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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET it 25 MAIL
BATH TUB 125 ADDRE
SHOWER 125 CITY ,�, TEL NO
LAVATORY 125 CONTRACTOR ,L a'k
SINK 125 ADDRESS L7 L Gci1 d
DISHWASHER 125 CITY 2TEL NO Z 7 y Z
LAUNDRY TUB 1 25 STA E LIC
LICENSE NO � CLASS 61
CLOTHES WASHER 125 DISTRICT NO GROUPE I PROCESSED BY
WATER HEATER 1 501 C)
GAS SYSTEM OUTLETS 1 50 INDUSTRIALWASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM 30 SPECTION RECORD U
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APPROVALS DATE INSPECTOR IGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING // r"M � ear
TOTAL FEE GAS PIPING l J
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP 1 TION
AN STATE THAT THE ABOVE IS CORRECT AND AGREE T COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING HOT WATER HEATER l P
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES r
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST ('
CALIFORNIA OR THAT 1 AM THE GAL OWNS OF AND INTEND TO �r
RESIDE IN THE AB E DEC RTIA ROP UTILITY CO NOTIFIE / Ell- or
SIGNATURE
OF PERMITTEE FINAL o",A-a 7
�LIDATION JACK R ALLEN
M o CASH SUPERVISING MECHANICAL ENG R
Cleo 9 5 5 JUN 2 3 5 D 9.7 5N
MENEM, zoidi"a".n)
COUNTY OF LAS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1103280010
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285 0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ITR 5903 IT 39 UN 002 1 6248 AVON AV
I IFEE DESCRIPTION QUANTITY UOM AMOUNT SGAB CA 917752608
ASSESSOR INFORMATION NUMBER 1 NEAREST CROSS STREET LONGDEN
15386 009-009 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID G2 LOCALITY TEMPLE CITY Cl
1 107 BATHTUBS/SHOWERS 3 00 FIX 48 80 1
TENANT 121 HOSE BIBB(S) 1 00 FIX 16 30 JISSUED ON PROCESSED BY PLAN BY
1 125 LAVATORIES/SINKS 3 00 FIX 48 80 103/28/11 SR
145 WATER CLOSET/URINAL 2 00 FIX 32 50 1
OWNER TEL NO 147 WATER HEATER(S) 1 00 WTH 16 30 IF AL DATE FINAL BY CODE
IGOH MICHAEL 163 WATER PIPING BR/FIX 7 00 FIX 47 00
16248 AVON AV I TOTAL FEES 237 50
ISGAB 917752608 1 IDESCRI TIO OF WORK
I 1 IPLUMBING FOR NEW BATHROOMS WATER HEATER GAS LINE AND
I 1 IRE PIPING
(APPLICANT TEL NO 1 I 1
IDARRIN KLAASSEN (626) 216 5361 1 1 1
11155 N LYMAN AVE 1 ISPECIAL CONDITIONS
ICOVINA CA 91724 1 1 1
I I I I
I I I I
ICONTRACTOR TEL NO I 1APPROVALS DATE INSPECTOR SIGNATURE 1
(HASSLE FREE PLUMBING (626) 216 5361 1 1 1
11155 N LYMAN AVENUE LIC NO I 1UNDER SLAB WORK 1 1 1
ICOVINA CA 91724 913828 C36 1 1 11 1
I 1 IWATER SERVICE 1 1 1
1 1 IPLASTIC YIN METAL YIN 1 1 1
1 ARCHITECT OR ENGINEER TEL NO 1 11///------���--���I}
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ROUGH PLUMBING
1 LIC NO
1 1 IGAS PIPING
1 I IGAS VENT I ( I 1
1 I
1 1 1HOT WATER HEATER 1 1 1
1 I I
1 1PLUMBING FIXTURES I I
I I 11
1 1 ILAWN SPRINKLERS I I 1
I I 1 11
1 1 IGAS TEST I I 1
I I 1 11
I 1 1UTILITY COMPANY NOTIFIEDI I 1
I I I I I I
I ICWV I I
I I I I I I
1 1 1GRAY ATER SYSTEM 1 1 1
I I I I I I
I I I I I I
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I I I I I I
I I I I I I
1 1REPORT ID DPR263 ROUTE TO BS0508
I I I I I I
J
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DEPARTMEINT OF BUILDING AND SAFETY APPLICAT-10IN FOR nM=
COUNTY OF LOS ANGELES PLM, IBING
NAI URI' Or INSI tLI AlIOM' D15TRICT No GROUP I No,/ PEP-MIT No
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READY FOR RECEIV[p Y DAT[ 1 UN'/
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LIAS I MI3CELLANCOOS
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CESSPOOL I
WASH TRAY _URINAL
—L—WATER CLOSR 6fPTIC TANK DRINKING FOUNTAIN 1
/ � I
/ WATER HEATER DENTAL LAVATORY SEWER
METER OAS SODA ►OUNTAIN UTILITY CO NOTIFIED
FINAL I �I ) iI I L
1 AM THE LEGAL OWNER OF THE ABOVE LOO ANGELES
COUNTY REGISTRATfN NUMBER
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