HomeMy Public PortalAbout9027 BROADWAY_Plumbing__ 76A567-CECBIT 4-64 /p/p/ A
APPLICATION FOR PLUU LLlrl//Brr IG P RMIT(
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
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BUILDING AND SAFETY DIVISION ADDRESS
I JOHN A. LAMBI E. COUNTY ENGINEER
WILLIAM A. JENSEN, SUP of BUILDING c n
LOCALITY G l.,
FOR APPLICANT TO FILL IN NEARESTCROSS _
NEARE sr.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER Q G
WATER CLOSET 71.25 MAIL
t' BATH TUB 1,25 YIJ ADDRESS
SHOWER 1,25 �� CITY TEL. NO.
LAVATORY 1.25 'CONTRACTOR ��L
SINK 1.25 ADDRESS
DISHWASHER 1.25 y. CITY CSEL. NOLO Z �Z
LAUNDA 1,25 CONTRACTOR'S STATE
17
REGISTRATION NO. O O COUNTY
CLOTHES WASHER 1.25 015TRIC7 NO G PRO SBEp o
WATER HEATER 1.50 �j (J/1
CAS SYSTEM OUTLETS 1.50 '� INDUSTRIAL y
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD A
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APPROVALS wwDATE 1' �t
INSPECTOR'5 SICNATypRE
PERMIT SILICATION
UNDER SLAB WORK ��'t,"l�(..� F✓Yiy
ROUGH PLUMBING 4
TOTAL FEEGAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIGAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES ANO STATE LAWS REGULATING HOT WATER HEATER
PLV MBING. F
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES—47
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF (�
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF.,AND INTEND TO GAS TEST �U RESIDE IN,THE ABOVE OESCRIBEO REST E TIAL PROPERTY. UTILITYCO. NOTIFIED ��SIGNATUREOF PERMITTEE n mFINALi19a
VALIDATION ROBERT A. WOOD
CK. M.0. GSH SUPERVISING MECHANICAL ENG'R
( � 7 6 9 2—� JAN 19 5 D 1 7.550
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76A667A ICE 81701- 11/78
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TVPEI BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY
BATH TUB CROSS ST. I\ 0z 5-'e;-/Y) C'AC1T
SHOWER OWNERMAIL
LAVATORY ADDRESS `,Al
SINK CITY '
(1 p' TEL.NO.'DISHWASHER
DISHWASHER �' CONTRA T 1C INST
CLOTHES WASHER ADDRESS' (L 2 E J�
SWIMMING POOL RECEPTOR CITY 'MPLE CITy LN
LAWN SPRINKLER SYSTEM STATE
WATER HEATER LICENSE NO. CLASS
GAS SYSTEM OUTLETS �SIQNb GROOUUP ZA3ROC ED BV
OUTLETS OVER — >-
5
5 PER SYSTEM INDUSTRIAL Ll IL
WASTE APPROVAL U
INSPECTION RECORD u
%�s X/t T &,ft/ G
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N
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Plan check fee
PLUMBING PERMIT ISSUING FEE$ a
TOTAL FEE / 1
Plan check applicant /
APPROVALS DATE INSPECTOR'5 SIGNATURE
Nome
UNDERSLAB WORK
Address ROUGH PLUMBING
City Tel.No. GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF.CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPER". (//�� ///1 UTILITY CO.NOTIFIED
SIGNATURE / � //1/./1
OF
SIGNATURE
TEE Ll�� l/ JI h*1/ / FINAL
I
PLAN CHECK VALIDATION r CK. M'O' cases PERMIT VALIDATI N/ cK. M.D. CASH
aror
.T za 5 u %.50 0"73
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