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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT 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 ADDRESS
/ SHOWER 1.25 CITY TEL. NO.
Z LAVATORY 1.25 CONTRACTOR '��
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO. ,L j
LAUNDRY TUB 1.25 CONTRACTOR'S STATE
REGISTRATION NO. ! $ COUNTY
CLOTHES WASHER 1.25 DISTRICT NO. GROG` ONE PR SED BY
WATER HEATER 1.50 1
CL
GAS SYSTEM 1.50 INDUSTRIAL
OUTLETS d
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 u
INSPECTION RECORD
GC
O
F
u
W
CL
Z
APPROVALS DATE INSPECTOR'S S IGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE D4 GAS PIPING
I 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
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF '
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST ',.
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
I
SIGNATURE
OF PERMITTEE - �'
FINAL
VALIDATION ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENG'R
III
76A667-CE#617 2-62 7Ldt:i3lI B LE CF]TY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER [NEAREST
UILDING
BUILDING AND SAFETY DIVISION DDRESS J �
JOHN A. LAMBIE, COUNTY ENGINEER L Lfi
WILLIAM A. JENSEN, SUPT OF BUILDING OCALITY TGIF
FOR APPLICANT TO FILL IN
ROSS-ST. L—
(�
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1,25 ADDRESS
CITY TEL. NO
SHOWER 1.25
LAVATORY 1.25 CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
LAUNDRY TUB 1.25 CONTRACTOR'S STATE Cl
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25' DISTRICT O. GROUP ZONE P SSED BY
WATER HEATER 1.50 L
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECZION RECORD d
0
U
0
0
V
u/
d
N
z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE ✓ GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
LRESIDE
COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
.
Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
A OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
THE ABOV DESC RESIDENT L PROPERTY UTILITY CO NOTIFIED
RE / rMITTE FINAL f � ✓,b
VALIDATION l ROBERT AJWOOD . Y
c ,r M o CASH SUPERVISING MECHANICAL ENG'R
L r�l�o 8 1 7 1"S J � ` C: D
Y
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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1210220023
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID I BUILDING ADDRESS: 1
1 ON FILE I 1 9545 BLACKLEY ST I
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917803143 I
(ASSESSOR INFORMATION NUMBER: I - - NEAREST CROSS STREET: CLOVERLY
18590-005-022 101 PERMIT ISSUANCE FEE - •27.80 1-. THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, Cl
1 107 BATHTUBS/SHOWERS 1.00 FIX 16.20 1 - I .
(TENANT: 113 DISHWASHER(S) 1.00 FIX - 16.20 (ISSUED ON: PROCESSED BY: PLAN BY: 1
I 125 LAVATORIES/SINKS 3.00 FIX 48.60 110/22/12 SR 1
1 145 WATER CLOSET/URINAL 1.00 FIX 16.20 1 11
(OWNER: - TEL. NO. 1 TOTAL FEES 125.00 IFINAL DATE FINAL Y: CODE: 1
ICHOO SOOYOUNG;SOOMYUNG (714) 669-8184- 1 1 / 1
11292 DEBORAH DR I -
1TUSTIN CA 92780 I IDESCRIPTION OF WORK 1
I IREPLACE BATH/SHOWER, DISHWASHER„2 LAVATORIES, 1 SINK AND 1
I 1WATER CLOSET FOR KITCHEN AND BATHROOM REMODEL 1
1APPLICANT: TEL. NO: 1 1 1
1CHOO, SOOYOUNG '(714) 669-8184' 1 1 I
11292 DEBORAH DR - 1 ISPECIAL CONDITIONS:
ITUSTIN CA 92780 -
I
I I '
1CONTRACTOR: TEL. NO: 1 - - _ 1APPROVALS DATE INSPECTOR SIGNATURE
I
1R-JS GENERAL CONSTRUCTION (909) 503-2104- 1 1 I
119624 EL RIVINO ROAD LIC. NO - 1 - 1UNDER SLAB WORK I I 1
1RIVERSIDE CA 92509 928560 1 1 1 1 I
IWATER SERVICE 1 I
I IPLASTIC Y/N METAL Y/N I I I
(ARCHITECT OR ENGINEER: TEL. NO: 1 I I I I
I - IROUGH PLUMBING
1 LIC. NO:
I
I I IGAS PIPING I I
I I I
I I
IGAS VENT I I 1
I I I
I 1HOT WATER HEATER
I I I
1 - - - 1PLUMBING FIXTURES
I I I
1 I ILAWN SPRINKLERS
I I I
I IGAS TEST I I
I1 11
I I
I I 1UTILITY COMPANY NOTIFIED( I
Icy
I 1GRAY ATER SYSTEM
I I I I I
I I I I I I
I I I I I I
1 1REPORT ID: DPR263 ROUTE TO: BS0508 I I 1 I
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