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Home My Public Portal About5743 KAUFFMAN AVE_Plumbing__ 76A667-CE817 12/59 TEMPLE CoTy APPLICATION FOR PLUMBING PERMIT � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONBUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS �✓ L r� WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY ' M FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER i r WATER CLOSET MAIL BATH TUB �/q p ADDRES : vLs t_ CITY T O. SHOWER CONTRACTOR LAVATORY 9 SINS ADDRESS , DISHWASHER CITY TEL, CONTRACTOR'S STATE ❑ LAUNDRY TUB REGISTRATION NO. COIMY ❑ i WATERCLOTHEHEA ER ER DISTR��ICT I GP ( ZONE I PROCE O BY „ GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD y a O L) a 0 F. U W a rn z @ $1.00 PER ITEM `f OR FIXTURE $ I APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK TOTAL FEE-L� �J7� ROUGH PLUMBING GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURESLICENSED OF CA IFORNIASORETHAT DI AML GELES THE OS N LEGAL OWNER OFCOUNTYN THEATE ABOVE GAS TEST DESCRIBED RESIDENTIAL RIIO Y. UTILITY CO.NOTIFIED SIGNATURE 'p /�// OF PERMITTE ` FINAL /O x?/Z (hrl j,/ OF VALIDATI ROBERT A. WOOD, cB. M.O, cases UPERVISING MECHANICAL ENG'R !J 7 76A667-CE8173-59- l! � � irAPPLICATION FOR PL,UMI3I�iG PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER �r BUILDING AND SAFETY DIVISION BUILDING V JOHN A. LAMBIE, CountT EngineerADDRESS tJ FF CASSATT D. GRIFFIN, Supt of Building LOCALITY FOR APPLICANT TO FILL IN CROSS TT. , NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS CITY TEL. NO. SHOWER CONTRACTO LAVATORY yAnNTEREY PI c() ING- sINx ADDRESS 410 SO. GARFIELD AT 2-2604 DISHWASHER CITY MONTEi EY*ARAPULIFORNIA CONTRACTOR'SSTATE LAUNDRY TUB REGISTRATION NO. COUNTY E3 CLOTHES WASHER DISTRICT NO. GROUP ZONE O SSED BY WATER HEATER i GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD 9 1 / PER ITEM OR OFIRTURE $ I / f� APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ Itl 2 00 UNDER SLAB WORK ��nn TOTAL FEE ROUGH PLUMBING IDJ�1'Za® 'CRt! /ILD GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONy GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY' LDESCRIBED COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER . ry Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST A OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE RESIDENTIAL OPERTY. .� UTILITY CO. NOTIFIED RE . i ITTE OQ FINALME 1133MBEEM YtLC/' .! Or VAT-MATIROBERT A. WOOD, CK. M.o. CASH SUPERVISING MECHANICAL, ENG'R 17 4 1 12 G1 5 D ��yy ,�W40RKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 1.41 1. that I have a certificate of consent to self 20-0026 DPW 6/87 I insure, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Politry.4140, _ 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 tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Appli4ant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. �y COMPENSATION INSURANCE SHOWER OWNER/% L, (This section need not be completed if the work Involved by the permit Is for one hundred dollars($100)or less.) LAVATORY J 96C MAIL ADDRESS I certify that in the performance of the work for which this iv permit is issued, I shall not employ any person in any manner SINK CIT TEL. NO. n�� so as to become subject to the Work s'Com nsation Laws. \� � �� DISHWASHER CONTRACTOR A Date Applicant CLOTHES WASHER 1` NOTICE TO APPLICANT: If, of r ak this Certificate of ADDRESS y Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CIT TEL. NO�� T LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT P CES ED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS p� (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER v and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION DATE r—j0. License Number Lic. Class Q. FINAL X Contractor Date BY 0. ❑ I am exempt under Sec. LU ^a' B.&P.C. for this reason 6� Plan check fee ® U) Z Date: PLUMBING PERMIT ISSUING FEE$ Signature - •- TOTAL FEE Plan check applicant SINGLE FAMILY 5 HOME OWNER-BUILDER DECLARATION Name AMA' hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and ��7 (No lam-(rof�ess'ons Code): City Tel. No. " ' 1 g /X\ LJ I, as owner of the property, will do the work and the nn structure is not intended or offered for sale (Section ® TOTS 70.50 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCYCKEM 70®50 I hereby offirm that there is a construction lending agency for the performance of the work for which this permit is issued CHANE n00 (Sec. 3097, Civ. C.). Lender's Name MM-13JI 7/14/89 Lender's Address 4Q2 1 AH101121 I certify that I have read this application and state that the lop. e 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 above-men ed property for inspection purposes.✓� SEE REVERSE FOR EXPLANATORY LANGUAGE �Si nat r of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1009010002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 6561 LT: 510 1 5743 KAUFFMAN AV 1 1 .IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917802506 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: WORKMAN 1 18587-022-010 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl 149 WATER TREATING EQUIP 1:00 SYS 16.30 I (TENANT: I TOTAL FEES 44.10 (ISSUED ON: PROCESSED BY: PLAN BY: 1 109/01/10 SR 10WNER: TEL. NO: 11 IF;,NAL DATE FIN BY: CODE: 1 IMCCLURE, MICHELLE (626) 643-2735- 1 /ry/ I 15743 KAUFFMAN AV Imo` f�� ITEMP 917802506 JI)SCR PTION OF WORK 11NSTALLING A WATER SOFTNER IN GARAGE I I I I i (APPLICANT: TEL. NO: I ISAME AS OWNER - I I ISPECIAL CONDITIONS: I I I I I I I I ICONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE { ISAME AS OWNER - I I 1 I LIC. NO I 1UNDER SLAB WORK I I I I- I I I IWATER SERVICE I I 1 I I 1PLASTIC YIN METAL YIN I I 1 1ARCHITECT OR ENGINEER: TEL. NO: I I 1 1 - I IROUGH PLUMBING I I I 1 LIC. NO: I 1 1 IGAS PIPING I I I I I i I IGAS VENT I I I I I I I I I IHOT WATER HEATER I I I I I 1 1PLUMBING FIXTURES I I I I I I 1 1LAWN' SPRINKLERS I I IGAS TEST I I 1 I I 11 I I (UTILITY COMPANY NOTIFIEDI I I I ICWV I I I I 1GRAY 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 1 IREPORT ID: DPR263 ROUTE TO: BS0508 I I 1 1 I 1 l I I I