOM: AMOUNT: ( TEMP CA 917802506 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: - 1 18587-022-006 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl 1 - 151 LOW PRS GAS 5 OUTLET 1.00 SYS, 16.20 1 1' (TENANT. I TOTAL FEES 43 95 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON. 1 104/07/09 SR 10/04/09 I I I I TOWNER: TEL. N0- I IF.IN DAT :nBy: CODE: I ICONTRERAS, JIM (626) 285-0789- _ 1 15725 KAUFFMAN AV - - 3 ITEMP 917802506 IDE CRIPTI OF WORK IGAS LINE FOR HVAC SYSTEM I I I I (APPLICANT: TEL. NO• I _ ITEMPO A/C & HEATING (626) 444-8885- 15937 N. OAK AVENUE - 1 ISPECIAL CONDITIONS: 1 ITEMPLE CITY CA 91780 - I (CONTRACTOR: TEL NO: 1 (APPROVALS • DATE INSPECTOR SIGNATURE 1 ITEMPO AIR CONDITIONING AND HEATING (626) 285-1218-'l 15937 N. OAK AVE. LIC. NO •1 (UNDER SLAB WORK I I ITEMPLE CITY, CA 91780 - 274880C20 I I IWATER SERVICE I I I I I IPLASTIC Y/N METAL Y/N (ARCHITECT OR ENGINEER: TEL NO: I - I - I IROUGH PLUMBING I I I LIC. NO I 1 11 I I (GAS PIPING �I I IGAS VENT I I I IHOT WATER HEATER i 1 I -1-1 I IPLUMBING FIXTURES I I I I I I I I ILAWN SPRINKLERS- IGAS PRINKLERS-IGAS TEST (UTILITY COMPANY NOTIFIED I 14 1 II I I ICWV I I 1 I I I I I I I IGRAY WATER SYSTEM 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 IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I