HomeMy Public PortalAbout9123 BLACKLEY ST_Plumbing__ ' 76A667 DBB 17 11-50 ' APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING
' �'
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN
DISTRIC�T NO. GROUP I ZONE
3 P -`f qY4
PLUMBER' C'7 RECEIVED BY READY FOR DATE ISSUED
q _ FIRST INBPECTION
ADDRESS �/
BUILD
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CITY fy�y–J' �+ TEL NQ ��y,�® ADDREISS
COUNTY �116— LOCALITY i
LI NSE ND EXPIRES
PERMIT FEES
CSS
T.
NUMBERTYP[OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) @ 050 $ C2 0 ADDRESS
BATH TUB @ 0.50 "�C' CITY TEL No
SHOWER @ 0.50 / d� I HEREBY ACKNOWLEDGE THAT'' HAVE READ THIS
LAVATORY (WASH BASIN) @ O 50 / �� APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN BINK @ 050 „�� AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSBESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0504,7
50O ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
/ GAS SYSTEM ` OUTLETS @ 0.50 SIGNATURE OF
WATER HEATER @ 050 3 PERMIT)
SLOP SINK @ D so INSPECTION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ O 50
DISHWASHER @ 0.50 , 'v
DRINKING FOUNTAIN @ 0.50
URINAL Q O 50
Q
HOUSE SEWER @ 050 Z
MISCELLANEOUS C7
O
APPROVALS
DATE INSP[CTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ ID0 CESSPOOL
SEPTIC TANK SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1 00 e)Q SEWER
PERMIT t DD GAS TEST
UTILITY CO.NOTIFIED r/ �'"j-
TOTAL FEE
FINAL L - JL
76A667 (CE-817)-8-71 i
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APPLICATION FOR PLUM ING PE IT {�
; LJ
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING c,
ADDRESS C'
LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM @ FEE i
OWNER
WATER CLOSET 1 75
MAIL
BATH TUB 1 75 ADDRESS
SHOWER 1 75 CIT Q TEL NOa
LAVATORY 1 75 CONTRACTOR
SINK 1 75 ADDRESS
DISHWASHER 1 75 CITY TEL NO
CLOTHES WASHER 1 75 STATE LIC
LICENSE NO CLASSe
SWIMMING POOL RECEPTOR 1 75
DISTRICT NO GRO Z E C D BY
LAWN SPRINKLER SYSTEM 1 75 0
WATER HEATER 1 75 INDUSTRIAL
WASTE APPROVAL
/ GAS SYSTEM OUTLETS 1 75 O
INSPECTION RECORD (�
OUTLETS OVER
5 PER SYSTEM 30 0
U
MA
A.
H
z
Plan check fee See reverse
PLUMBING PERMIT ISSUING FEE $ 3 00 e
TOTAL FEE
APPROVALS DATE INSPECTOR S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel No GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I 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
PLUMBING -. GAS TEST L "
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF /
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE D CRIBED RESIDENTIAL PROPERTY FINAL
SIGNATURE C O
OF PERMITTEE
PERMIT VALIDATION r CK M o c H
PLAN CHECK VALIDATION CK M D CASH
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