HomeMy Public PortalAbout9429 BLACKLEY ST_Plumbing__ 76A667C (CE-817B) -9/75 _
APPLICATION FOR PLUMBING PERMIT
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BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN IP,RINT OR TYPEI BUILDING -�
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST
SHOWER OWNER
LAVATORY MAIL ` .C/���
ADDRESS �L
SINK CITY ^^&- Cll-(,l TEL NO /
DISHWASHER CONTRACTOR \ 1 g
CLOTHES WASHER \ L•
ADDRESS - UIC
SWIMMING POOL RECEPTOR 7
CITY LC- U TEL NO _'?Cr?b
LAWN SPRINKLER SYSTEM
STATEn 1 {y g LIC
WATER HEATER LICENSE NO d 1 O CLASS �
DISTRICT NO GROUP O E PROC ` ED BY JCD
CD
GAS SYSTEM OUTLETS / V
OUTLETS OVER v �
5 PER SYSTEM U
INDUSTRIAL
WASTE APPROVAL 1y
INSPECTION RECORD cn
Z
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant 7,�j
Name APPROVALS DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING
City f
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HATHIS APPLICATION GAS VENT
AND ;TATE THAT THE ABOVE IS CORRAGREE TO COMPLY
WITH ALL COUNTY ORDINANCES ANDLAWS REGULATING HOT WATER HEATER
PLUMBING
I HEREBY CERTIFY THAT I AM PROEGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGETY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGALF, AND INTEND TO
RESIDE IN THE ABOVEDESCRIBEDRESIDROPERTY UTILITY CO NOTIFIED
SIGNATURE ^OF PERMITTEFINAL r Q�
PLAN CHECK VALIDATION cK M o CASH PERMIT VALIDATION (KI CASH
3 2 4"r--JAN �� � 7.5
7GA667-CE#817 10_82
/ S
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRSS
E
WILLIAM A JENSEN, SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1 25 MAIL
BATH TUB 1 25 o�J ADDRESS
SHOWER 125CITY TEL NO
.5�
LAVATORY 125 D CONTRACTO
SINS 125ADDRESS Q
DISHWASHER 125 CITY TEL N 'y
STATE
LAUNDRY fUB 125 REGISTRAT
C NTRATS 6 COUNTY
g�ICON NO d
CLOTHES WASHER 125 D155T T NO GROUP ZONE ESSED BY�
WATER HEATER 150
GAS SYSTEM OUTLETS 1 50 Q INDUSTRIAL I d
WASTE APPROVAL Q
OUTLETS OVER 5 kfil SYSTEM 30 a INSPECTION RECORD., V
- - a
�~ /0
k. APPROVALS DATE jINSPF.CTOR S SIGNATURE
PERMIT $ 2 O UNDER SLAB WORK _/ _s
�. ROUGH PLUMBING f ��f.d IYL,yI/QfL/V1i1�
TOTAL FEE S GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
Je
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 1
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
- I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ,Y " f�,
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO _ ¢'
RESIDE IN THE ABOVE SCRIBED RESIDENTI�AL�P/R/pPERTY UTILITY CO NOTIFIED
SIGNATURE /// r
OF PERMITTEE (J'� ,RIO
VFINAL �v iT f'P`ALIDATION ROBERT A•WOOD 1
cK M o CASH SUPERVISING MECHANICAL ENG R
4 3 2 7�, JAN 13 5 D 1 5.0 0