The URL can be used to link to this page

Home My Public Portal About6230 KAUFFMAN AVE_Plumbing__ 78A687 (CE-817) - 1/75 I� APPLICATION FOR LU1MBING PERMIT. COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING ADORESS L'— HARVEY T. BRANDT, COUNTY-ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. F FIXTURE OR ITEM @ FEE OWNER WATER CLOSET 2.00 D(j O 'v MAIL - Agoe BATH TUB 2.00 ADDRESS- SHOWER 2.00 ao CITY TEL. NO. LAVATORY 2.00 GD CONTRACTO r SINK 2.00 ADDRESS DISHWASHER 2.00 CITY // TEL. NOJ Y� Ile CLOTHES WASHER 2.00 STATE `, ' LIC LICENSE NO. �'�f' CLASS ASl SWIMMING POOL RECEPTOR 2.00 DISTRICT NO.GROUP qONE PR CES3�ED Y LAWN SPRINKLER SYSTEM 2.00 WATER HEATER 2.00 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 2.00 INSPECTION RECORD OUTLETS OVER 30 5 PER SYSTEM CD A W r d r� ILA- I Plan-check fee See Reverse PLU G PERMIT ISSUING FEES *;2z- TOTAL FEE -2- APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address .� GAS PIPING City Tel. No . GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ .THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING _FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL SIGNATURE OF PERMI TEE P RMIT VALIDATION CK. M,D CASH PLAN CHECK VALIDATION CK. M.0. CASH 4r2jtTR 12 5 v 2 .2.5 0 ,&S" I SIUMBING DEPARTMENT OF 'COUNTY ENGINEER DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING WILLIAM J. FOX, COUNTY ENC31NEER ADDRESS FOR APPLICANT TO FILL IN LOCALITY BUILDING 230 N K ,p f NEAREST' ADDRESS '6230 L� 11CLL�lll11aY1- CROSS ST. DISTRICT NO. GR P IO ENO. sN-O,. LOCALITY Temple City' � v� NEAREST T,, CROSS ST. -tongden RECEIYVD BY Ready for Inspection DAT. ISSUEEI OWNER' JZ 4(� �I7G/ MAIL I INDUSTRIAL ADDRESS WASTE APPROVAL CITY TEL.N0. INSPECTION RECORD PLUMBER Statewide Plum'oing Co ADDRESS Box 236 . ` CITY Temple CityTEL.NO. AT 6-8041 ` STATE LICENSE NO. .1��000NTY J PERMIT FEES a z_ 4tIMBER TYPE OF FIXTURE OR ITEM FEE I.7 -1 WATER CLOSET(TOILET) @ 0.80 3 880 l BATH TUB @ 0.80 8 O SHOWER @ 0.80 LAVATORY(WASH BASIN) @ 0.80 180 KITCHEN SINK @ 0.80 80 1 LAUNDRY TUB OR TRAY @ 0.80 80 SLOP SINK @ 0.80 FLOOR SINK @ 0.80 FLOOR DRAIN @ 0.80 DISHWASHER @ 0.80 DRINKING FOUNTAIN @ 0.80 URINAL @ 0.80 Z - GAS SYSTEM.....4..._OUTLETS @ 1.00 0 Z WATER HEATER @ 1.00 .00 MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT ; 1 00 ROUGH PLUMBING TOTAL FEE _7'j.oo GAS PIPING -�" 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- GAS VENT ��0 �?t sUb v 4�� 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 ` « L AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE y //� • v OF PERMITTE6l.:.--------..l-Ge��t� .......--...._...............---- FINAL J —0000, 76A667 DBS 17 1/53 CE 817(REV.6/78) , (!�S APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL'IN(PRINT-OR TYPE) BUILDING G� ADDRESS- �O _ NUMBER FIXTURE OR ITEM ® FEE LOCALITY WATER CLOSET / NEAREST ' BATH TUB CROSS ST SHOWER OWNER LAVATORY MAIL ADDRESS SINK" CITY TEL NO -� DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY TEL NO, LAWN SPRINKLER SYSTEM - STATE. LIC WATER HEATER LICENSE NO CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK G) 5 PER SYSTEM ROUGH PLUMBING' GAS PIPING GAS VENT HOT WATER HEATER p®�� PLUMBING FIXTURES �A GAS TEST 6 o� �(��Z.