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HomeMy Public PortalAbout6012 KAUFFMAN AVE_Plumbing__ 76AG67C (CE-8178) -9/75 .�� APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING i nBA FIXTURE OR ITEM @ FEE ADDRESS TER CLOSET LOCALITY NEAREST THH TUB CROSS S SHOWER OWNER LAVATORY MAIL ADDRESS SINK CITY ` L. NO. DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS -SWIMMING POOL RECEPTOR CITY TEL. NO. LAWN SPRINKLER SYSTEM , STATE LIC y. WATER HEATER LICENSE NO CLASS DISTRICT NO. GROUP 12�01NEJ PROCESSED BY' v GAS SYSTEM OUTLETS (� �- C= CD OUTLETS OVER Q 5 PER SYSTEM INDUSTRIAL a WASTE APPROVAL INSPECTION RECORD Z Plan check fee PLUMBING PERMIT ISSUING FEE $ TOTAL FEE Plan check applicant Name APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel. NO. GAS PIPING I HEREBY ACKNOWLEDGE THAT I 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 TO RESIDE IN THE ABOVE DE RIB D RESID TIAL PRO ERTY. UTILITY CO. NOTIFIED SIGNATU RE OF PERMITTEE t' FINAL PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATIONcK.v M.0. CASH 5 0 5tiNOV 29 5 2.5 0 Ate, 76A667A(CE817A) - 8/70 - -r, • APPLICATION FO PLUMB G PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION g MAKE CHECKS PAYABLE TO: ADDRESS BUILDING'4 ,f f HARVEY T. BRANDT, COUNTY ENGINEER LOCALI FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST NUMBER FIXTURE OR ITEM @ FEE CROSS ST. OWNER WATER CLOSET MAIL BATH TUB ADDRESS SHOWER CITY T �p 'LAVATORY CONTRACTO r SINK ADDRESS DISHWASHER - CLOTHES WASHER TATE _ LIC /f7 LICENSE O CLASSCr c3 `sem SWIMMING POOL RECEPTOR _ DISTRIC NO. GROUP ZONE ROCESSED BY LAWN SPRINKLER SYSTEM WATER HEATER INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS INSPECTION RECORD d OUTLETS OVER O 5 PER SYSTEM V . O F u ' W a Vf Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ TOTAL FEE APPROVALS DATE INSPECTOR 5 SIGNATURE Plan check applicant UNDER SLAB 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 STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES ' WITH -ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. I HEREBY CERTIFY THAT 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 O , AND INTEND TO _ 101 RESIDE IN THE ABOVE DESCRI BED RESIDENTIA P OPERTY. FINAL .7 SIGNATURE OF PERMITTE PERMIT VALIDATION CK. M.0. CASH PLAN CHECK VALIDATION CK. M.O. CASH 3:1 1 XJI .28 5 B 7.5.0 498 Yexear -�� APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL INDISTRICT NO. GROUP ZONE PERMIT NO. PLUMBER Belvedere Plumbing COn RECEIVED BY FIRSREADY FOR T INSPECTIONDATE ISSUED ADDRESS 136___S Palm Ave, z.may- ,tea BUIL ((''��C ADDRESS N. Kauffman f CITY Alhambra TEL. NO. AT75025COUNTY ' , L CENSE NO. $O$'I+�I EXPIRES 6 f 30151 LOCALITY Temple City NEAREST PERMt T FEES CROSS ST. ' NUMBER � TYPE OF FIXTURE OR ITEM FEE OWNER D. Forrest Smith MAIL _I WATER CLOSET (TOILET) Q 0.50 I S o ADDRESS BATH TUB @ O 50 I CITY TEL. NO. SHOWER Q 0.50 I 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS 2' LAVATORY (WASH BASIN) C) 0.50 I� APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE A COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ O 50 I STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY Q 0.501 50 ANGELES COUNTY LICENSE. OR t AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM-OUTLETS Q 0.501 SIGNATURE OF WATER HEATER Q 0.50 50 PERMITTEE (.•�-!