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Home My Public Portal About6210 KAUFFMAN AVE_Plumbing__ 76A667-CE9817 9/63 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION TNEAREST ILDINGJOHN A. LAMBIE. COUNTY ENGINEERDRESSWILLIAM A. JENSEN, SUPT OF BUILDINGCALITYFOR APPLICANT TO FILL IN OSS ST. NUMBER FIXTURE OR ITEM EACH .� ,, e OWNER n WATER CLOSET $1.25 .a MAIL BATH TUB 1.25 ADDRESS SHOWER 1.25 CITY TEL. NO. n LAVATORY 1.25 ` CONTRACTOR.4 an -17,u cr., 1131b i Inc* t SINK 1.25 ADDRESS • fit: {7 •� 425 N� vhl staiut DISHWASHER 1.25 CITY ptoalltJvl3 "', TEL. NO35• 1 71. CONTRACTOR'S STATE)lU LAUNDRY TUB I,25 REGISTRATION NO. ')l COUNTY ❑ CLOTHES WASHER 1.25 5 DISTRICT NO. GROUP ZONE PROCESSED BY WATER HEATER 1.50 5 } GAS SYSTEM OUTLETS 1.50 Z INDUSTRIAL 0 WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD � t� Q z O a w H APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE 5 GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE I 4 FINAL VALIDATION ROBERT A. WOOD CK. M.O. ,J CASH SUPERVISING MECHANICAL ENG'R I COUNTY OF LOS ANGELES- APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer PLUMBINU D S PERF41T NO. FOR APPLICANT TO FILL IN TRICT NO. ROUP NE PLUMBER R•E' Slay den RECEVED BY READY FOR DATE ISSUED 5042 RoM FIRST INSPECTION 5_'/ I f ADDRESSBUILDI semead Blvd. (/ Pi co nn ADDRESS 6210 Y. Kauffman CITY n TEL. No.0X' 97915 COUNTY LICENSE NO. T 4EXPIRES j une 3 j LOCALITY Temple City NEAREST PERMIT FEES cRDes ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER Hart 1 e tt //�� MAIL 8322 Las- Tunas WATER CLOSET(TOILET) Q 0.50 $ •8�-1 ADDRESS BATHTUB @ 0.50 • 80 c., Temple lty TEL. NcAT 44557 SHOWER 0.50 1 HEREBY ACKNOWLEDGE THAT- [ HAVE READ THIS LAVATORY (WASH BASIN) 0.50 • APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK 0.50 .8() AND STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY ® 0.50 TANG ELES COUNTY LICENSE, OR I AM THE LEGAL OWNER I I. 00 OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM_� OUTLETS 0.50 I n SIGNATURE OF _WATER HEATER 0.50 I. 00 PERMITTEE SLOP BINK 0.513 INSPECTION RECORD FLOOR SINK Q O.SO FLOOR DRAIN 0.50 DISHWASHER 0.513 DRINKING FOUNTAIN 0.50 URINAL Q 0.50 f T L"19-411 VI `J HOUSE SEWER 0.50 Z MISCELLANEOUS /9/,� egg y &-B"// �G Or v D! 0 fel5/41IVW,4�' W,V, 0�9/_Z— /I'e -r.,"A O ALS ROUGH PLUMBING �6 GAS PIPING ^�7"—•---- GAB,VENT /r CESSPOOL 1.00 CESSPOOL F - SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) 1.00 SEWER PERMIT 1.DG GAS TEST /�� 1 r UTILITY CO.NOTIFIED TOTAL FEE 6 . 20 FINAL 76A667 DBS.#17 6-52 76A667—CE 817468 P�F C-ITY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ADDRESS la JOHN A. LAMBIE• COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST rAv CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNEft_ 117 WATER CLOSET 1.50 BATH TUB 1.50 ADDRESS �Q t SHOWER 1.50 CITY TEL. NO, LAVATORY 1.50 CONTRACTOR SINK 1.50 ADDRESS f—fZf ®�f DISHWASHER 1.50 CITY TEL. NO � CLOTHES WASHER 1.50 STATEy LIC LICENSE NO. B/ CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP ZONE I PROCESSED BY LAWN SPRINKLER SYSTEM 2.00 ' 0 &n O WATER HEATER 1.50 Li O INADUSTRIIAIu APPROVAL GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD O OUTLETS OVER ` 5 PER SYSTEM .30 V W D. (A z Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 8 2 00 TOTAL FEE . �0 APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel. No. HOT WATER HEATER r IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN, THE ABOVE PIBED RESIDENTIAL PROPERTY. FINAL SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICAL OF PERMITTEE PERMIT VALIDATION CK. MO.O. CASH ; PLAN CHECK VALIDATION CK. M.O CASH (',.2 5 6 2D 4 5 D -C �WPRKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT Ihereby, affirm that I hqve a certificate of consent to self 76A667A ,insure, �a certificate-of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified co0y thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company ❑ Certified copy-is hereby furnished , t FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING b` _ ❑ Certified copy is filed with the county building•inspec- ADDRESS t��! N # tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER'CLOSET NEAREST n CERTIFICATE OF EXEMPTION FROM WORKERS'• BATH TUB CROSS ST ` COMPENSATION INSURANCE OWNER ((N—( j o w/�N (This section need not be completed if the work Involved by SHOWER MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner CITY C4 TEL NO �S�8 7Sb (tPP so as to become subject to the Workers'Compensation Laws. DISHWASHER /�� Q i.��),�(�( CONTRACTOR - Date '�Applicantyt�U��C��I r' `1W" 1 CLOTHES WASHER pi1 NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY hAlv TEL. NO. LAWN SPRINKLER SYSTEM with comply with such 'provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO C LICENSED CONTRACTORS DECLARATION DISTRICT NO P CESSED BY thereby affirm that I am licensed under,provisions of Chapter 9 GAS SYSTEM OUTLETS h� (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER !/ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION DATE —0, ai License Number Lic Class0 FINAL U. Contractor Date BY / ❑ I am exempt under Sec. 0 U B.BP C for this reason Plan check fee LLJ Date- PLUMBING PERMIT ISSUING FEE$ U Z Signature r� TOTAL FEE Plan check applicant SINGLE FAMILY , HOME OWNER-BUILDER DECLARATION Name G CO]— U41,14 /4/I I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address 0, /�, ✓� 'PP jfessions Code): City GA Tel No kt (0� 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). 5 8 2.3 A CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for # 0 0,0 0,0 5 the performance of the work for which this permit is issued (Sec 3097, Civ C ) J 0 0 2 8.5.0 Lender's Name o 0 0 2 a 5.0 5 Lender's Address iJ Q 2 9 i`8 6 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 inspectiori purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 'Sigh6ture of Permittee Date