HomeMy Public PortalAbout5115 CAMELLIA AVE_Plumbing__ 76Aa67A tCa 9 170),11/76 -
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APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
EOR APR.+C TTOFILLIN(PRINTORTYPE) BUILDING
NUMBER FIXTURE OR REAR O FEE ADDRESS
WATER CLQSEr LOCALITY
el z
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER /C "/i
MAIL
LAVATORY A.D 13RESS / ^
SINK CITY TE3,NO
DISH WASHER CONTRACTOR
CLOTHES WASHER ADOR>ESS
SWIMMING POQt RECEPTOR
aTY TEL NO.
LAWN SPRINKLER SYSTEM STATE UC
WATER HEATER LKS NO. CLASS
C,AASS�YYEE
SYSTEM OUTLETS
OUTLETS DISNED
DISTRICT NO. GROUP ZOE PROCESSBY
05 P8t SYSTEM I N D USTRlA1
WASTE APPROVAL
INSPECTK)IN V
v
Plan check fee
PLUMBING PERWT ISSUING FEE;
TOTAL FEE r
Plan check applicant
APPROVALS DATE IKSPEC�TOR-S SW"TURE
Name
UN DER SLAB WORK
Addrms L ROUGH PLUMBING -
C}ty Tel,NoDs,,., G.KS PIPING
IHEREBY E THAT S WD TRIM APPLICATION MD STATE GAS VENT
THAT THC ABOVE O OORRECT AND AGREE TQ COMPLY WrrH All CQNTY ORDINANCES
AND STATE LAWS REGUTAT1 Na PLUMBI11a HOT WATER HEATER
I HERESY CM FY THAT I AM PROPERLY ItEGtfTERED AMD/OR LICENSED AS PLUMBING FI
[RLEQMUr1M8D3 AMOLL"CQKTY AMD STATE Q?CALIPOWA OR THAT I AY THE GAS TEST
,MND NrDfD TO REAlDE IM THE ABOVE DESCRIBED RESDgKTIAL
UTA LITY CO. TI RED
R NAL
PLAN CHECK VALIDATION cx r,o. CASH PERMIT VAUDATIQN cx ii�0- LAW
74fASS7 17 5'60 0 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING
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COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROrUP ZONE PERMIT NO.
( I
PLUMBER ; RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
ADDRESS C421 /s�f/L 'L�,Y.
), rJ �„ BUILDING
CITY _.. .*'o ,fes'-..�a.-�,.TEL. N ,/ ADDRESS
COUNTYLOCALITY
—LICENSE NO..—. `^ EXPIRES _ ! - �✓' f,[ {,�. / 7°'
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER t . .+1✓.-�..•
MAIL
WATER CLOSET (TOILET) @ 0.50 $I I ADDRESS ;TM"
BATH TUB @ 0.501 CITY ;f:,=,y,r, TEL. NO.
SHOWER @ 0.501 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.501 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING PLUMBING.
1Y KITCHEN SINK @ 0.50 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
ANGELES COUNTY LICENSE. OR 1 AM THE EGAL O�/NER
LAUNDRY TUB OR TRAY @ O.50 OF THE RESIDENPERTY CRIBED ABOVE.�+
GAS SYSTEM '- OUTLETS @ 0.501
WATER HEATER @ 0.501 SIGNATURE OF
PERMITTEE TIACL' G �
I SLOPSINK @ 0.501 INSPECTION RECORD
FLOOR SINK @ 0.501
FLOOR DRAIN @ 0.501
DISHWASHER @ 0.501
DRINKING FOUNTAIN @ 0.501
URINAL @ 0.501 I ..��..... ..1
HOUSE SEWER @ 0.50 I I Q
Z
MISCELLANEOUS ,c.
' O
I�
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
ICESSPOOL @ 1.00I CESSPOOL _
1 SEPTIC TANK: I SEPTIC TANK
I DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT . I 1.00 GAS TEST
�1 UTILITY CO. NOTIFIED
F__
TOTAL FEE $ J
FINAL
1