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City of Temple Cit H259Q '
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APPLICATION FOR PLUMIEING PERMIT y
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
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DDRESS 5002 A nes
JOHN A LAMBIE COUNTY ENGINEER g f°
WILLIAM A JENSEN SUP T OF BUILDING OCALITY Temple City
FOR APPLICANT TO FILL IN nOsssr Lower Azusa
NUMBER FIXTURE OR ITEM EACH FEE
OWNER Akatsuka
WATER CLOSET $125 MAIL
BATH TUB 125 ADDRESS Same
SHOWER 125 CITY TEL NO
LAVATORY I25 CONTRACTOR General Installation Co.
SINK 1 25 ADDRESS6558 West Blvd.
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DISHWASHER 125 CITY Los Angeles TEL No PL 3-2541
CONTRACTOR 5 Ex
LAUNDRY TUB 1 25 REGISTRATION NO Ci-36 151839 787 COUNTY
CLOTHES WASHER 125 1 DISTRICT NO GROUP ZONE PROCESSED BY
WATER HEATER 150 '"' '�
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GAS SYSTEM OUTLETS 150 INDUSTRIAL a
V�ASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM 90 INSPECTION RECORD V
1 water softener 1 50 Re dy for Insp otriori Now FO
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APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 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
PLUMBING HOT WATER HEATER
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/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 RESID AO,//` UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
VALIDATION ROBERT A WOOD ire
M o CASH SUPERVISING MECHANICAL ENG R
LALO1 6 0 4OCT 18 5 D 350-
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