HomeMy Public PortalAbout6114 KAUFFMAN AVE_Plumbing__ i 76A667 17.5-49 tp APPLICATION FOR PERMIT
DEPARTMENT.OF BUILDING AND SAFETY
�) COUNTY OF LOS ANGELES L
WILLIAM J. FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN D S T NO. GROUP I ZQNE PERM-I�TgNO.
/15'
PLUMBER 1 er, ? five R CEIVED BY READY FOR DATE ISSUED
7 ,q l� �,/ FIRST INSPECTION /�`�r✓
ADDRESS oop
/t/ s �J: /e � �hY{� yA+' , BUILDING /� /�� �7 y d s
CITY�I � 1 "TEL. NOI��✓ ADDRESS W 'v: h*,4' 4,M
LICENSE NO. EXPIR VIPJO'- 'COUNTYLOCALITY >/t �7y
NEAREST �A �;/ j R A� ,u✓l
,PERMIT FEES CRASS ST. !/� i
�q
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
y WATER CLOSET (TOILET) @ 0.50 ADDRESS _
BATH TUB @ 0.50 _ CITY TEL. NO.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
O Iff LAVATORY (WASH BASIN) 0.50 AGREE TO COMPLY WITH ALL COUNTY'ORDINANCES AND
KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 '� ANGELES COUNTY LICENSE, OR_ 1 AM THE LEGAL OWNER
OF THE RESIDENT PROP CRIBED ABOVE.
GAS SYSTEM OUTLETS ® O.50
SIGNATURE OF
WATER HEATER @ 0.50 \ •`„✓ PERMI
SLOP SINK @ 0.50 INSPECTION REC
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.50
rd'
DRINKING FOUNTAIN @ 0.50 Cm it ABO
URINAL @ 0.50
HOUSE SEWER @ 0.50
MISCELLANEOUS
0
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING �.I�Y� ,(�.•L'
GAS PIPING /
GAS VENT
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
I. DRAIN ( ) PIT ( @ I.00 SEWER
PERMIT 1.00 GAS TEST /
a� UTILITY CO. NOTIFIED .
TOTAL FEE $ I V FINAL
76AS67 Des 17 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING
�� ���� '
--COIINTY OF LOS ANGELES
WILLIAM J. FOX, CHIEr ENGINEER
DISTRICT
NO. GROUP I ZONE PERMIT NO.
FOR APPLICANTgT1�O FILL IN � � d 4 47 I
PLUMBER /) ,`` JA^^ RECE VED BY READY FOR DA E 1 SUED
FIRST INSPECTION ^
ADDRESS _ L
BUILDING
CITY TEL NO. ADDRESS If I
AJ.
COUNTY LOCALITY
LICENSE NO. EXPIRES v
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) 0 0.50 S ADDRESS
BATH TUB ® O.50 CITY TEL NO.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) 0.50 APPLICATION AND STATE THAT THE ABOVE IB CORRECT
AND'AGREE TO COMPLY WITH ALL'COUNTY ORDINANCES
KITCHEN SINK Q O.SD AND'STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY a 0.50 ANGELES'COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROP RTY DE R ED AS VE.
GAS SYSTEM OUTLETS Q 0.50
SIGNATURE OF
WATER HEATER @ D.50 PERMITTEE
SLOP SINK Q 0.50 IIdSPECTION RECORD
FLOOR SINK 0.50
FLOOR DRAIN Q 0.50
DISHWASHER Q 0:50
DRINKING FOUNTAIN 0 0.50 _
URINAL Q 0.50 J
a
HOUSE SEWER ® 0.50 Z_
MISCELLANEOUS B
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
- CESSPOOL @ l;pp CESSPOOL ..v ! L
SEPTIC TANK: I j SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 1 SEWER
PERMIT .
l.00 GAS TEST
TOTAL FEE s UTILITY CO.NOTIFIED .�
2
FI NAL
WORKERS'COMPENSATION DECLARATION 76A667q
I hereby, affirm that I have a certificate of consent to self CE 817 (z-eo) A P P L I C A T I.O N • FOR P L U M E'I N G , P E R M I T
insure, or a'certificate of Workers'Compensation'lnsurance,or -
a certified copy thereof(Sec. 3800,Lab.C.) u
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company -
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
ADDRESS // �["Ff'!/ f" �' `' i• " r `
Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE , •� �,y
department. WATER CLOSET y LOCALITY
Date Applicant / NEAREST_ �j A'
BATH TUB CROSS ST. (Jf j'"Tt�>/�!'T�--1
CERTIFICATECOMPENSATION INSURANCE CEORKERS' ! SHOWER OWNER
LAVATORY MAIL
(This section'need not be completed if the work involved - ADDRESS II'� V :O
by;the permit is, for one hundred dollars .($100) or,less.) SIN K
r CITY '' TEL. NO. U
'I certify that in the performance of the work•for;ivhich this` DISHWASHER
"permit is issued, I shall not employ any person in any manner / CONTRACTOR 0 Gl�� �(J 0
'so as'to become subject to th wworkkersI o sa on, aw CLOTHES WASHER
--J� � ADDRESS IU `
Date Applicant 19 SWIMMING POOL RECEPTOR d
NOTICE TO_APPLICANT: If, after"making this Certificate of CITY ;1EE1_ (nExem tion, you shouldbecome subject to the Workers' LAWN SPRINKLER SYSTEM ZP 1 STATE --Compensation provisions of the Labor Code, you'must forth- LICENSE•NO.with comply with such provisions or this permit `shall be WATER HEATER �deemed revoked. GAS SYSTEM OUTLETS DISTRICTNOO. ED B,�Y/��LICENSED CONTRACTOIfS DECLARATION OUTLETS OVER �g
I hereby affirm that I•am licensed under provisions of Chapter , 5.PER SYSTEM
9 (commencing with Section•7000) of Division 3 of the Busi- y�� J FINAL
Hess and Professions Code, and,my license is infullforce and /���` DATE �Z0 � VALIDATI N
effect. F'
- � FINAL, -
License'Number Lic.Class BY
Contractor Date
❑ I am exempt from,the licensing requirements as I am a Plan check fee
licensed architect or, a registered professional engineer PLUMBING PERMIT ISSUING FEE,$
acting in my professional capacity'(Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lic.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address- 3 4 1,7 A
License Law for the following reason (Section 7031.5, Busi- City Tel.No.
`o,o 0 0 0
nese and Professions Code): �;� '
I,,as owner of the property, am exclusively contracting j'o co (j[(
with licensed contractors to construct, the' project
" (Section 7044, Business and Professions Code). `o Mo;o�6[( 5-Q Q
CONSTRUCTION LENDING AGENCY 0 4,"0 2—8'2
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 r
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
-ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this-County io enter upon the
above-me io d perty"for in ection pur ores.
Signature of Permittee Date '