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HomeMy Public PortalAbout4825 CLOVERLY AVE_Plumbing__ 76A667-CE817-8-58 APPLICATION ON FOR PLUMBING PERMIT UNTY T' 1.. OS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS a CASSATT D. GRIFFIN,Sup t of Building LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS a � CITY TEL. NO. SHOWER LAVATORY CONT R A 9 OR SINS ADDRESS DISHWASHER CITY TEL. NO. LAUNDRY TUB CONTRA R'S ®a� STATE '' REGISTRATION NO. OU TY ❑ `� CLOTHES WASHER DISTRICT NO. GROU2 ?ZNE f P OC SED BY WATER HEATER A r7 •��' / GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD q t r APPROVALS ER ITEM OR FIXTURE $ / 0-p DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK v d-� PERMIT $ 2 00 ROUGH PLUMBING TOTAL FEE A ®� r GAS PIPING i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT A ,i AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED f' DESCRIBED RESIDENTIALPROPERTY. SIGNATURE �� / ( � �!/ I �G6 OF PERMITTEE' t, FINAL �r � � •6 /:'��.,�i ROBERT A.WOOD. ®F VALIDATION SUPERVISING MECHANICAL ENG'R CK. M.0. ASH" jam? 0 5 4:0; SEP 2 A3 4 Y76A667 - CE817 5/70 —r- (' APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 17A JOHN A. LAMBIE, COUNTY ENGINEER �UCOLEMAN W. JENKINS. SuP r. of BUILDING I E (1,f FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST CROSS ST. (Q NUMBER FIXTURE OR ITEM EA N FEE OWNER WATER CLOSET 1. 0 MAIL BATH TUB 1. 0 '�C, ADDRESS SHOWER 1. 0 .7 CITY TEL. NO. LAVATORY ^ 1. 0 •l `"J CONTRACTOR t SINK F \ 1.io '� ADDRESS DISHWASHER I.;0 CITY 5�V t) TEL. NO. CLOTHES WASHER 1.;0 STATELIC LICENSE NO. a-? 3 CLASS SWIMMING POOL RECEPTOR 1. 0 DISTRICT NO. GROUP ZONE CESSED BY LAWN SPRINKLER SYSTEM 2. 0 WATER HEATER 1. 0 i [ INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1. INSPECTION RECORD OUTLETS OVER 5 PER SYSTEM •30 am MJI (�4D Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE .$ b0 TOTAL FEE © c7 APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name i/ LAA 1 , ROUGH PLUMBING Address 0D _ - GAS PIPING GAS VENT City 5p 1v Tel. No. '3 Sv 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 TEST PLUMBING. IHEREBY 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 DESCRIBED RESIDENT PROPERTY. FINAL Vni SIGNATURE �, JACK R. ALLEN, s PER`VISING ANICAL ENG'R. OF PERMITTEE / S PERMIT VALID TION CK. M.O. CASH PLAN CHECK VALID ON CK. M.O• CASH FEB 14 5. D 1 0.0©-