HomeMy Public PortalAbout5130 DALEVIEW AVE_Plumbing__ 79.667 -CE#617 2-62
APPLICATION FOR PLUM PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDINGBUILDING AND SAFETY DIVISION ADDRESS E
JOHN A. LAMSIE. COUNTY ENGINEER
WILLIAM A. JENSEN. SUPT OF BUILDINGLam-
LOCALITY
FOR APPLICANT TO FILL IN NEAREST / FZ^
CROSS ST. L-
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 8125 MAIL +/
BATH TUB 125 ADDRESS /
SHOWER 1.25 CITY e TEL. NO. ..
LAVATORY 125 CONTRACTOR
SINE 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
LAUNDRY TUB 125 CONTRACTOR'S STATE ❑
REGISTRATION NO. COUNTY
'CLOTHES WASHER 125 DISTRICT NO. GROUP ZONE P ESSED BY
WATER HEATER 1.50 S/
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .01) 1 ! INSPECTION RECORD S
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APPROVALS DATE/ IEyNSPCT—OR�'S 51_GN_ATURE
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PERMIT S 2 00 UNDER SLAB WORK � O- q L
ROUGH PLUMBING f I_ / f
TOTAL FEE GAS PIPING 'G1�/
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY I A
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
/J
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL ER OF,AND INTEND TO GAS TEST
RESIDE IN,TME ADOV SCRI REST L PROPE v. UTILITY CO. NOTIFIED y ��
SIGNATURE
OF PERMITTE
FINAL 1 9
VALIDATION ROBERT A:WOOD
cK. M.o. CASH SUPERVISING MECHANICAL ENG'R
LACO.3643�,- AUG29 5 D 15.0 /00-
.