HomeMy Public PortalAbout4857 CLOVERLY AVE_Plumbing__ 76A667-CE#817 5/69
C I T Y O F T E m P L E C I T Y H 7 8 3 5
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FNM"REST
BUILDING AND SAFETY DMSION 4857 to e 1
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING
Temple City
FOR APPLICANT TO FILL IN In Rnqp Dr.
NUMBER FIXTURE OR ITEM EACH FEE
owNER H. Blanthorne
WATER CLOSET $1 25 MAIL
BATH TUB 125 ADDRESS Same
SHOWER 125 CITY TEL NO
LAVATORY 125 CONTRACTOR General Installation
SINK 125 ADDRESS
8,998 West 'Rlvd-
DISHWASHER 125 CITY LOS Angeles TEL NO pL
CONTRACTOR S
REGISTRATION ON NO C-36 151839 7 STATE pc
LAUNDRY TUB 125 COUNTY
CLOTHES WASHER 125 DII§XWCT(N gWO GROUP ZQNE P SSED BY
WATER HEATER 1 50j
1 50INDUSTRIAL d
GAS SYSTEM OUTLETS WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 U
INSPECTION RECORD
Ready for Inspection Now 0
V
Lu
D.
(Al
Z
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $F3,
QO UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 50 GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR i PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDE — O,/ UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE / /��/t
FINAL -IDlp-
ALIDATION ROBERT A WOOD
CK M O CASH SUPERVISING MECHANICAL ENG R I
i "o5 ri 0 FEa17 5 � 3.50N
76 A 667 - CE 817 7-69 I `
APPLICATION FOR PLUMBING PERM
COUNTY OF'LOS ANGELES '
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION gU1LDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS IQ �-
r COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER `
WATER CLOSET 1 50 MAIL i +
BATH TUB 1 5o ADDRESS ±j /o
SHOWER 15o CITY O J TEL NO �3Q� •J
~ LAVATORY - 1 50 CONTRACTOR lZ U LV r...
SINK 1 50 ADDRESS ig 4
a
DISHWASHER _ 150 CITY r^ �„ -L `TEL NO
CLOTHES WASHER 1 50 STATE LIC
LICENSE NO 3 �j CLASS C .3 (�
SWIMMING POOL RECEPTOR 1 50 DISTRICT NO �.G RO P Z014E PRdE0$EJB
LAWN SPRINKLER SYSTEM 2 00 , 4pep
WATER HEATER 1 50
JNDUSTRIAL APPROVAL (�
GAS SYSTEM ` OUTLETS 1 50 WASTINSPECTION RECORD
OUTLETS OVER 30
5 PER SYSTEM
1
N
z
Plan check fee 25% of above See reverse
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FEE 7�375F
APPROVALS DATE INSPECTOR S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name t ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel No HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST ¢
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED SAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM-THE LEGAL OWNER F AND INTEND TO
RESIDE IN THE ABOVE DE /RIB RESIDENT AL OPERTY FINAL
SIGNATURE ✓ JACK R ALLEN,
r~ SUPERVISI ANICAL
HOF PERMITTEE PERMIT VALIDATION o
PLAN CHECK VALIDATION- CK qMO CASH, FEB 1 55 02 ✓r,
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