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76A667-CE817 1259
APPLICATION FOR PLUMBI G PERMIT;
OF
COUNTY LOS OS AN EL
G ES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 9950 East Daines Dr.
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY Temple City,
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER Stanley Sa
lata
WATER CLOSET AMAIL
DDRESS 99 0 East D
BATH TUB
CITY Temple Crit TEL. NO-AT- -08
SHOWER
LAVATORY CONTRACTORARCO PLUMBING CO.
SIN% ADDRESS 527 West Garvey Ave.
DISHWASHER
cITYMonterey PargEL. NO.CU- 3-9055
CONTRACTOR'S STATE Zl
LAUNDRY TUB REGISTRATION NO. 113206-CI6 COUNTY 10
CLOTHES WASHER D,ISTTRIC�T)N - GRO P ZONE P /C� S Y
1
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD w
O
U
a
0
U
W
GL
y
Z
ca $1.00 PER ITEM
1 OR FIXTURE $ 1.00 APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE 3 00 ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE _
OF PERMITTEP
FINAL
OF VALIDATION ROBERT A. WOOD,
Cr.
M.o. cnsx SUPERVISING MECHANICAL ENG'R
L�` 6 a 8 DEC 4 S D 3.0