HomeMy Public PortalAbout9321 BROADWAY_Plumbing__ 76A667-CE.817 10-67 \
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION AUILDIN 21 Broadway
JOHN A. LAM81E, COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALTTYTemple City
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEARcRosS stEhCiriita AVC
NUMBER FIXTURE OR ITEM EACH FEE
OWNER GoQld. VG
WATER CLOSET 1.50
BATH TUB 1.50 iDDRERs 9321 $Qrw%d &,V Broadway
1 SHOWER1.50 CITY em eCityTEL. NO.
LAVATORY 1,50 CON[RACTORHOward Ke Uler
SINK 1.50 ADDRESS$ 'L Sepulveda Blvd.
DISHWASHER 1.50 CITY Sepuplvgeda,913*,5NGS92-124j
CLOTHES WASHER 1.50 SATEIc
LICENSE NO. VOr 2 62 CLAss C-54
SWIMMING POOL RECEPTOR 1.50
}DISTRICT NO. GROUP If ZONE P CESSED BY r
LAWN SPRINKLER SYSTEM 2.00 - J I �� R-I ' I d
O
WATER HEATER 1.50 INDUSTRIAL U
WASTE APPROVAL ee
O
GAS SYSTEM OUTLETS 1.50 rNSPECTION RECORD U
OUTLETS OVER .30 d
5 PER SYSTEM
N
_ Z
Plan check fee 25'. of above. See reverse.
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FEE
APPROVALS DATE INSPECTORS SIGNATURE
Plan Check applicant UNDER SLAB WORK
Name ROUGH PLUMBING _
Address GAS PIPING
GAS VENT
City Tel. No. HOT WATER HEATER
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AN D,STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANO 9 ATE OF /
CALIFORM
IA OR THAT I AM E LEGAL OWNER OF.AND TEND TO
RESIDE IN.THE ABOVE DE RIBEO RESI NTIAL PROPERT FINAL
SIGNATOR ,_�( / j JACK R. ALLEN, SUPERVISING MECHANICAL ENG-R.
OF PE
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CH. M.O. CASH
LACO 6 8 4 5 kS CCT 14 5 0 35 0