HomeMy Public PortalAbout10525 1/2 DAINES DR_Plumbing__ 1
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76A667-CE617 6-60
APPLICATIO�FOR PL MBING PERMIT,
COUNTY OF
OCUNYNINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS 105251,12' Dain Dr.
WILLIAM A JENSEN, SUPT of BUILDING LOCALITY Temple City
FOR APPLICANT TO FILL. IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER Rose len Const.
WATER CLOSET ins 10217 LowerAzusa Rd.
BATH M e
CITY Y TEL. NO.
SHOWER
LAVATORY CONTRACTOR Cavanaugh Plumbincl
SINK
ADDRESS P.O. Box 205
DISHWASHER CITY 1riO TEL. NO.
CONTRACTOR'S ATE ❑
LAUNDRY TUB REGISTRATION NO. S�S COUNTYEj
CLOTHES WASHER DISTRICT NO GROUP I ZON7 I PA10CESSED BY
WATER HEATER 3(/h
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
D.
P.
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N
W
P.
a $1.00 PER ITEM
OR FIXTURE $ C) l APPROVALS DATE INSPEC,TOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK i-g /
TOTAL FEE ROUGH PLUMBING
GAS PIPING ✓ '�
AHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING HOT WATER HEATER
I
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
CE
LINSED AS REQUIRED BY GELES COUNTY AND STATE OF GAS TEST � � �..J �= -`•r+-,i, a_;
CALIFORNIA OR THAT I A LEGAL OWNER OF THE ABOVE y
DESCRIBED RESIDENTIAL Y. UTILITY CO NOTIFIED
SIGNATURE n ,
OF PERMITTEE ^
FINAL
Or VALIDATION ROBERT A WOOD,
SUPERVISING MECHANICAL ENG'R
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