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APPLICATION FOR -PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION AUILDING
DDRESS 10816 Daines
JOHN A_LAMBI E. COUNTY ENGINEER
WILLIAM A. JENSEN, SUP'Y OF BUILDING LOCALITY
Temple City
FOR APPLICANT TO FILL IN NEAREST -
CROSS ST.
'NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSES 51.25 OWNER AlroMAIL
BATH TUB 1,25 ADDRESS qpm.
SHOWER 1.25 CITY SEL. NO 11.46720
LAVATORY 1.25 CONTRACTORPacific Installers
SINE 1.25 ADDRESS 10 920 E. Gr2nd _
DISHWASHER 1.25 CITY Temple City TEAL' ND' 442-1234
LAUTOR'S STATE IS
NDRY TUB 1.25 REGINSTRATION NO. 2118 8 COUNTY
CLOTHES WASHER 1.25DISTRICT wi GROUP E PRO E66ED BY
l WATER HEATER 1.50 1 50 (? 5?— r
6
CAH SYSTEM-OUTLETS- 1'� WASTE APPROVAL O
OUTLETS OVER S PER SYSTENI .30 V
HISnCT10N RECORD
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2' 00 UNDER SLAB WORK
ROUGH PLUMBING ✓
TOTAL FEE 3,SO GAS PIPING , l
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY GAS VENT I w
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING. y
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING"FIXTURES
LICENSED AS,REQUIRED BY LOS ANGELES COUNTY AND.STATE OF GAS TEST / r
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO I
RESIDE IN.THE ABOVE OES CR BED RESIDENT IA PROPS Y. UTILITY CO. NOTIFIED
SIGNATURE G/E��-_
OF PERMITTEE
FINAL C
LIDATION ROBERT A*'WOOD
cK. M.O. CASH SUPERVISING MECHANICAL ENG'R
LAW 4 6 5 2-a Jtifd 2 0 5 D 3.50-