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HomeMy Public PortalAbout6031 KAUFFMAN AVE_Plumbing__ y KERS'COMPENSATION DECLARATION + APPLICATION FOR PLUMBING PERMIT rhereby,affiFtn'that 1,6,ve a certificate of consent to self 76A667A ins're,;Or a certificate of Workers' Compensation Insurance, CE 817 (REV. 8/86) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company ❑ Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING. �J / Certified copy is filed with the countbui ding inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Appli4ant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 6 v0 CROSS ST, COMPENSATION'INSURANCE r SHOWER /t OWNER (This section need not be completed if the work involved by v MAIL O / the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 1 certify that in the performance of the work for which this Ly r3 �- permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO.� r so as to become subject to the Workers'Compensation Laws, DISHWASHERa CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code;you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLA S LICENSED CONTRACTORS DECLARATION DISTRICT NO. OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)-of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM DATE -7 ��� VA ATION V License Number Lic. Class DATE @C FN O Contractor Date BY /'` ❑ I am exempt under Sec. UJI B.BP.C. for this reason Plan check fee g Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant --7 6 9.3 A SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name # o 0,0 0 0 5 I hereby affirm that I am exempt from the Contractor's License Law for.the following reason (Section 7031.5, Business and Address 1 -.034,50 Pr fessions Code): City Tel. No. o io 0 3[L 5 0 50 I, as owner of the property,. will do the work and the structure is not intended or offered for sale (Section ® 0 a 1 7 6 g 7 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 :Zbnti ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signat re of Permittee ate COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer �' DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Englneer DISTRICT N.O. GROUP ZONE FPPLICANT TO FILL IN PLUMBER alo"— RECEIVED BY READY FOR DATE ISSU D _ FIRST INSPECTION 2� J ADDRESS o f / BUILDING CITY TEL. N •fes/ ADDRESS 92 COUNTY LOCALITY LfCEN9 O. EXPIRE NEAREST a PERMIT FEES CROSS ST. ra, NUMBERTYPE OF FIXTURE OR ITEM FEE OWNS MAIL WATER CLOSET(TOILET) ADDRESS . BATH TUB ® CSO CITY a TEL. SHOWER @ O I HER ACKNDWL THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) Q D APPLI CA N AND ST E HAT THE ABOVE IS CORRECT AND AG E TO COMP ITH ALL COUNTY ORDINANCES KITCHEN SINK @ O O AND STATE LAWS REG ATING PLUMBING. 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ O. O ANGELES COUNTYL ENSE. OR I AM THE LEGAL OWNER -OAS SYSTEM OUTLETS O. O URE OF THE RESIDENT & PR ERTY DESCRI / A OVE. SIGNATOF WATER HEATER Q O PERMITTE SLOP SINK @ O O INSPECTION RECORD _FLOOR SINK a 4SO FLOOR DRAIN @ ON O DISHWASHER ® .50 DRINKING FOUNTAIN @ 0.NO URINAL @—.M4 O J a HOUSE SEWER 0.50 _Z MISCELLANEOUS E3 O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL ® 1,00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT . . 1.130 GAS TEST TOTAL FEE UTILITY CO.NOTIFIED $ � �® FINAL 76AG67 DBS#17 10/52 N ✓,VORKERS"COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that 1 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. 380 ab. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Compan IL�J Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ` Certified copy is filed with the co inspec- tion ADDRESS CD. tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET Date Applicant NEAREST fICEATIFICATE 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 ($100)or less.) LAVATORY ADDRESS LC I certify that in the performance of the work for which this ^ permit is issued, I shall not employ any person in any manner SINK oQ CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER 00 ADDRESS `� , NOTICE TO APPLICANT: If, after making this Certificate of �/ • � ^ Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Exem P Y I CITY t� TEL. NO. �A (� Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM "' � � ,0,? with comply with such provisions or this permit shall be STATE ' LIC , deemed revoked. WATER HEATER LICENSE NO. C:l CLASS ZZ— LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS C`� (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINALVALIDATION DATE (LI License Num r Lic. Class Q��' Zc� Contra for Date FI U. W ❑ I am exempt under Sec. U B.BP.C. for this reason LU Plan check fee ® ELI Date: PLUMBING PERMIT ISSUING FEE$ Signature _ ®• TOTAL FEE Plan check applicant :9 5 0 21 A SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name # 0 0 0 0 0 5 1 hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and o o 4 Q 5 0 Professions Code): City Tel. No. 