HomeMy Public PortalAbout9523 BLACKLEY ST_Plumbing__ APPLICATION FOR PERMIT
ARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
( WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUPI ZONE PERMIT NO.
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PLUMBER /es RECEIVED BY READY FOR DATE ISSUED
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LICENSE NO /�,/9\ EXPIRES O O
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PERMIT FEES CROSS ST
NUM FR TYPE OF FIXTURE OR ITEM - FEE OWNER
WATER CLOSET (TOILET) @ O 50.1 S I MAIL
ADDRESS
BATH TUB @ O 50.1 I CITY L NO.
SHOWER @ 0 50I 1 HEREBY A KNOW LEDG THAT I HAVE READ THIS
CATION AND STATE THA THE ABOVE IS CORRECT AND
LAVATORY (WASH BASIN) Q O 50APPLI
1 I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCH EN SINK Q O 501L_. STATE LAWS REGULATING PLUMBING
I t CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
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LAUNDRY TUBO TRAY Q O 50 ANGLES COUNTY LICGNSE. OR I ED LEGAL OWNER
I GAS SYSTEM D OF THE RESIDEty�T- L! OPE DES ED ABOVE.
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SIGNATURE OF
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WATER HEATER Q 0.501 I PERMITTE
SLOP SINK @ O 501 I INSPECTION RECO
FLOOR SINK Q O 50
FLOOR DRAIN @ 0.50
DISHWASHER Qi O 501
DRINKING FOUNTAIN Qi O 501
URINAL @a O 501 ..1
IHOUSESEWER Q O 501 1 Z
MISCELLANEOUS
1 I O
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1 11
1 1 APPROVALS
1 D INSPECTOR'S NAME
1 ROUGH PLUMBING
1 GAS PIPING �r
1 GAS VENT
CESSPOOL Q 1 00 I CESSPOOL I _
SEPTIC TANK I I SEPTIC TANK
DRAIN ( ) PIT ( Q 1 001 I SEWER
PERMIT I '1 00 GAS TEST
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TOTAL FEE
UTILITY CO NOTIFIED
$
FINAL �I
76A667-CE61712/59 TEMPLE CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �-�
JOHN A. L IE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
' LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
tOWNER 91 e
WATER CLOSET
ADD HESS / '
BATH TUB �-
CITY Cy TEL NO. tWG
SHOWER
CONTRACT
LAVATORY
ADDRESS
SINK
DISHWASHER CITY NO.
CONTRACTOR'S STATE ❑
LAUNDRY TUB REGISTRATION NO. COUNTY ❑
CLOTHES WASHER DISTRICT NO. GROUP ZONE P OCESSEDBY
WATER HEATER OO. .J[:
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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$1.00 PER ITEM „
OR IIXTURE $ APPROVALS DATE INSPECTOR'S§IGNATURE
PERMIT $ 2100 UNDER SLAB WOR 4
TOTAL FEE I ROUGH PLUMBING D s
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND. STATE LAWS REGULATING HOT WATER HEATER—a
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI PE UTILITY CO.NOTIFIE
SIGNATURE I I I��" '?A
OF PER EF FINAL 4 v D i • Llr�'1
®n VALIDATION ROBERT A. WOOD, �"
cs. M.0. CASH SUPERVISING MECHANICAL ENG'R
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