HomeMy Public PortalAbout9302 BLACKLEY ST_Plumbing__ r+
76A667 (CE-817)-8-71
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDINGDDRESS
A
LOCALITY Tem le City
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST \
NUMBER FIXTURE OR ITEM @ FEE
OWNER
WATER CLOSET 1 75 Mr. Jobn Sell
�O
MAIL
BATH TUB 1 75
ADDRESS 2023 Bella Vista Drive
SHOWER 1 75 g CITY Arcadia TEL NO 445-2772
LAVATORY 1 75 3 J CONTRACTOR Owen Bros. Plumbin Inc•
` SINK 1 75 73 ADDRESS 4265 North Baldwin Avenue
DISHWASHER 1 75 CITY El Monte TEL NO "3-0078
/ CLOTHES WASHER 1 75 LICENSE NO 231 LIC
7 1 CLASS c36
SWIMMING POOL RECEPTOR 1 75
DI TRICT NO GROUP N P CES D B
LAWN SPRINKLER SYSTEM 1 75 �y '
WATER HEATER 1 75 / `� INDUSTRIAL `—
WASTE APPROVAL
/ GAS SYSTEM OUTLETS 1 75 IN ECTI N RECORD V
OUTLETS OVER 30 1
5 PER SYSTEM
AA
0"
LU
44- 11L
V
i Vf
z
Plan check fee See reverse .5
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE ,2
APPROVALS DAT.E PIE CTOR 5 ATURE
Plan check applicant UNDER SLAB WORK 1p ,
Name ROUGH PLUMBING
Address GAS PIPING
City `
Tel No GAS VENT
HOT WATER HEATER
1 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 4e 9
PLUMBING GAS TEST
1-119
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 ASO VEC BED RESIDENT L PROPERTY FINAL
SIGNATURE
OF PERMITTEE
PERMIT VALIDATION ' cK M o CASH
PLAN CHECK VALIDATION CK M o CASH
tC� 2 5'f r;,f .FED 2 6, 5 D 22.25-
CE 817(REV 6/78)
APPLICATION ZVP LUM ING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY r
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /� � /�CI�!
NUMBER FIXTURE OR ITEM ® FEE ADDRESS &LA l_
LOCALITY
WATER CLOSET
NEAREST
BATH TUB CROSS ST
SHOWER OWNER
MAIL
LAVATORY ADDRESS
SINK 3 CITY eZtd e-C TEL NO
DISHWASHER CONTRACTOR
CLOTHES-WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY �� TEL NO")Sf
LAWN SPRINKLER SYSTEM STATE / Q LIC
WATER HEATER LICENSE NO r (�� CLASS S3
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING I IV
GAS VENT
HOT WATER HEATER /
p®
PLUMBING FIXTURES 6Il
GAS TEST !
Plan check fee UTILITYCO NOTIFIED
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE ` <j� FINAL
PLAN CHECK VALIDATION
Plan check applicant
Name
Address
City Tel No
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE - :@ 6�6&9 A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLU PERMIT VALIDATION # O O O O O 5
1 HEREBY CERTIFY THA AM PROPERLY EGISTERE ND/OR LICENSED AS
REQUIRED BY LOS ANGELES OUNTY AND STAT OF CAL) OR A OR THAT I AM THE 2 O O 1300
LEGAL OWNER OF AND INT ND TO RESID H ABOVE D CRIRED RESIDENTIAL °
PROPERTY °
Q Q Q 1 3�006
SIGNATURE �7
OF PERMITTEE 9. 1 3'- / 9
DISTRICT NO P CESSE
INDUSTRIAL
WASTE APPROVAL