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HomeMy Public PortalAbout6027 KAUFFMAN AVE_Plumbing__ 76A667 -CE#y617 2-62 ULtl V r APPLICATION FOR PLUMBING .PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BI'LD s G JOHN A. LAMBIE, COUNTY ENG INEER ADDRE �t WILLIAM A. JENSEN. SUPT 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 v CITY TEL. N SHOWER 1.25 4 ' LAVATORY 1.25 CONTRA TO SINK 1.25 ADDRESS L �y DISHWASHER 1.25 CITY ,G "e�a TEL. NO LAUNDRY 'PUB 1.25 STATE CONTRACOR'S COUNTY REGISTRATION NO. a CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROC SSED BY LVWATER HEATER 1.500 O �� GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD Q. Ix �\ Lu tAtA APPROVALS DATE INSPECTOR'S SI`NATURE PERMIT $ 2 00 UNDER SLAB WORK ray ROUGH PLUMBING TOTAL FEE `, ' (� GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY L' - LL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER If, ING.REBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURESED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TESTRNIA OR THATIMTHE LEGAL OWNER OF,AND INTEND TO IN,THE ABOVE SCR ED RESIDENTIAL PRO ERTY. UTILITY CO. NOTIFIEDTUREERM ITTEl, �p f'r FINAL f D H!;,lo--f ///A cs' ✓ VALIDATIO ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENG'R _o. 23 :5;1 J W-1 8 5 © 3.5004 WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT J7 t,hereby affirm that I have a certificote of consent to self 20-0026 DPW 6/87 insur%, ot a c4'rtificate of Workers' Compensation Insurance, 76A667A JL(I or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. k Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT BUILDING rr/r Certified copy is filed with the county building inspec- OR TYPE) ADDRESS, L-,02� 1\,/Qt(t-t✓YtQrl tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET � l Ct Date Appliganl NEAREST AA CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. 00C r c(-t COMPENSATION INSURANCE SHOWER OWNER vi z_e i (This section need not be completed if the work involved by MAIL. �('�� the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS �-7 Kau c'r►"�avi I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY7'eme 1� �� TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR ll 0 &60 AJ AL Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT WQ. ESSE I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS C © Y (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER J VVV }} and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION DATE '� O', License Number Lic. Class C�. FINAL Contractor Date BY ElI am exempt under Sec. B.&P.C. for this reason Plan check fee „•'- --._-- Date: M.a �,CJ Signature PLUMBING PERMIT ISSUING FEE$ TOTAL FEE .�p. 2s "- -Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I on)exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code)': City Tel. No. IRI, as owner of the property, will do the work and the +,i Z, structure is not intended or offered for sale (Section 7044, Business and Professions Code), CONSTRUCTION LENDING AGENCY 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.). 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 enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE (2a,[A%c�� X I,cJ.t�u,r.P Nov. Iv. 15'9 i Signature of Permittee 0 Efate DECLARATI WORKER'S COMPENSATION ate of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT • 76A667A I hereby affirm that I have a certificate of consent to self insure, or 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. Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING❑ O A`,F fin/)tV 19 C l V/Certified copy is filed with the county building inspection ADDRESS (� /,d17 VF- department. NUMBER FIXTURE OR ITEM p FEE LOCALITY Date Applicant WATER CLOSET CROSS ST. T. Woe)^/Q(}LJ/��t/f/) /� �^ CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE ASSESSOR MAP BOOK PAGE (This section need not be completed if the work involved by the SHOWER PARCEL/� permit is for one hundred dollars($100)or less.) LAVATORY OWNER tt5# 1 jel CI�f Z I certify that in the performance of the work for which this permit //�� s /� '/ is issued, I shall not employ any person in any manner so as to SINK ADDRESS w27 ��(��/—� V f�, MAIL become subject to the Workers'Compensation Laws.' DISWASHER CITY1�`;� /' 1 TEL.NO.a C��/ -(� Date Applicant CLOTHES WASHER r�•�— C 'v CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.N0. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000) of Division 3 of the Business and STATE LIC. 0 Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS /i� LICENSE NO. PROCESSED (� OUTLETS OVER DISTRICT NO. C-ba�Z��G BY O 5 PER SYSTEM License Number Lic.Class U FINAL VALIDATION W DATE FZ Contractor Date fA ❑ I am exempt under Sec. FINAL Z B.&P.C.for this reason Date: Plan check fee , Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law -: c for the following reason (Section 7031.5, Business and Professions Address Code): y ?T i';. City Tel. No. I,as owner of the property,will do the work and the structure �••�:r--, ---r"�. P P Y, is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 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.) 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 represent ves f this C;�t to nt uW".4 above-mentioned proper rM ection . SEE REVERSE FOR EXPLANATORY LANGUAGE 9q Signature of Permittee Dat WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT ere M affirm that' have a certificate of consent to self in- 76A666 DPW 4/87 76A667A sure ar"o certificate of W6rkers'Compensation Insorance,ora CE 817(REV. 8/86) certified cop'y.tliereof (Sec. 3806, Cab. C.) -� COUNTY OF.LOS ANGELES DEPT. OVPUBLIC WORKS Polir,y No: - Company ❑ 'Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN (PRINT OR TYPE) 'Certified copy is filed with the county building inspection ADDRESS 17� V TNV department. NUMBER FIXTURE OR ITEM Lal FEE / LOCALITY"��^�t. C Date Applicant WATER.CLOSET(TOILET) F '6 / 0Q NEAREST `C��1"-T- :!_W L.