'o o - 4Q5 0 5 ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section , '0 T1 4-86 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby nffirm 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 a�-meed atives of this County to enter upon the aro ert for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 20-0026 DPW 4/87 1 herby, affirm that I have a certificate of consent to self in- 76A667A sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified copy thereof (Sec. 3800, Lab. C.) ' "fl- COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. - Company Certified copy is hereby furnished. El / Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGADORES "�' department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET) NEAREST 4 CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. 1 � COMPENSATION INSURANCE OWNER SHOWER (This section need not be completed if-the work involved by MAIL the permit.is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY TEL. NO. as to become subject to the Workers' Compensation Laws. DISHWASHER CONTRALTO -,G�• Datg�/ Applica� / _� r�!�� CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this.Certificate of Ex- emption, you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR sation,provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM CITY TEL. ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO.�Z 46 CLASS C.ZO LICENSED CONTRACTORS DECLARATION DIST NO. PRO SSED BY I hereby affirm that I am licensed under provisions of.Chapter GAS SYSTEM / OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER err and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL _i> VALIDATION fect. DATE CSJr License Numbq__--z26/z Lic..Classe�z 7 0 O FIN f U Cont� v� ate � B - I am exempt under Sec. �� V B.&P.C. for this reason @ Plan check"fee , U) Date: O PLUMBING PERMIT ISSUING FEE$ © �� / 8 4 9.9 R Signature SINGLE FAMILY TOTAL FEE' # 0 0 0 0 0 5 HOME OWNER-BUILDER DECLARATION. Plan check applicant 1 hereby affirm that I am exempt from the Contractor's License Name I o o 11 650 50 Law for the following reason (Section 7031.5, Business and o o•o 5 0 6 Professions Code): Address I, as owner of the property, will do the work and the City. Tel. No. 12.03-8 7 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 Pool and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-m ti ned prppert��,,.for inspection purposes. lz�le✓ ,/�'2_47 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 7 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1202290001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID TR: 6561 LT: 114 UN: .002 I BUILDING ADDRESS: i 6031 KAUFFMAN AV I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801742 1 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: KAUFFMAN 15385-018-007 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl _163 WATER PIPING BR/FIX 2.00 FIX 13.60 I I (TENANT: 192 NO PERMIT OWNER-BLDR 257.00 DOL 257.00 (ISSUED ON: PROCESSED BY: PLAN BY: - I 1 TOTAL FEES 298.40 102/29/12 SR I IFAFINAL B1 OWNER: TEL. NO: INAL TE Y: CODE: 1 I p /I� � LA DOCHY, STEVE (626) 287-3484- 1Il/^/ 6031 KAUFFMAN AV ITEMP 917801742 I IDE CRIPTION OF WORK IREPLACEMENT DRAIN LINE KITCHEN AND LAUNDRY ROOM I I I I (APPLICANT: TEL. NO: ISAME AS OWNER I I (SPECIAL CONDITIONS: I I I I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE ISAME AS OWNER - I I 1 LIC. NO 1 1UNDER SLAB WORK I IWAT$R SERVICE IPLASTIC Y/N METAL Y/N I I (ARCHITECT OR ENGINEER: TEL. NO: I- I I I I I (ROUGH PLUMBING I I LIC. NO: _ 1-1 IGAS PIPING I I I IGAS VENT _ I I I I I IHOT WATER HEATER I I I IPLUMBING FIXTURES I I I I I ILAWN SPRINKLERS I I I IGAS TEST I I I I I I I (UTILITY COMPANY NOTIFIEDI I I I ICWV 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 r I I I I I I I I I IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I