HomeMy Public PortalAbout6202 KAUFFMAN AVE_Plumbing__ PLUMBING ' -1
DEPARTMENT OF COUNTY ENGINEER
DIVISION.OF. BUILDING AND SAFETY PERMIT APPLICATION
"CODUNTY OF LOS-ANGELES BUILDING �q
WILLIAM J.,,:FOX. COUNTY ENGINEER SADDRESS
FOR APPLICANT TO FILL` IN LOCALITY C
BUILOI,NO' NEARESTa�
ADDRESSCROSS ST.• /—',o
_ DISTRICCTT NO. GROTUPONE )PERMIT NO.
LOCALIT-Y.- I _l l
NEAREST_
CROSS ST. (� Op�yRECEIVED BY , - Ready for Inspection D"ATE ISSUED
OWNER" 1 i�� //� l
MAIL'`.• INDUSTRIAL
ADDRESS rg �(1�,; _L;l,t�.rg�ye ,> WASTE APPROVAL
CITY TEL.NO. INSPECTION RECORD
PLUMBER,
ADDRESS
CITY TEL.NOd 3
J I C]STATE
LICENSE N0. f!e J °� '7 I n COUNTY J
PERMIT FEES a
JUM!3ER TYPE OF FIXTURE OR-ITEM FEE - - L7
WATER CLOSET(TOILET) @ 0.80 $ D:
BATHTUB @ 0.80
SHOWER '@ 0.80
LAVATORY(WASH BASIN) @ 0.80
KITCHEN SINK' @• 0:80
LAUNDRY TUB OR TRAY @ 0.80
SLOPSINK @ 0.80
FLOORSINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN- @ 0:80
URINAL @ 0.80
GAS SYSTEM..............OUTLETS @ 1.00
.WATER HEATER @ 1.00 (�
MISCELLANEOUS,
APPROVALS
rA DATE INS,PECTOR'8 SIGNATURE
UNDER SLAB WORK
PERMIT ; 1 00 ROUGH PLUMBING
TOTAL FEE GAS'PIPING
I HEREBY'ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GAS VENT "
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
I HEREBY CERTIFY THAT I. AM' PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS.TEST
AND.STATE'OFCALIFORNIA THAT I AM THE LEGAL OWN-
ER.OF THE ABOVE CE
I IDENTIA PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF,PERMITTEE-- - ---19-1.—
- - ...._. !r
FINAL Y
'76A667 DBS 17 rd 6 1 9.59 i
` WORKERS' COMPENSATION DECLARATION APPLICe4TION F,OR PLU.M�,IIVG PERMIT
I hereby affirm that I have a certificate of,consent to self 176A667A
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
Policy No Company.
Cerfified copy is hereby furnished.
-FOR APPLICANT,TO FILL IN(PRINT OR TYPE) BUILDING '
Certified copy is filed with the county,building inspec ADDRESS
NUMBER FIXTURE OR ITEM @• ,FEE. x:
tion department LOCALITI'?1* Vi
WATER CLOSET..-'.
Date ` i" Apphi ant NEAREST _i
CERTIFICATE•OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST -
COMPENSATION INSURANCE OWNER s
(This section need not be completed if the work involved by ' SHOWER•. 0
the permit is for'one hundred dollars (;100)'6r le's`s.) t 'LAVATORY, 0D ADDRESS v,/
IC
I 'certify that in-the performance of the work for,which-chi's 5
permit is issued, I shall norem to an person in an mar
in , SINK CIT w����p� TEL NO ,®
so as to become subject to�the Workers'•Compensation Laws• DISHWASHER w
� CONTRACTOR�i►
Date App I tf+l����� 5- CLOTHES'WASHER ADDRES$3 /
NOTICE TO APPLICANT`If; after making this .Certificate of SWIMMING POOL RECEPTOR 70w
Exemption,.you should,become sublect to .the Workers' CITY, TEL.,NO
Compensation.'provisions,of,tF Labor Code,'you,must forth- • °
LAWN SPRINKLER SYSTEM
with cornply'with such.provisions or 'this,permit 'shall be - STATE- LIC:
deemed revoked WATER HEATER e �( LICENSE N CLASS
LICENSED CONTRACTORS-DECLARATION•, (� DISTRICT NO. P ESSED BY "
*hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000),of•Division 3 of-the Business OUTLETS OVER "
and Professions Code,and my license is in full force and effect 5 PER SYSTEM - FINAL ��
VAL ATION
DATE ✓ l O_
License Number Lic. Class
' FIN � , ' - 0C
Contractor Date BY V
a — _ �'--
I am exempt.under Sec. W� ,-
B.BP.0 for this reason ;
• 'Plan check fee - _ -�2 7 G,7�A•
Date PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE J #,010 0 0 o 5
z
SINGLE FAMILY Plan check'apphcant a �• :I"o o,4 0,.5 O
• -' '
HOME OWNER-BUILDER DECLARATION .-• Name e -,o 4 Q,5 0 U
I hereby-off irm'that I'am exempt from the Contractors License Address -
Law'for-The following-reason (Section 7031 5, Business and k 1.0. '2 O_8 5
P-rofe oons Code),. City- - Tel. No.
LJ I, ds owner of the property, will do the work and the
•r` 'structure'is.nbt,intended.or-offered-for'sale (Section' ,
7044, Business and,Professions Code,) D '
CONSTRUCTION*LENDING AGENCY
-
I hereby affirm that there is 6 construction lending agency4or
the;perfOrman ce of the work for-which,this permit is issued
(Sec 3097,,Civ C.). r
Lender's Name-
Lender's Address
I certify that I have read tliis application and state•that the
' above information-is correct I agree to comply,with all County' ►
ordinances and Slate laws regulating Plumbing, and hereby
'authorize representative of-this County.jo enter upon the
above-mentioned proper ,for inspection,purposes
SEE REVERSE'FOR_EXPLANATORY LANGUAGE -
Signature of Pe rttee , Date '