�–SS CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 10 CROSS ST. W�R COMPENSATION INSURANCE OWNER SHOWER (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL 7 C} ADDRESS I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so SINK CITY TEL..NO. as to become subject to the Workers' p nsation Laws. DISHWASHER -7 y 2S-gS CONTRACTOR Date_ Applicant C�Lrr CLOTHES. - - Certificate of Ex- emtion, subject ADDRESS NOTICE TO APPLICANT: If,after making this: you should become suect to the Workers'Com en= SWIMMING POOL RECEPTOR P Y I P CITY TEL. NO. sation,provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ; ly with such provisions or this permit shall be deemed revok- STATE. LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. P C SSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER (f Q and Professions Code, and my license.is in full force and ef- 5 PER SYSTEM FINAL (_— VALI ATION .fect. C� License Number Lic. Class C FINAL U 99 Contractor Date BY O I am exempt under Sec: LLI B.&P.C. for this reason Plan check fee Poo. (� Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE ;20268A SINGLE FAMILY #;o^o,o ©`0 5: HOME OWNER-BUILDER DECLARATION Plan check.applicant I hereby affirm that I am exempt from the Contractor's License Name ° 67 Q 5 0 Law for the following reason (Section 7031.5, Business and Professions Code): Address o,o 0 7 0 5.0Z I, as owner of the property, will do the work and the City . Tel. No. Q 7.2 5.�8 8 structure.is not intended or offered for sale(Section 7044; Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm,that there is 6 construction lending agency for the 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 enter upon the abov e ned prop ty far i specti purposes. cosi. 7"'2;'_g�S ZSEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Comp ation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, L C. COUNTY OF LOS ANGELES BU IN AND STY 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 NUMBER doe tion department.. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant loxWATER 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 ADDRESS 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 I TEL. NOW7 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY r TEL. NO.�g/aj.7D7� with comply with such provisions or this permit shall be STATE LIC. Q deemed revoked. • WATER HEATER LICENSE NO. CLASS CG 1 LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS r- (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 15 PER SYSTEM lfCPAP "� VALIDATION License Num r //��v Lic. Class `- �" '_VQV r 3� ® FINAL ar Contractor Date BY ❑ �.., r� I am exem e e B.&P.C. for this reason ?m Plan check f - - Date: �y Y PLUM ING PERMIT ISSUING FEE$ C.i Signature TOTAL FEE /'� 7, (1 Plan check applicant SINGLE FAMILY L 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 sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 1 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.). 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 enter upon the above-me tioned property for i pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Ll Signature of Permittee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent 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 PolPolicy No.-Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ /'j2-? /i Q e A/fin Certified copy is filed with the county building inspec- ADDRESS ; (f /"tV ,v/l7ty tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET IP[C C rT Y Date Appli4ont 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 nn/ the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Work s'Co pensation L s. DISHWASHER CJZ?i/ /V A CONTRACTOR !7 C9 1� Date �'`��� CLOTHES WASHER �/ �1 l[ APPlicant J�2 '\ NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS UN/�S Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY % � TEL. NO. 2g5-- �2 with comply with such provisions or this permit shall be STATE 77 LIC. -� deemed revoked. WAT R LICENSE NO. ! ` CLASS LICENSED CONTRACTORS DECLARATION DISTRICT P 0CESSED BY" / I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL J VALIDATION DATE d: U License Number Lic. Class E � `. FINAL Contractor Date BY `� 1° ❑ I am exempt under Sec. B.&P.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE 50 Plan check applicant SINGLE FAMILY 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 Address Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the ® oC' , structure is not intended or offered for sale (Section ` 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 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.). 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 Co my to enter upon the abopEg-rientioned pro er y for ins p tion purpo es. p- SEE REVERSE FOR EXPLANATORY LANGUAGE 14" asd Signature of Permittee Dat It WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a,certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) � or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES � ', c', BUILDING AND SAFETY / Policy No�= ' �Compan;r3"l '^'�� F-1Certifiedcopy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS Q-- �tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY `" Lf.. Date( ( Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTIO FR - WORKERS' BATHTUB bVuw t CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by a MAIL ,v� the permit is for one hundred dollars ($100)or less.) 1 LAVATORY j ADDRESS S I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITYTEL. NO. P Compensation provisions of the Labor Code, you must forth- C 4A,)�VK-- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. ® deemed revoked. WATER HEATER LICENSE NO. Z CLASS Y� LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS L (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER }� and Professions Code,and my license is in full forces and effect. 5 PER SYSTEM FINAL �fi VALIDATION License NumberZ �<t`I Lic. Class DATE � t FINAL Contractor c -`l7tYt BY �.m•3 .. ❑ 1 am exempt under Sec. B.&P.C. for this reason g Plan check fee 0101 Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Off—3— Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address r: .• 1.2 A Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. C a 0 0 0 j ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ® o 2 R E Q 7044, Business and Professions Code). ' CONSTRUCTION LENDING AGENCY G J I hereby affirm that there is a construction lending agency for (1. the performance of the work for which this permit is issued n ? _ (Sec. 3097, Civ. C.). Lender's Name Lender's That th I certify at 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 enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 6r Ll f Signat re of Permittee Date