� � A]/fa /mow -��L xxxx)uc Disposal a o,Sol 0 INSPECTION RECORD FLOOR SINK Q O 50 FLOOR DRAINcQ 0.50 I DISHWASHER Q 0.501 1 I Z`�I Mu 4 4-1- r/L kS[',- dl,- DRINKING FOUNTAIN 0.501 I ,r r ' teprl r URINAL O 501 rfj,,z HOUSE SEWER Q O 50 1 I - Q Ilan 0 U� _ l.n�.k C i� Z lMISCELLANEOUS1 �j 1'r 9 Lr- Fr„r O K . l 6 -G"I I_J eR �j r A/ii • � � � ��s�orl�� i�Crr,�/� APPROVALS - DATE INSPECTOR'S NAME ROUGH-PLUMBING GAS PIPING GAS VENT CESSPOOL © 1.00 I I CEGSPOOL 1 SEPTIC TANK: I SEPTIC TANK �I I I DRAIN ( ) PIT ( ) Q 1.00 I SEWER PERMIT . I 1.00 GAS TEST --16-J I r TOTAL FEE UTILITY CO. NOTIFIED S 5 p _ FINAL I •�q��I 4b\ AKA M 70AG67 17 3-$0 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING 1 WILLIAM,J. FOX. CHIEF-ENGINEER FOR APPLICANT TO FILL IN, DIST LCT NO. GROUP ZONE PERMIT NO. PLUMBER /�' RECEIVED BY READY•FOR DATE ISSUED �. FIRST INSPECTION ADDRESS !2 r..sr'�yt �"�%+I� BUILDING CITY 4s TEL. NO. ADDRESS COUNTY LOCALITY LICENSE NO. EXPIRES NEAREST PERMIT FEES cRoss sr. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET (TOILET) @ 0.50_ $ I ADDRESS 1 BATH TUB @ 0.50 I CITY TEL. NO. 1 SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) Q 0.501 APPLICATION AND STATE"THAT THE ABOVE-IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING. JJ 1 CERTIFY THAT I ,POSSESS THE ABOVE VALID LOS' LAUNDRY TUB OR TRAY @ 0.501 ANGELES COUNTY LICENSE, OR I,AM THE LEGAL OWNER OF THE RESIDENTIA PROPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS Q 0.501 SfGNATU WATER HEATER _Q_1 10 1 ' PERMITTEE ?? SLOP SINK @ 0.501 INSPECTION RECORD 1 FLOOR SINK @ 0.501 FLOOR DRAIN @ 0.501 DISHWASHER @ O.SO 1 DRINKING FOUNTAIN @ 0.50 1 URINAL @ 0.50 J 1 HOUSESEWER @' 0.501 z MISCELLANEOUS • 1 0 APPROVALS 1 DATE INSPECTOR'S NAME ROUGH PLUMBING 1 GAS PIPING 1 GAS VENT CESSPOOL @ 1:00 1 CESSPOOL SEPTIC TANK: SEPTIC TANK I DRAIN ( ) PIT ( ) Q 1.00 SEWER . PERMIT . t.o GAS TEST T UTILITY CO. NOTIFIED FINAL TOTAL FEE $ WORKERS' COMPENSATION DECLARATION , APPLIC. TION FOR PLUMBING PE'RMIT- I hereby affirm that I have a, certif-ate fof•,i;onsent to self 76A667A, insure, or a certificate of.Workers' Compensation Insurance, CE 817(REV-10/81) or a certified copy thereof,(Sec. 3800, Lab. C ) COUNTY OF,LOS ANGELES BUILDING,AND SAFETY Pohcy No. Company r -0 Certified copy is herebyfurnished. .I FOR APPLICANT TO FILL IN(PRINT OR TYPE). BUILDING F-11Certified copy is filed with the county building inspec-' ADDRESS P1 �, tion department � NUMBER FIXTURE OR ITEM Q FEE' LOCALITY ` e a .7 t WATER CLOSET _ • Date Appligant NEAREST. CERTIFICATE-OF EXEMPTION,FROM WORKERS' BATHTUB CROSS ST COMPENSATION INSURANCE OWNER / ` (This'section need not be completed if'the work involved by _ SHOWER' f i Qi. the.permit is for one hundred dollars ($100)or less.) LAVATORY MAIL Sc�.� ADDRESS- 12 I,certify that in the performance of,the work for which'this permit is,issued, I•shall not employ any person in,any manner SINK,' CITY TEL NO: so as to become'subject to the Workers'Compensation Laws DISHWASHER s c+Jn Y _/�g CONTRACTOR Date Applicant W, � t 4�� s CLOTHES WASHER, ADDRESS NOTICE TO APPLICANT: If, after.making this Certificate of SWIMMING POOCRECEPTOR / Exemption, you should become subject to the Workers' ' Compensation provisions of the Labor Code, ,you must forth CITY TEL. NO - LAWN SPRINKLER SYSTEM with -comply with such provisions or this permit' shall be STATE LIC deemed revoked. WATER HEATER LICENSE NO CLAS LICENSED'CONTRACTORS DECLARATION �'" j A DISTRICT NO ESSED,BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 5 /�� (commencing with Section 7000) of Division 3 of the Business' OUTLETS OVER (� 9 and Professions'Code,and-my license is in full force and effect. - 5 PER SYSTEM FINAL VALID ION O DATE License Number Lic. Class- V f;f9 FINAL O Contractor Date BY _ u El , W I am exempt under Sec - � 0- B.BP.0 for this reasonZ , Plan•check:fee • .. � . Date: /� ► PLUMBING PERMIT ISSUING FEE$ �v Signature TOTAL-FEE SQ' a' Plan check'applicant - r SINGLE FAMILY x`2.9 7 A HOMEOWNER-BUILDER DECLARATION Name # o o,o.'o 0,-5, I hereby affirm that l arr exempt from the Contractor's License Address Low for the following reason (Section,7031.5, Business and ) o'01 6:5,0_ �Professions Code): - Gty,.