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BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUILDING �/ ��
NUMBER FIXTURE OR ITEM ® FEE ADDRESS /'� C
WATER CLOSET LOCALITYt G r
BATH TUB NEAREST • '
CROSS Si. N
SHOWER OWNER e I�
LAVATORY MAIL yC_
ADDRESS F R
SINK ., CITY TEL.N
DISHWASHER coNPA64FIC INSTALLLHti
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SWIMMING POOL RECEPTOR
LAWN SPRINKLER SYSTEM CITY TEMPLE CITY, CAL>�FN, �-
STATE p� LIC.
I WATER HEATER LICENSE NO. e CLA55
GAS SYSTEM OUTLETS DISTRICT NO. GROUP Z NE P $SED BY
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WASTE APPROVAL O
INSPECTION RECORD V ,
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PLUMBING PERMIT ISSUING FEE$ K—O
TOTALFEE v
Plan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel.No. GAS PIPING
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ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING, HOi WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED PND/OR LICENSED AS PLUMBING FIXTURES
REOUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE (Y� 'Y // q/
OF PERMITTEE ✓ ` / s - +� FINAL
PLAN CHECK VALIDATION CK, No; CASH PERMIT VALIDATION CK, M.o. CASH
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APPLICATION FOR-IIPLUMBING PERM&
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS Al, J
COLEMAN W. JENKINS, SUPT DF BUILDING LOCALITY
P Ci
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OS
WATER CLOSET $1.25 OWNER
MAIL
BATH TUB 1,25 ADDRESS �• AL} e'_
17
SHOWER 1.25 CITY `i` C / TEL. NO. _ SQ
LAVATORY 1,25 CONTRACTOR PAC F (� ST LLE'RS
SINK - 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL.
LAUNDRY TUB 1.25 CONTRACTOR'S STATE
REGISTRATION NO. Q� COUNTY
CLOTHES WASHER 1.25 DISTRICT NO. GROUPONE PROCESSED
WATER HEATER 1.50 /;�/
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL Y
WASTE APPROVAL CL
OUTLETS OVER 5 PER SYSTEM .00 0
INSPECTION RECORD
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APPROVALS DATE INSPECTOR5SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK /� C
ROUGH PLUMBING �, 1
TOTAL FEE GAS PIPING
HEREBY ACKNOWLEDGE THAT 1 HAVE HEAD THIS APPLICATION GAS VENT
AND STATE.THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER I { {
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES I "
LICEN5EO A$ REQUIRE. BY LOS ANGELES COUNTY AND STATE OF GAS TEST t�
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN. THE ABOVE DESCRIBED RESIDENTIAL�P./Rf PERTY. UTILITY CO. NOTIFIED \
SIGNATURE A
OF PERMITTEE L. /= _. m //I ,/AL
FINAL/�WCJIYS(41 t P,
/VALIDATION' rtoeER A. WOOD I
..0. cwsN SUPERVISING MECHANICAL ENG�R
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