HomeMy Public PortalAbout5443 BALDWIN AVE_Plumbing__ CITY OF TEMPLE CITY
76 A 667 - CE 817 7-69
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES B487 7 5
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS 5443 No. Baldwin
JOHN A LAMBIE COUNTY ENGINEER y
COLEMAN W JENKINS SUP T OF BUILDING LOCALITYTempltx City
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
GROSS ST
NUMBER FIXTURE OR ITEM EACH 1 FEE
OWNER W. R. Ellis
WATER CLOSET 1 50
MAIL
BATH TUB 1 50 ADDRESS Same
SHOWER 1 50 CITY ` TEL NO ^_
LAVATORY F 1 50 CONTRACTOR General InStallatlOn Co
SINK 1 50 ADDRESS T. 6668 wt Blvd
DISHWASHER 1 50 CITY LOS Angeles TEL NO PL 8-2541
CLOTHES WASHER 1 50 STATE LICENSE NO C-36 151839 LIC
CLASS
a
SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GR ZQNE P ZEW9 BY
LAWN SPRINKLER SYSTEM 2 00
1 WATER HEATER 1 50 1 50 INDUSWASTAPPROVAL Q
GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD
OUTLETS OVER 30 Read for Tnspeebon Now
5 PER SYSTEM Y �A O
WATER BOPTENEB u
W
Vf
Plan check fee 25% of above See reverse
PLUMBING PERMIT ISSUING FEE 8 2 00
1 I TOTAL FEE
4 APPROVALS DATE INSPECTOR S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
AddressGAS PIPING
z
3 GAS VENT
Cit) �'Iel NO SHOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Y
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED R NTI PR RTY FINAL 3 7/
1
SIGNATURE JACK R ALLEN SUPERVISING MECHANICAL ENG R f
OF PERMITTEE
PERMIT VALIDATION M o CASH
PLAN CHECK VALIDATION CK M o CASH v
1A^ 8-972 rink 5 D � cJO � v
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