HomeMy Public PortalAbout6008 KAUFFMAN AVE_Plumbing__ V�
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APPLICATION FOR PLUMBING PERMIT .
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /1 4
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS (J
WILLIAM A. JENSEN..SUP'T OF BUILDING LOCALITY
FOR APPLICANT-TO'FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE -
' OWNER '
WATER CLOSET $1.25 MAIL
BATH'TUB 1.25 :ADDRESS D
CITY I TEL. '
SHOWER 1.25
LAVATORY 1.25 CONTRACTOR
SINK I,25 ADDRESS
DISHWASHER 1.25 -CITY'' TEL. NO.
CONTRACTOR S STATE El
LAUNDRY TUB 1.25 N COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP
R-� ZONE' PljQrESSED BY
WATER HEATER 1.50
GAS SYSTEM' OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS'OVER 5 PER SYSTEM '.30 - INSPECTION RECORD d
O
O'.
' W
z
LS _ 'S SIGNAPPROVA " ATU RE
PERMIT ., $ 2 OQ UNDER SLAB WORK
ROUGH PLUMBING , //Ar��
TOTAL FEE -GAS PIPING I
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT -
AND 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 T
RESIDE IN,THE ABOVE DESCRIBED RESIDEN PROPERTN UTILITY CO. NOTIFIED
SIGNATURE'
OF PERMITTEE P FINAL
VALIDATION ROBERT A. WOOD
CK' - M o CASH SUPERVISING MECHANICAL ENG'R ,
-r ? 5 D 5.7 5' `
/ '7 8 2 JUL
J.
WORKERS",COMP_ENSATION<DECLARATION
20-0026DPW;4;87 APPLICATION FOR PLUMBING PERMIT
�I hereby,affirm that-I have a certificate of consent-to self,in- . ' .76A667A.
sure,or a=certificaie of Workers'Compensation Insurtdnce,.or a CE 817(REV
certified copy the�eof,(Sec 3800; Lab. G),
COUNTY PF LOS.ANGELES. DEPT. OF•,PUBLIC WORKS
Policy Nod Ft Company. o ;
Certified copy is hereby furnished'- _ s
- FOR.APPLICANT TO FILC'IN (PRINT OR TYPE)' BUILDING'
Certified'copya,`s filed"with'the county buildirig inspection ADDRESS
T NUMBER @-.department FIXTURE'ORITEM
LOCALIT•
Date�.�.f. Applicant ' WATER,CLOSET' O NEAREST ��
r y CROSS ST `? t-
•'''CERT'IFICATE OFEXEMPTION+FROM WORKERS, BATH`TUB v
COMPENSATION INSURANCE SHOWER" -•-u owNER.'. -
'(This•sectton need"riot be completed if tFie=worK involved by MgIL -
the permit is;for one huri'dred dollars (5100)o`r•less.)- LAVATORY. r 1 t x• ADDRESS C/CY 1 '
� ._
-I certify that•inithe'pefformance of,the wo�k'for ebhfeh'this per
mit is issued, 1'shall,n8t employ any per ria nner so
SINK CIT �O TEL N
as to become,sublec"t to:tfie Workers, om'p ,ns Laws-L , �g- " ' „
DISHWASHER CONTRALTO!
Dat 'ApplicantCLOTHES WASHER,',*
NOTICE TO APPLICANT- If,cifter-making'th s'Cer'tific Jte- 'Ex- , • - ADDRESS
SWIMMING POOL RECEPTOR' i,,/
emption, you•should.become Oblect`to the'Worke'rs' en- CITY 4W C.
cation provisions,ofcthe`.Laboe Code;•yo'u niust'fdrihvJrtli comp- LAWN SPRINKLER SYSTEM
ly with succi provisions or this permit shall'be deeme.4,revok-- STATE LIC'
ed. $, `, WATER HEATER-,'� -LICENSE CLASS ;
LICENSED-CONTRA'CTORS;DECLARATION L DISTRI T NO PRO ED BY
I herebyaffirm that I am licensed under rovisionrof,Cho ter G4S,SYSTEM` OUTLETS � �) a, s' ~
9'(commenang with Section 7000)of-Division 3 of-the Business OUTLETS OVER
and Profes5lons-,COde, and my license is in full-force'and of 5-PER SYSTEM FINAL ar
fect. / z. DATE VALID TION a
License Num �� 'Lic Clds U:
FINAL
Contracto - "Dat• _ � BY
F lamexempt and Se
CL
B 8P'C.'forjthi3 reason ; Plan',check fee
`` Date F •/ ► .. .�. x•9-2 �. �.
