HomeMy Public PortalAbout4514 CLOVERLY AVE_Plumbing__ 76A667-CE817 12/59 TEMPLE CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER gUiLDING
BUILDING AND,SAFETY DIVISION ADDRESS
JOHN A. LAMB[ COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY ` +
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM •
OWNER i
WATER CLOSET MAIL
ADDRESS
BATH TUB
CITY TEL. NO Y
SHOWER
CONTRA OR
LAVATORY
SINS ADDRESS
DISHWASHER CITY TEL. N �t�
CON C 'S STATE
LAUNDRY TUB REGIS ON NO. COUNTY ❑
CLOTHES WASHER DISTRICT N G ZONE R D BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD �.
w
O
U
a
0 .
U
W
a
in
$1.00 PER ITEM
OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE C' ROUGH PLUMBING
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOSANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT t M E LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL RO RTY. UTILITY CO.NOTIFIED
SIGNATURE /J,,/
OF PERM ITTE x FINAL
®F VALIDATION ROBERT A. WOOD,
CK. M.0. CARR SUPERVISING MECHANICAL ENG'R
3.5 f_
0 3 4 r� Ji." [ 4 D