HomeMy Public PortalAbout4821 CLOVERLY AVE_Plumbing__ 76A667 - CE8,' 5/70 /(�� C,
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS U 1=
COLEMAN W JENKINS SUPT OF BUILDING LOCALITY �{
FOR APPLICANT TO FILL IN PR OR TYPE) NEAREST
CROSS ST v Lv L
NUMBER FIXTURE OR ITEM EA H FEE
OWNER `
WATER CLOSET 1 0
MAIL j
BATH TUB 1 !0 ADDRESS
SHOWER I !0 CITY TEL NO
LAVATORY 1 0 CONTRACTOR D —
SINK 1 0 g ADDRESS 16 0 () '5-1
5
DISHWASHER 1 0 CITY TELNO 3SaJ0
CLOTHES WASHER 1 0 STATE LIC
LICENSE NO Q21 3 CLASS R —<t-36
SWIMMING POOL RECEPTOR 1 0
DISTRICT NO GROUP ZONE SSED BY
LAWN SPRINKLER SYSTEM 2 0 L;'-09) S re-
WATER
p,
WATER HEATER 1 0 I WASTEAPAPPROVAL (a�
GAS SYSTEM OUTLETS 5 INSPECTION RECORD
OUTLETS OVER 30
5 PER SYSTEM O
a
Z
Plan check fee 25% of above See reverse
PLUMBING PERMIT ISSUING FEE 8 00
TOTAL FEE
APPROVALS DATE INSPECTOR SSIGNATURE
Plan check applicant UNDER SLAB WORK
Name Ru 1% /11IN ROUGH PLUMBING
Address 00 6 GAS PIPING
GAS VENT
City Tel No S ,,d
HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS AS TEST
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDE NTI PROPERTY FINAL 1 ?,
OF PERMITTEE
SIGNATURE JACK R ALLEN, SUPERVISING ANICAL ENG'R
o-
PERMIT VALIDATION cK M o CASH
PLAN CHECK VALID ION CK M o CASH
!Ko 1 0 5 11.) 14 0 6.50- 14
76 A 667 - CE 817 7-69
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER ING
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BUILDING AND SAFETY DIVISION fN
DRESS /�(/ C G�
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUP T OF BUILDING CALITY 7
FOR APPLICANT TO FILL IN(PR NT OR TYPE) ARESTOSS ST LGS�C
NUMBER FIXTURE OR ITEM EACH FEE n T
WATER CLOSET 1 50 OWNER V NUJ
BATH TUB 1 50
ADDRESS /�' / C/o/O ✓elr
SHOWER 1 50
CITY f�`y TEL NO J2
LAVATORY y 1 50 CONTRACTOR
SINK 1 50 ADDRESS
DISHWASHER 1 50 CrfY TEL NO
CLOTHES WASHER 1 50 STATE LIC
LICENSE-NO CLASS
SWIMMING POOL RECEPTOR 1 50 DISTRICT NO 6.R�,I,1P N S ED BY
LAWN SPRINKLER SYSTEM 2 00 5-6 `� n
WATER HEATER 1 50INDUSTRIAL g
WASTE APPROVAL �J
GAS SYSTEM OUTLETS 1 50 / _50 INSPECTION RECORD
OUTLETS OVER 30 O
5 PER SYSTEM
�Y
N
z
Plan check fee 25% of above See reverse
` � b
PLUMBING PERMIT ISSUING FEE 3 2 00 r
TOTAL FEE
APPROVALS DATE INSPECTOR 5 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name 0/V ROUGH PLUMBING
Address GAS PIPING 7- alb V j
��� / lGAS VENT 7„-20-70
City Tel No �j`23 HOT WATER HEATER
I HEREBY ACK WLEDGE 7 T i HAVE READ TH 19 APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL"COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DEQ REST TIAL PROP RT Y FINAL `
SIGNATURE .TACK R ALLEN, SUPERVISING MACHANICAL ENG'R
OF PERMITTEE
PERMIT VALIDATIO cK I M o CASH
PLAN CHECK VALIDATION CK M o CASH }'
.0 17 5 Jb 35 0 ff
N CQ