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DST17 40.55 APPLICATION FOPLUMBING P . Ra• Om •
'
DIVISION OF BUILDING AND .SAFETY
Department of County Engineer e P
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER • ADDRESS 9319 Daines 'Dr. -
CASSATT D GRIFFIN P
SUT OF BUILDING Cit-z.;:. . :.._ .....:, LOCALITY Temple City Y
FOR APPLICANT TO FILL IN ' j NEAREST .
ST.
OWNER R• F. Duff' DISTRICT GROUP R II READY FOR INSPECTION
MAIL - �9dI
r ADDRESS 5529 N. -Rosemead
INDUSRIAL
CITY Temple CitY1EL. NO.. WASTE APPROVAL
PLUMBER Blelvedere Plumbing Co. INSPECTION RECORD
ADDRESS 11900 E• Garvey Ave o �y L 2 1 3 .' �� �,�te_ ,,J,�,..I."
• CITY El ,M011Ita TEL NO. FO 89836 _
LICENSE NO. 54932 .
NUMBER TYPE OF FIXTURE OR ITEM FEE -
2< WATER CLOSET (TOILET) @ $1,.00 $ 2.00"
l BATH TUB @ $1.00 l.-0
1 < SHOWER @• $1.00 1.0
2 LAVATORY (WASH BASIN) @ $1.00 0
KITCHEN SINK .@ $1.00 •
DISHWASHER @ $1.00
Z LAUNDRY TUB OR TRAY' @ .$1.00 1.0
1 ` " CLOTHES WASHER @ $1.00 1.0 -
l ,WATER HEATER @ $1.00 00
1 GAS SYSTEM @ $1.00 1•0
disposal
APPROVALS
-• DATE INSPECTOR'S SIGNATURE
- UNDER SLAB WORK -
` ROUGH PLUMBING - i / P` AA.�-•�`�•-
PERMIT $. 1, 00
GAS PIPING '
TOTAL FEE l3 oO GAS VENT
I HEREBY ACKNOWLEDGE•THAT. 1 HAVE READ.THIS APPLICATION e.
AND STATE THAT THE ABOVE IS CORRECT AND AGREE•TO COMPLY HOT WATER HEATER
WITH. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING. h
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNEROF T F ABOVE UTILITY CO.NOTIFIED 1
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE 1 _
OF PERMITTEE ! �• FINAL dl
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CASH
_ Zr2.u4•0 AT426 3 13.00
17 L�
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