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76A667-CE817-8-58
APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION�nBUILDADDRING 5419 N. Cloverly
JOHN A LAMBIE CountF Engeer
CASSATT D GRIFFIN,Sup t of Buildmg LOCALITY Temple City
FOR APPLICANT TO FILL IN CEARF_CT
CROSS ST
NUMBER FIXTURE OR ITEM
12 WATER
Jack Nisbet
WATER CLOSET
MAIL
1 BATH TUB ADDRESS
1 SHOWER CITY TEL NO
2 LAVATORY CONTRACTOR Belvedere Plumbing Co.
1 SINS ADDRESS 11900 E. Garvey Ave.
1 DISHWASHER CITY El Monte TEL No GI 89836
CONTRACTORS 179568 coTTATE O
LAUNDRY TUB REGISTRATION NOUNY
1 CLOTHES WASHER DISTRICT~hIO A�GRO� Z E P OCESSED BY
1 WATER HEATER
GAS SYSTEM INDUSTRIAL
1WASTE APPROVAL
INSPECTION RECORD
I-Alf i
APPROVALS
11 @ $1 00 FIXE IE TEM $ DATE INSPECTOR S SIGNATURE
11.00 UNDER SLAB WORK
PERMIT $ 2 00 ROUGH PLUMBING
TOL
1 00 GAS PIPING /��/
I HEREBY ACKNOWLEDGE THATAD THIS APPLICATION GAS VENT �Q Q ,Q,t//r/
AND STATE THAT THE ABOVE ISND AGREE TO COMPLY HOT WATER HEATERWITH ALL COUNTY ORDINANCESTE LAWS REGULATING PLUMBING PLUMBING FIXTURES pfI HEREBY CERTIFY THAT I AY REGISTER D AND/OR GAS TEST OLICENSED AS REQUIRED BY LOSOUNTY A STATE OF CALIFORNIA OR THAT 1 AM THOWNER 0 THE ABOVE UTILITY CO NOTIFIEDDESCRIBED RESIDEN �A PROPERSIGNATURE FINAL
OF PERMITTE
ROBERT A WOOD
®r VALIDATION SUPERVISING MECHANICAL ENG R
CK H 0 CASH
[ ACO 6 1 00 ' MAY 8 5 A 1 3.0 0
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0907230010
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
ILEGAL ID FEES PAID I BUILDING ADDRESS I
ON FILE I I 5419 CLOVERLY AV 1
IFEE DESCRIPTION QUANTITY UOM AMOUNT I TEMP CA 917803108 1
(ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET OLIVE 1
18588-028-018 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY, Cl
1 107 BATHTUBS/SHOWERS 2 00 FIX 32 40 1-
ITENANT 145 WATER CLOSET/URINAL 1 00 FIX 16 20 (ISSUED ON PROCESSED BY PLAN BY EXPIRES ON 1
1 TOTAL FEES 76 35 107/23/09 SR 07/23/10 I
(OWNER TEL NO I IF DAT FINAL BY CODE 1
IHUI, SALLY -
15419 CLOVERLY AVE I I I
ITEMPLE CITY CA 91780 1 JDEIISCR�IPTIOli OF WORK 1
I (PLUMBING FOR BATHROOM REMODEL 1
1APPLICANT TEL NO I
ILAI (626) 288-2651- I I
18748 VALLEY BLVD #K I ISPECIAL CONDITIONS 1
IROSEMEAD, CA 91770 I I I
I I I I
ICONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE 1
(DAVID GENERAL BUILDING CONSTRUCTION (626) 926-2728- I 1 I
1420 S ELECTRIC AVE LIC NO I (UNDER SLAB WORK I
IALHAMBRA, CA 91603 768772B I I I I I
I IWATER SERVICE I
I I IPLASTIC Y/N METAL Y/N I I
(ARCHITECT OR ENGINEER TEL NO I J I I I
- I IROUGH PLUMBING I
LIC NO 1 I-
I
I IGAS PIPING
IGAS VENT
I
I IHOT WATER HEATER I
I I I I I
I (PLUMBING FIXTURES I
I I I I I I
I I ILAWN SPRINKLERS
I I I I I I
IGAS TEST 1
I I I
(UTILITY COMPANY NOTIFIEDI
I I I I
I ICWV I I
I I I I
IGRAY WATER SYSTEM 1 1 1
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
IREPORT ID DPR263 ROUTE TO BS0508 I I I
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