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APPLICATION G
PERMIT
COUNTY OF LOS ANGELES Lot # 4
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDAESS 5921 Avon Ave.
JOHN A. LAMBIE, COUNTY ENGINEER B
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
San Gabriel
FOR APPLICANT TO FILLJIN NEAREST
CROSS ST.JCo.
NUMBER FIXTURE OR ITEM EACH FEE OWNER J. B. Weber Dev,
3 WATER CLOSET $1.25 3 75 MAIL
1 BATH TUB 1.25 1 25ADDRESS 5926 Temple City Blvd.
CIT
2 SHOWER 1.25 2 50 Y Temple City TEL. NO.
3- LAVATORY 1.25 3 75 CONTRACTOR Valley Plumbing Co.
1 SINE 1.25 1 25 ADDRESS 442 W. Fleetwood Place
1 DISHWASHER 1.25 1 25 CITY Glendora TEL. NO. Ed 51293
CONTRACTOR'S 209431 COSTATE UNTY p
LAUNDRY TUB 1.25 REGISTRATION NO.
1 CLOTHES WASHER 1.25 1 25 DISTRICT NO. GROUP I ZONE P CESSED BY
1 WATER HEATER 1.50 1 50
GAS SYSTEM OUTLETS 1'5 1 50 INDUSTRIAL a
WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .30 30 INSPECTION RECORD u
O
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APPROVALS DATE INSPECTOR'SpSjIGNATU,RE
PERMIT $ 2 QO UNDER SLAB WORK 3�6 �� �jj�'�a�✓
ROUGH PLUMBING
TOTAL FEE 20 30
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION I�
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY F' GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST01
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED SIDENTIAL PROPERTY. UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL.
ALIDATION ROBERT WWOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R!%''��
CJ.. 2 4 L t s ea n Jr A .5`f rs
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