HomeMy Public PortalAbout6127 KAUFFMAN AVE_Plumbing__ 76A667 •CEV817 9/63 �S - - 076112
City of Temple City t
APPLICATION F'OR : PLUMBING PERMIT I
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION . FADDRESS
DING
JOHN A. LAMBIE. COUNTY ENGINEER 612 N Kauffm Ave,
WILLIAM A. JENSEN, SUPT OF BUILDING
ALITY Tem le City °
FOR APPLICANT TO FILL-IN SS si. Z03 TuriaS
NUMBER FIXTURE OR ITEM EACH - FEE '
OWNER C'e' lAlde
WATER CLOSET $1.25'
' MAIL
,BATH TUB 1.25 ADDRESS Same, '
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR Geneii3i histall-ation
1,25 ADDRESS 6558' West- BIVd.
DISHWASHER 1.25 CITY Los:'An ales TEL. NO. PL 3-2541
CdNTRACTOR'S STATE
LAUNDRY TUB 1.25 REGISTRATION NO. C-36 1518.39 787 COUNTY
CLOTHES WASHER _ 1.25 DISTRICT NO. T=GRI ,P� ZONE PgQgESSED BY -
WATER HEATER 1.50
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL d
WASTE APPROVAL O
OUTLETS OVER 5 PER,SYSTEM, .30 INSPECTION RECORD u
l WATER SOFTENER 1 0 Ready, for Inspection Now ' O
u
W
- a
Z
APPROVALS DATE INSPECTOR'S,SIGNATURE _
PERMIT $ 2 00 UNDER SLAB WORK, - A
ROUGH PLUMBING
TOTAL FEE GAS PIPING I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -GAS,-VENT .J
AND STATE THAT THE ABOVE IS CORRECT'AND AGREE TO COMPLY
WITH-ALL COUNTY ORDINANCES AND STATE LAWS REGULATING '
_HOT WATER HEATER.
PLUMBING. - g
[ HEREBY CERTIFY THAT I AM "PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST -� 9
CALIFORNIA OR THAT 1 AM-THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN, THE ABOVE DESCRIBED RESIDEN L(PPRRROOPERTY UTILITY CO, NOTIFIED T
'SIGNATURE G • -
OF PERMITTEE ` �,�.• ,
FINAL.
LIDATION ROBERT A. WOOD r
CK M O CASH SUPERVISING MECHANICAL ENG'R
PLUM
NGI
DEPARTMENT OF COUNTY ENGINEER B ' Y
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION -
COUNTY OF LOS ANGELES BUILDING
WILLIAM'J. FOX. COUNTY ENGINEER ADDRESS C �l
FOR APPLICANT TO FILL IN LOCALITY
BUILDINEAREST
NG (ADDRESS �� -Al, �C CROSS•ST. LSZ
DISTRICT NO. GROUP ZONE PERMIT NO.-
LOCALITY 7-CA4,:k 4r/ .7q 553B
NEAREST RECEIVED BY Ready for Inspection. DATE ISSUED
CROSS ST. �19/Q/QP%OV �O '
OWNER 0IM�i�� c3�x/E?r'
}RAIL INDUSTRIAL
-ADDRESS WASTE APPROVAL"
CITY TEL:NO, INSPECTION RECORD
PLUMBER ► �A A" _
ADDRESSAej /V•,' 1_1�la-'e&Mr
CITY 13I�(.1/IAp 00W, TEL.NO.�'0���1�$' s
[3 STA
LICENSE N0. � COUNTY J'
PERMIT FEES a
-IUHOER TYPE OF FIXTURE OR ITEM FEE -
_L WATER CLOSET(TOILET) - @ 0.80 $ 4 i X
O
BATH TUB @ 0.80
SHOWER @ 0.80
LAVATORY(WASH BASIN) @ 0.80 �D -
KITCHEN SINK @ 0.80 leo
LAUNDRY TUB OR TRAY @ 0.80
SLOP SINK @ 0.80
FLOORSINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN- @ 0.80
URINAL . @ 0.80
GAS SYSTEM.............:OUTLETS @, 1.00 y OO
WATER HEATER @ 1'.00 OO
MISCELLANEOUS
;p APPROVALS
a;DATE INSPEC,TOR'SSIGNATURE
UNDER SLAB WORK'
^ PERMIT $ `1, 00 ROUGH PLUMBING:
TOTAL.FEE ®� GAS PIPING`
THEREBY ACKNOWLEDGE THAT I HAVE READ T IS APPLI GAS-VENT i
CATION AND STATE;THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO'COMPLY WITH ALL COUNTY ORDINANCES.AND STATE LAWS
REGULATING,PLUMBING. PLUMBING,FIXTURES `- S
I HEREBY CERTIFY THAT. I AM R PROPERLY, REGISTERED �1� L �/
AND/OLICENSED AS REQUIRED BY LOS ANGELES COUNTY GASTEST
AND STATE OF CALIFORNIAORT T 1 AM THE LEGAL OWN.,
ER OF THE-ABOVE DESCRIBED R IDENTIAL PROPERTY. UTILITY CO.NOTIFIED _
SIGNATURE _
OF PERMITTEE �� ;
------ _..- FINAL
