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DEPARTMENT OF COUNTY ENGINEER PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY 'S.
BUILDING NEAREST
ADDRESS 9304 Raines CROSS ST.
LOCALITY Temple City
DISTRICT NO. GROUP ZONE PERMIT NO.
.51
NEAREST
CROSS ST. RECEIVED BY Ready for Inspection DATE ISSUED
OWNER William N . Ave.A . wilson /�,�11, 1 '7—/Zs�
t
MAIL INDUSTRIAL
54.
ADDRESS WASTE APPROVAL
CITY 1Vionterey Park TEL.NO. INSPECTION RECORD
PLUMBER belvedere rlumbing 00. c , v �/�� a'rc
I
ADDRESS 11900 E• (sarvey blvd.
j CITY ;l Monte F0 898
TEL.N0.
36 «
STATE
LICENSE N0. 54932 ❑COUNTY
PERMIT FEES
NUMBER TYPE OF FIXTURE OR ITEM FEE
i
2 WATER CLOSET(TOILET) @ 0.80 $1 6u
BATH TUB @ 0.80 ty
1- SHOWER @ 0.80 80 A._4001 A11-1-
2 LAVATORY(WASH BASIN) @ 0.80
1 KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY @ 0.80
SLOP SINK @ 0.80
j FLOORSINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
j DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM__-4.......OUTLETS @ 1.00
WATER HEATER @ 1.00 _�
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT = 1 00 ROUGH PLUMBING �r9
TOTAL FEE 101,20 GAS PIPING
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST N K U
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROP E Y. UTILITY CO.NOTIFIED
SIGNATURE ,,�pp��11��,, h
OF PERMITTEE.j:�&sllL.l?4.e- -. - q Fl
FINAL LI �{ c/ •�LA..EG.Y.�t' c_-
76A667 DBS 17 1/53 221 -