+• 66��J Plan Check fee UTILITY CO NOTIFIED PLUMBING PERMIT ISSUING FEE$ FINAL TOTAL FEE 7 Plan check applicant PLAN CHECK VALIDATION Name" v pa•pA7 •.�1�a °I - Address City Tel No. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE - gg '[ , THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES a 5 '.A 3 A AND STATE LAWS REGULATING PLUMBING, PERMIT VALIDATION • ' ' I HEREBY CERTIFY THA I AM PROPERLY REGISTERED AND/OR LICENSED AS V �# 0 0 0 0 0 5 REQUIRED BY LOS ANG SCO NTY AND STATE IA OR T T_ I AM THE LEGAL OWNER OF,A INTEND O REST E IN THE ABOVE DES BED SIDENTIAL PROPERTY SIGNATURE 'O O'a , 0 0'Q V OF PERM ITTEE it4 - - DISTRICT NOV PROCESS D BY 0625-79 INDUSTRIAL WASTE APPROVAL i � RKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I her rm that I have a certificate of consent to self in- 76A666 DPW a/87 surE'br a certificate of Workers' m ensation Insurance,or 76A667A P CE 817(REV. 8/86) certified copy thereof (Sop._19ei,lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. BUILDING n � o �,A / Certified copy is filed with the FOR APPLICANT TO FILL IN (PRINT OR TYPE) o `acounty building inspection ADDRESS /�/ department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) C Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM•WORKERS' BATH TUB /f CROSS ST. COMPENSATION INSURANCE SHOWER Cs' OWNER ' �pQ (This section need not be completed if the work involved by MAIL "� the permit is for one hundred dollars ($100) or less.) LAVATORY ADDRESS (J j?1t,f/V I certify that in the performance of the work for w h this per- mit is issued, I shall not employ any pers i n manner so SINK CIT r: LC TEL. NO. SZ as to become subject to the Workers' o ❑tion Laws, DISHWASHER �J C CONTRACTOR Date "� ' Applicant CLOTHES WASHER ADDRES NOTICE TO APPLICANT: If, after making this Cer fi ate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Work Compen- CITY /Z l7� ' TEL. N � " sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM '✓ 0-A 69F ly with such.provisions or this permit shall be deemed revok- STATEy�7 LIC. Q/_ ed. WATER HEATER LICENSE NOp� ! / ,p CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROC S BY I hereby affirm that I am Licensed under provisions of Chapter GAS SYSTEM OUTLETS D 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALID ON fect. 'f DATEa bo)V 0 License Num c. Class -�6 U FINAL g Contra Date BY A O ❑ I am exempt under Sec. B.&P.C. for this reason Plan check fee , g Date: PLUMBING PERMIT ISSUING FEE$ 10 S_LJ1 Signature TOTAL FEE SINGLE FAMILY 2 7 9 5 b A HOME OWNER-BUILDER DECLARATION Plan check applicant # o o,o 5 1 hereby affirm that I am exempt from the Contractor's License Name Law.for the following reason (Section 7031.5, Business and ( o,0 2 a5,0 Professions Code): Address I, as owner of the property, will do the work and the city Tel. No. o,o• 2&5 0 36 structure is not intended or offered for sale(Section 7044, Business and Professions Code). o9, 1 8Poo s 8 7 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 ® ' obove'information is correctOfthis agree to comply with all County ordinances a State s gulating Plumbing; and hereby outhoriz a ese es County to enter upon the above a oned rty for inspectio <oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Si natu a of Pe mittee Date