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APPLICATION, FOR PLUM NG PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING •
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
CrT
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $125 MAIL
BATH TUB 1 25 .�y ADDRESS
SHOWER 125CITY TEL NO
2 LAVATORY 125 so CONTRACTOR
SINK 125 S ADDRESS S S
DISHWASHER 125 CITY TEL NO
LAUNDRY fUB 1 25 CONTRACTOR S STATE
REGISTRATION NO COUNTY [�
CLOTHES WASHER 125 DISTRICT NO GROUP ZOt�E� PR CES 4 BY
WATER HEATER 150 O ///����
GAS SYSTEMOUTLETS 1 50 INDUSTRIAL O
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30
INSPECTION RECORD A u
..d'0'Y��v Pt� W
916
17 -
IVa r��d ri', �+.e,... Z
A2 ROV'ALS\-- DATE INSPE(�� R S S/G//4U RE
PERMIT $ 2 00 UNDER 5948 WORK ;
ROUGH PLUMBING
TOTAL FEE t� GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
i
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
/ / /
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST �y-
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO j� n�Qg
RESIDE IN THE ABOVE DESCRIBE RESIDENTIAL PROPERTY UTILITY CO NOTIFIED Ylliff'
SIGNATURE - , /
OF PERMITTEE AS /�/4 3
FINAL
VALIDATION ROBERTA WOOD
cK M O CASH SUPERVISING MECHANICAL ENG R
L � 1592 HR 5 5 D 16 5
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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING-PERMIT-=y
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508=9704290008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE (818) 285 0488 EXT
LEGAL ID F55S PAID BUILDING-ADDRESS
TR 9481 LT 8 BL 001 5029 BALDWIN AV--�
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP-CA-917804011
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LA ROSA
8589 026-026 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID B4 LOCALITY TEMPLE CITY
51 LOW PRS GAS 5 OUTLET 1 00 SYS 16 35
TENANT TOTAL FEES 44 10 ISSUED ON -PROCESSEDX S ON
04/29/97 TC 04%29/98
OWNER TEL NO FINAL DATll/ INAL B CODE
YU KENNY S,SHARON Y TRS (818) 443 1866 ff
5029 BALDWIN AV "
TEMP 917804011 DESCRIPTION OF WORK
EXTEND GAS LINE FOR CHANGE OUT HEATING & AIR/COND SYSTEM
APPLICANT TEL NO
SAME AS OWNER
SPECIAL CONDITIONS
CONTRACTOR TEL NO LES
SAME AS OWNER LIC NO ATFR ALS DATE INSPECTOR SIGNATUR
L 0
T P SERVICE
0 G PLASTIC Y/N METAL Y/N
ARCHITECT G-- RbM
H PLUMBING
LIC NO
111111GAS PIPING
GAS VENT
Olam- �C WOO " I "' (AST-WATER R - -
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
CWV
GRAY WATER SYSTEMREPORT ID DPR263 ROUTE TO BS0508