HomeMy Public PortalAbout5510 CLOVERLY AVE_Plumbing__ "�*7 2 6 2
APPLICATION FOR -PLI`JMB(NG PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS510 C' overt
WILLIAM A JENSEN SUP T OF BUILDING
LOCALITY Tem l.e Cit
FOR APPLICANT TO FILL IN NEAREST
CROSS ST Broad
NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET $125 OWNER R. FortnerMAIL
1. BATH TUB 125 1 ADDRESS
SHOWER 125 CITY TEL NO
LAVATORY 125 1 CONTRACTOR Van Curers Plumbin
SINK 1 25 1
ADDRESS 42 W. Chestnut St.
DISHWASHER 125CITY Monrovia TEL NO EL-97134
LAUNDRY fUB 125 CONTRACTOR S STATE ❑
REGISTRATION NO COUNTY ❑
CLOTHES WASHER 125 I25 DISTRICT NO GROUP ZONE PR/ SED BY
WATER HEATER 150 1 Q ( ��
OUTLETS 50 OASTEAPPROVAL,SYSTEM ��+ �e era
OUTLETS OVER 5 PER SYSTEM 30 fI MIONSPEC,'ON)RECORD
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APPROVALS YDAT /INSNSECTR SSIGNATURE1 91 2 O
PERMIT $ 2 00 UNDER SLAB1WORK ((1y/;,Mb
ROUGH PLUMBING /R(0 ly1 -!A / / 11 ,
TOTAL FEE Ill 2 GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT ,
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER �� p�
PLUMBING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURESp' p;
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST �r?7 �
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO _ �_��
RESIDE IN THE ABOVE D RIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATUF PERMITTEE ,Y`
FINAL
�jALIDATION ROBERT A WOOD v
cK J M O CASH SUPERVISING MECHANICAL ENG R
LAAO 5 3 8 11 OCT 10 5 D 1 1.2 5,
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0511140008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ON FILE 5510 CLOVERLY AV
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917802547
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET BROADWAY
8588-005-026 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY C
07 BATHTUBS/SHOWERS 1 00 FIX 16 20
TENANT 25 LAVATORIES/SINKS 1 00 FIX 16 20 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
45 WATER CLOSET/URINAL 1 00 FIX 16 20 11/14/05 JK 05/13/06
TOTAL FEES 76 35
OWNER TEL NO FINAL DATE FINAL BY CODE
NG MALADY (626) 616-6684-
5510 CLOVERLY AV (�
TEMP 917802547 DESCRIPTION OF WORK
PLUMBING FOR NEW BATHROOM
APPLICANT TEL NO
SAME AS OWNER -
SPECIAL CONDITIONS
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC NO , UNDER SLAB WORK
WATER SERVICE
` PLASTIC YIN METAL YIN
ARCHITECT OR ENGINEER TEL NO
- ROUGH PLUMBING
LIC NO
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
CWV
GRAY WATER SYSTEM
REPORT ID DPR263 ROUTE TO BS0508