HomeMy Public PortalAbout5104 BALDWIN AVE_Plumbing__ (2) 76A667 CEA817 4 64 /
APPLICATION FOR PLUMBING RMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEERZCROSS
B�UoILDING AMNB E AFECOUNTTY DIVISION
510h No Balldvidn
WILLIAM A JENSEN SUP T OF BUILDING Templer:/Crit,
FOR APPLICANT TO FILL IN
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1 25
BATH TUB 125
DRESS51011 N
SHOWER 125 CITY Temple City TEL NO
LAVATORY 125 CONTRACTOR
SINK 125 ADDRESS 13351 E• Garvey Ave,
DISHWASHER 125 CITY Balftin Park TEL NO E aD-85032
STATE
LAUNDRY TUB 125 CONTRACTOR 8
REGISTRATION NO 17465 COUNTY
CLOTHES WASHER 125 DISTRICT NO G OUP ZONE EBBED BY
WATER HEATER 1 50 C `�
GAS SYSTEM OUTLETS 1 so INDUSTRIAL p�
WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V
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5 a-KA5- 9O
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APPROVALS DATE/ _INSPECTOR.SS SIGNAT2ttEj
PERMIT 5$ 2 00 UNDER SLAB WORK ` ?19 /
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AN
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST V «_
CALIFORNIA OR THAT 1 A HE GAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE RIB RESIDENTIAL PROPCnY UTILITY CO NOTIFIED
d ♦ /
SIGNATURE c
OF PERMITTEE FINAL G5
f
DATION ROBERT A WOOD ✓
cK M O CASH SUPERVISING MECHANICAL ENG R
� �,�,0052I PAR2(9 5 D 525