HomeMy Public PortalAbout10611 DAINES DR_Plumbing__ TGAGB]A LCE YI'!B) A171
APPLICATION FOR PLUMBING PERMIT
2-& eA�,BUILDING AND SAFETY DI 1 ION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS /61
WATER CLOSET LOCALITY Tiflet&A7G / /
BATH TUB NEAREST
/^ /w CROSS ST. /f G
SHOWER �} 4 V OWNER 4CAwicox,4
LAVATORY _
MAIL
J5 6/ ADDRESS /0( //
SINK CITY -' TEL.NO.* 3-rD 90
,,MOXX elDISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS C) /;- P4 Ily
SWIMMING POOL RECEPTOR
CITY TEL NO.
LAWN SPRINKLER SYSTEM
STATE LIC. (l AA
WATER HEATER LICENSE NO. Q CLASS
GAS SYSTEM OUTLETS DISTRICT NO. GROUP ZONE PRO SSED
j CD
OUTLETS OVER v O � � V
5 PER SYSTEM I INDUSTRIAL
WASTE APPROVAL C
INSPECTION RECORD C)
W
fi
h
Z
Plan check fee
PLUMBING PERMIT ISSUING FEE$ O[�
TOTAL FEE
Plan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
Name RdA0L Q
UNDER SLAB WORK
Address SD,+ ROUGH PLUMBING
City r — Tel. No. ,- k-/f GAS PIPING f
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REG15TERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OFPERMITTEE FINAL
PLAN CHECK VALIDATION CK, Wo: CASH PERMIT VALIDATION .0. CASH
4 3 7�-JUL 5 5 D 1 3,0 Q AO,
tT L�
]BA86,]C(CEO 1APPLICATION FOR PLUMBll/llG�PE,F2MIT
COUNTY OF LOS GELES
DEPARTMENT OF OOUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
�[/�j �( pj
NUMBER FIXTURE ORIT M ® FEE ADDRESS
WATER CLOSET LOCALITY 5 ! P� r
BATHTUB NEARESTG
CROSS ST. M AG
SHOWER OWNER ly7O G'
LAVATORY MAIL
ADDRESS
SINK CITY �� �� C .NO.
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS 1.046
SWIMMING POOL RECEPTOR _�-
CITY j _
M I`�C e' 7 TEL.NO. (t
LAWN SPRINKLER SYSTEM lQ
STATE CENSE NO. J J?1i eO' CLASS
WATER HEATER
GAS SYSTEM Z,-� OUTLETS DISTRICT NO.6 UP NE PR CESSED
OUTLETSOVER _I
5 PER SYSTEM INDUSTRIAL L
WASTE APPROVAL O
INSPECTION RECORD V
� r
O
t
V
W
d
N
Z
Plan check fee - —
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
Plan check oppliconf
APPROVALS DATE INSPECTOR'5 SIGNATURE
Nome
UNDER SLAB WORK
Address lel11 10-44W3' ROUGH PLUMBING
City — Tel.No. **,6..J GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND-STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR LICENSED AS PLUMBING FIXTURES
- REOV IF ED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED gE510ENTIgL
PROPERTY. UTILITY CO.NOTIFIED" -\
SIGNATURE
OF PERMITTEEFINAL 2-7
PLAN CHECK VALIDATION cx. M.O. CASH PERMIT VALIDATION • Cx. M.O. CASH
9 1 7-° JUL 26 5 1 3.0 U efif
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