HomeMy Public PortalAbout9241 BLACKLEY ST_Plumbing__ CEB17(REV'6/7M®5 +
APPLICATION F PLLUMgrlNG PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING r L
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST
SHOWER 2 OWNER
LAVATORY MAIL
ADDRESS
SINK CITY, TEL NO2eUi
DISHWASHER CONTRACTOR U
CLOTHES WASHER ADDRESS
L
SWIMMING POOL RECEPTOR
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CITY TEL NO
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER LICENSE NO CLASS in>
GAS SYSTEM OUTLETS APPROVALS DATE INSP5CTOR S SIGNATURE
OUTLETS OVER UNDER SLAB WORK -
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING /
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES 9
GAS TEST will,
Plan check fee UTILITYCO NOTIFIED
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE 1 _XZ FINAL
Plan check applicant PLAN CHECK VALIDATION
Name ,41
o� P 21? 1'o-f 77
Address
City Tel No CJ(�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE - nn P
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THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES /d 4 1.y5 A
-..ANDSTATE LAWS REGULATING PLUMBING PERMIT VALIDATION
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS # 0 O 6,o O 5
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL 2 O O 22 00
PROPERTY \
SIGNATURE 14O O O 22005
OF PERMITTEE G
79
DISTRICT ROCE ED BY 06.01
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71NDUSTRIALROVAL
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76AG67 17 5-50 I® APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY L
.COUNTY OF LOS ANGELES
WILLIAM J FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERMIT NO
PLUMBER-sQ ` (•q! Q`K floont,, J "t U It'c RECEIVED BY READY FOR DATE ISSUED j
ADDRESS loo f , U� Ri 1I a �� FIRST INSPECTION
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'V� �rl�t1 �- fJ 'C IC'�(,3 ADDRESS
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CITY TEL NO
COUNTY � LOCALITY •I L�I�V��) -/7� r
LICENSE NO 0r�V EXPIRES
NEAREST
PERMIT FEES CROSS ST
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER /J41 fyf �'// r
if
- MAIL
WATER CLOSET (TOILET) Q O 50 S I ADDRESS/'V-ll /` i-
{ BATH TUB Q O 50 I CITY � �^�✓ TEL NO
ISHOWER Q O Sol I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Q O 501 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
I.KITCHEN SINK Q O 50 STATE LAWS REGULATING PLUMBING
_ 1 CERTIFY THAT 1 POS�2 S THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY Q O Sol ANGELES COUNTY LICENSE OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL OPE ESCRIBED ABOVE
I GAS SYSTEM OUTLETS CLQ O 501 SIGNATURE OF�" 1
WATER HEATER Q O 50 Il PERMITTEE,
SLOP SINK Q O 501 INSPECTION RECORD
FLOOR SINK Q O 50
FLOOR DRAIN Q O 50
DISHWASHER Q O 50I
I DRINKING FOUNTAIN Q O 501
l URINAL Q O 50I I J
HOUSE SEWER Q O 50 I I Q
Z
MISCELLANEOUS II a
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APPROVALS
DATE INSPECTOR S NAME
ROUGH PLUMBING
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GAS PIPING
GAS VENT
CESSPOOL Q 1 00 I CESSPOOL
SEPTIC TANK SEPTIC TANK
I DRAIN ( ) PIT ( ) Q I 00 I SEWER
PERMIT I 100 GAS TEST
UTILITY CO NOTIFIED
TOTAL FEE I $ oo
FINAL
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` 76A667 (CE-817)-4/72
APPLICATION FOA PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO BUILDING /
ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER
LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM @ FEE
OWNER
WATER CLOSET 1 75
MAI L
BATH TUB 1 75 ADDRESS
SHOWER 1 75 CITYt,"_& TEL f3
LAVATORY 1 75 CONTRACTOR K.
SINK 1 75 ADDRESS ez&
DISHWASHER 1 75 CITY TEL NO�� � �d/
CLOTHES WASHER 1 75 STATE LIC _
\ LICENSE NO CLASS CF-EJ
SWIMMING POOL RECEPTOR 1 75
DISTRICT NO G Z NE FR SSED BY
LAWN SPRINKLER SYSTEM 1 75
WATER HEATER 1 75 INDUSTRIAL
WASTE APPROVAL a
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD V
OUTLETS OVER 30
5 PER SYSTEM
O
H
V
W
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ ` &eo
TOTAL FEE 0
APPROVALS DATE INSPECTOR 5 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ,i- ROUGH PLUMBING
Address 3 / GAS PIPING
CItyN
Tel NO GAS VENT
��s- a�
HOT WATER HEATER
I HEREBY ACKNOWLEDGE H T 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 D;.r
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 O ER OF, AND INTEND TO
RESIDE IN THE ABOVE DESC IBED RESIDEN IA PROPERTY FINAL
SIGNATU RE
OF PERMITTEE
PERMIT VALIDAI ONo CK M 0 CASH
PLAN CHECK VALIDATION CK M 0 CASH O o 0 0 {.?
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