V PLUMBING PERMIT ISSUING FEE $ `# o e o 1
Signature n
TOTAL•FEE 5 Q-
SINGLE FAMILY '..' ., u _ S i s( e•I s 2.8
HOMEOWNER-BUILDER DECLARATION, " Plan check applicant' 'e:o 2$ 5 dam'
-' 4 f` - �-
-n' w � .{-',. ,. n 4 •. ,.,.r..�•,[y .. Inn S`� ,
I h'ereby,'affir'm;that l,am exempt from?the^Cor ttactors L'icer se` Ndme '_ �. $8
Law for the following reason (Section 7031.5,'Busmess and h03`� g
Profess ,Code) r.:,x° ,-r Address. ': z • ,
I; as owner of the property, will do the,work and.the City Tel. No t
r
L• 'structure,is not-intended or offered for sale(Section 7044;`• -
Busiriess a_nd Professions Code)'
" CONSTRUCTION LENDING AGENCY' -
(hereby affirm that there`is a'constructio_n lendmg ggencyafor. .;,, ' a•',-, • 1 r ,
the performance of the„woFk for which this permit is issued ` �'"' i• -
(Sec 3097,.6,�'C
Lenders Name.' {
. 'r', -r �'`� ' a: �rX. r`, -. •.y'd',.:^ -'> it a ,v.. .. �. .. - s. .. - .. - , ,
Lender's Address' : -
•I^certify that'I'.'haSe re"ad'.this''application>and;staie ihot'the
above information rs;correctt;-I agree to comply with all County
ordinances and;Sfate' ws'regulatmg'Plumbing;•and,,hereby
authorize' e a es of this_County'�to enter upon the
above= ro operty for inspectwn:purposes. c r Y
k
SEE REVERSE FOR-EXPLANATORY LANGUAGE
,Signa ure m
erittee - Date/' ' ,
r �
COUNTY OF LOS ANGELES TEMPLE CITY
# 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0807010005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID FEES PAID BUILDING ADDRESS: 1
ITR: 6561 LT: 106 1 I 6008 KAUFFMAN AV 1
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917801741 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET- 1
15385-019-016 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl
1 107 BATHTUBS/SHOWERS 1.00 FIX 16.20 I 1
(TENANT: 121 HOSE BIBB(S) 2.00 FIX 32.40 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I
125 LAVATORIES/SINKS 1.00 FIX 16.20 107/01/08 SR 12/28/08 1
164 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 1 1
(OWNER: TEL. NO: 1 TOTAL FEES 108.75 IF AL ATE FIN BY CODE: 1
IRAMIREZ, RICHARD (626) 285-1360- 1 I
16008 KAUFFMAN AV I
ITEMP 917801741 I jDCRMPTIZ51N OF WORK 1
I IREMOVE & REPLACE 1 SHOWER VELVE, 2 HOSE BIBBS, 1 LAVATORY,
I IFAUCET AND WATER MAIN 1
(APPLICANT: TEL. NO:
IRODRIGUEZ (800) 782-4744- - I
ISPECIAL CONDITIONS:
I
(CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE I
ICENTURY ROOTER AND JETTING SERVICE, (800) 782-4744- _
1501 E. SANDRA AVENUE LIC. NO 1 (UNDER SLAB WORK I I I
IARCADIA, CA 91006 707409/C36 I I I I
IWATER SERVICE I I
IPLASTIC YIN METAL YIN I I
1ARCHITECT OR ENGINEER: TEL. NO: I I I I
1 IROUGH PLUMBING I I
1 LIC. NO: I I
IGAS PIPING
IGAS VENT II
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I IHOT WATER HEATER I
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I I PLUMBING FIXTURES
I ILAWN SPRINKLERS I
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IGAS TEST I I
1 11
I J (UTILITY COMPANY NOTIFIED( I
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I ICWV I I I
I (GRAY WATER SYSTEM 1 I I
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I (REPORT ID: DPR263 ROUTE TO: BS0508 I I I
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