HomeMy Public PortalAbout9431 BLACKLEY ST_Plumbing__ 76A667 -CE4817 9/63 I
APPLICATION FOR PLUMBING PERM T
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUoIILDI HN NG AANB SAFETY DMSCOUNTY ENG EON ER ADDRESS �`13 c�
11
WILLIAM A JENSEN, SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSSSST
NUMBER FIXTURE OR ITEM EACH FEE ,
OWNER
WATER CLOSET $125 MAIL
BATH TUB 125 ADDRESS
SHOWER 125 CITY TEL NO
LAVATORY 125 CONTRACTOR /
SINK 125 ADDRESS a 7
a
DISHWASHER 125 C17 - TEL NO
STATE
LAUNDRY TUB 125 R GINS RATIOCTORN NO `�6' ! CSTATE
OUNTY ❑
CLOTHES WASHER 1 25 DISTRICT NO GRO P E P ES D BY
WATER HEATER 1 50 i O '(
GAS SYSTEM_OUTLETS 150 INDUSTRIAL d
WASTE APPROVAL �
OUTLETS OVER-5 PER SYSTEM 30 INSPECTION RECORD V
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APPROVALS DATE INSPECTOR_S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK ��\ , `i
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST f ,�
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RE IDENTIALrP�ROPPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE - ���iiCCC Cl'�
FINAL
r v
VALIDATION
ROBERT A WOOD
M O CASH SUPERVISING MECHANICAL ENG R
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�LI',�O 8 2 6 6 �PR 3 0 5 D 3.50-
D B B 17 25M SETS 7-47 APPLICATION FOR PERMIT
DEPARTMENT OF BUII.DING AND SAFETY ��� � �
COUNTY OF LOS ANGELES
WM.J. FOX. CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUP PERMIT NU.
ROUGH FIXTURESH
COMPLETE
HEATER CESSPOOL SEPTIC TANK RE V Y FIRST�INBPECTION DATE ISSUED
AS DY
MISCELLANEOUS I� "
APPLICANT FILL IN HEAVILY OUTLINED EQ
JOB r` ✓
d, NAME ADDRESS
W
AD 1 LOCALITYNEAREST
1r�� >f5 (a1s
d CITY TEL No CROSSST. W& 4,
COUNTY
CERT NO EXPIRES W NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL 3 MAIL
.+ i f
NORTH O � 6 S
CITY .cr t'S,.. � TEL No ♦ .JJ�
1 AM THE LEdAL POSSESSOR OF THE ABOVE L S
ANGELES COUNTYICERTIFICATE OI+ QUALIFICATION.
PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE. � '1.�
D
3
OWNER
CORRECTIONS
SOUTH W
DESCRIPTION OF WORK
_BATH TUB FURNACE -I
EL
SHOWER DISHWASHER
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING`FOUNTAIN DATE INSPECTOR'S NAME
' WATER HEATER ^ENTAL LAVATORY
ROUGH PLUMBING '
ETER GAS --------SODA FOUNTAIN
OUTL 6A8 PIPING
GAS VENT I
CESSPOOL
TOTAL NUMBER OF FIXTURES �+ SEPTIC TANK I I
CESSPOOl SEPTIC TANK Y A� SEWER I
UTILITY CO NOTIFIED
TOTAL FEE
FINAL