- Tel No., LTJ I, as owner of the property, will do the work and the 11 6:L5 O ' 'structure ,is not')ntended or offered'for. sale (Section 7044, Business and Professions Code). ,^ .0,9.d 7.7 8'5,' CONSTRUCTION LENDING AGENCY I hereby-affirm that there is a'construction lending agency for F the performance of the work for which•this permit is issued (Sec 3097, Civ C.) Lender's Name Lender's Address I certrfy that I have read this application and state that the above information is co_rrect 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 prope for inspection-purposes 1 a SEE'REVERSE FOR EXPLANATORY LANGUAGE-' fl Signature of Permittee Date ,WORKERS'COMPENSATION'DECLARATION i[ APPLICATION FOR PLUMBING PERMIT I hereby affirm that 1• have a certificate of consent to self j 76A667,4 nsure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10 81) CITY. OF- TEiT��a CITY ora certified copy thereof (Sec 3800,'Lab. C.) COUNTY OF.LOS ANGELES BUILDING AND SAFETY Policy No.—Company ScI24199 'O•REAOY FOR INSPECT ION / Certified copy is hereby furnished., FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ; Certified-copy is filed with the county building inspec ADDRESS 6Q12 O c3 'a 11 .AV@" tion department. NUMBER ,FIXTURE OR-ITEM @ FEE LOCALITY Date_ A li ant Gell4sC . WATER CLOSET /��g4 Temt�leM1Cit J PP 4 al InstallCROSS , SST Las . Tunas CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB _ COMPENSATION INSURANCE OWNER, Ing Tjv1an Lee (This section need,not be'completed if the work involvedSHOWER by MAIL h+" the permit is for one hundred dollars ($100)or-less.) LAVATORY same ADDRESS -1 certify that in the performance of th_e'work.for which this permit is issued, I shall not employ"6ny person in any manner SINK CITY TEL. NO-85 043 • so as to become subject to the Workers'Compensation Laws ; DISHWASHER "< CONTRACTOR'General Installation .,Co,. ,,,,-: Date Applicant ' CLOTHES WASHER - r -� - x•, NOTICE TO APPLICANT. If, after -making this Certificate of ADDRESS 558 incest ,Blvd. Exemption, you should become, subject to The Workers' SWIMMING POOL RECEPTOR CITY Lps Angeles TEL No 753=254 Compensation provisions of the Labor Code,'•you must forth g LAWN SPRINKLER SYSTEM " with comply with such provisions or this'permit shall be STATE 15.1839 ,LIC C35- deemed revoked 1 WATER HEATER 6 QQ ' LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION . DISTRICT NO P OCESSED BY I hereby affirm that I am licensed under provisions of,Chapter 9 GAS SYSTEM OUTLETS A f� (commencing with Section 7000) of Division 3 of the.Business OUTLETS OVER and Professions Code, and my.hcense is'in full force and effect 5 PER SYSTEM FINAL 1..51839 C36 DATE VALIDATION u License Number Lit. Class �G FINAL' O Contractor Tq•0• Prov In Date--4/55' ate 4/55 BY' I 1 am exempt under Sec. B.BP-C for this reason Z, Plan check fee f, ate. _ 10 , 50 PLUMBING PERMIT ISSUING FEE.$ ; Signature �(/�� /1�J TOTAL FEE 16 5 Plan check applicant , SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 2,9 5'0•A I hereby affirm that I am exempt from the Contractor's License ` Address Law for the following reason (Section.7031.5, Business and • o 0 0 o 5 " Professions Code)- City,-- ' Tel No ' ❑ 1, as owner of the property, will.do-thework and the ;' ° -16,,5,0-, ✓ structure,is•not intended or offered,for sale-(Section • x� , 7044; Business and Professions Code). '. �, _ � � � - • �' 1 � p � .6.50 CONSTRUCTION LENDING AGENCY' _ 06„1 7.—813 •' . 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. G.). - a 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 jaws regulating Plumbm•g,'and hereby , authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ` Signature of Permittee Date '