HomeMy Public PortalAbout10822 DAINES DR_Plumbing__ 76A667 (CE-817)-4/72
APPLICATION FOR. PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE 7'0r ADIDRESS i a 8� a
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY q
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
NUMBER FIXTURE OR ITEM @ FEE CROSS ST.
OWNER Qom/
WATER CLOSET 1.75
MAIL
BATH TUB 1.75 ADDRESS
SHOWER 1,75 CITY TEL!
LAVATORY 1,75 CONTRACTOR
SINK 1.75 ADDRESS Gr
DISHWAS R 1.75 CITY TEL. NO.J_ r
CLOTHES WASHER 1.75 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 1.75
DISTRICT NO. GROUP Z NE FR EBBED BY
LAWN SPRINKLER SYSTEM 1.75
WATER HEATER 1.75 INDUSTRIAL O
WASTE APPROVAL
GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD COA
OUTLETS OVER .30
5 PER SYSTEM
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Plan check fee See ReVersa -
PLUMBING PERMIT ISSUING FEE S 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR'9 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. No. GAS VENT
HOT WATER HEATER
HEREBY THAT
ACKNOWLEDGE THAT HAVE READ THIS PTO CO TION
AND STATE THAT THE ABOVE IS COR CT AND AGREE E COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORpIHANCE% STATE LAWS REGULATING GAS TEST
PLUMBING.
IHEREBY CERTIFY THAT I A PROPERLY REGISTERED ANO/OR UTILITY CO. NOTIFIED
LICENSEDAS REQUIRED BY L ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM E LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DES I/ TY. FINAL Q
SIGNA TU RE
J `
OF PERMITTEE
PERMIT VALIDATION cN. M.o. CASH
PLAN CHECK VALIDATI N CN. M.O. CASH
1 1r, 3 7 2 073 OCT 5 D 4 .7 5 e v