76A667 DES 17 1/53 vt
WORKERS'COMPENSATION ,' ., tib,.; �� APPLICATION FOR PLUMBING P'ERIViIT,
ls9' a - 20-0026 DPW 4/87
I`hereby, affirm that f have-o cert ficote of consent to self ln- 76A667A. /-n eh ~'
sure,or a certificate of Workers Compensation Insurance,o 'a CE 817(REV 8%86) A
testified copy thereof S
YI�OVI_5b,l ' :t COUNTY OF LOS:ANGELES DEPT. OF PUBLIC WORKS
Policy No. pany
-Certified.copy,is hereby'furnished" `
FOR,APPLI CANT TO FILL-IN,(PRINT OR TYPE) BUILDING
Certified copy,is filed wrth the coun buddinXnstrio ADDRESS
department'' s NUMBER' ' , `. .FIXTURE,ORI'TEN1LOCALITY'-.WATER CLOSET(TOILET)Date . ApplicantVV � • NEARESTCERTIFICATE,OFEXEMPTION FROM'WOR s• ' BATHTUB rt' CROSS ST3k
COMPENSATION INSURANCE :++ ". OWNER.- LS V
SHOWER
`Nis'section'need�riot bercorripleted if the work,involved.-kiy= MAIL
the pesmif is for one hundred dolldrs ($100)-or less.)^ �; LAVATORY �' ADDRESS`' I. � l �
,I e_rtify;th'at.in the.performance of.-the work,forwhich•this'per- , •"SINK
=mit is issued--I sh 11',not employ'in person irrany manner.so CITY- ��^ " ^; 'TEL' NO p�
as•totbecome.sublect"to fhe;Workers'Compen`sahon Laws" K DISHWASHER`.
d.' :• ,CONTRACTOR "
;-Date' Appl,cant, CLOTHES WASHER. t
ADDRESS- .
E;-
NOTICE-TO APPLICANT- If, after making'-this Certificate of .
�•• a,, `'a•' SWIMMING POOL RECEPTOR
-
SWIMMING su6lect to,tFie•Workers Compen- :' ' +• ° 'CITY;' T� O .' y
satiori•provision's of the-Labor Code, you must forthwith comp= "LAWN'SPRINKLER SYSTEM yr` /.i.l/r�/
ly,with•such'provisions or-this permrt,sF oll be deemed re'vok- STATE UC
ed a ' '' ` ' i� _ .WATER LICENSE NC - 077
CLASS
LICENSED CONTRACTORS DECLARATION = l0 'DISTRICO .- •. O SSED BY ,
I'herebyaffirmnihat I,am-licensed,under,,provisions 'f-,Chapter { GAS SYSTEM, OUTLETS �`
9_(cor rnencing�wrth'Section 7000)of Division 3 of the Business OUTLETS'OVER
and Professions Code, and my license is in force-and-ef-. 5'PER SYSTEM FINAL'
fect ' 'r• r rr`. a. - DATE' VALIDATION , a
License Number, • ✓ Lit CIds'sl� w-
r_ z FIN f 1 CD
Date;• `. BY / A 3 j' O
Con
s F+
0, dam exempt unde"Sec
B 8P C:.for.th,'s'reason -
Rlan:check-fee
' - ' ,Date'•' L , ' PCUMBING)P.ERMIT ISSUING FEE,$
Signature ,
�, •TOTAL FEE _
SINGLE FAMILY,', -a. "Y' .!,' T $e
HOMEOWNER-BUILDER.DECLARATION Plan check opplicanti + ".i' �•
I hereby'8ffir'm.thc't`4am,exempi from the Contractor's License' Name
Law forIthe following reason'(Section 7031 5,-Business,and +
�Pr ofessions Code) Address ' =
OI;*'as owner'.of-the property, will do~tHe work:ondr,tF e Gty= 'T J Tel No•
'-structure is not intended or'offered-for sale(Section 7044', b r_1• ,7.
Busme's"s'and Piofessions',Co'dep 1 x p --� _-c
z CONSTRUCTION LENDING AGENCY , CHECK -
hereFiy dffi�m ihat'there is•a construction lending agency for.:'
the,performgnce of the.work for which this.permit is issued y �; �'
HAN
Lender's Name R - -.... 1Jt3�1 3/I13/8-?
' e+ ,. M. r y
,Lender's Address C . "` 1830 , 1' AH10:�i�i
�I cerhfy,that,I have read,this,applicationand state.That the. ^t
above information'is correct..)ag'ree`to com'ply with-all Gounty x } J
/ordrtes and State I ulatmg Plumbmg;:rand hereby " '., ` ;:z represen es of s.County to,;enter ,upon-the
a tro ed r erty for spectionIToses 'SEE REVERSEFOR EXPLANATORY LANGUAGEre of Pe 'ittee ;Date-
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