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DEPARTMENT OF COUNTY ENGINEER I PLUMBING 1
DIVISION OF BUILDING AND' SAFETY P,ERQIrA'IIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
1s► r F
WILLIAM J. FOX, COUNTY ENGINEER +
ADDRESS `j //
FOR APPLICANT TO FILL IN LOCALITY (� ,
BUILDING NEAREST
ADDRESS 4864 Enc ini to CROSS ST
LOCALITY Temple City DISTRICT NO- GROUP ZONE PERMIT NO.
NEAREST S ��75.E
CROSS ST RECEIVEDBYReady for Inspection DATE ISSUED
OWNER J. F. Stevens
MAIL INDUSTRIAL
ADDRESS WASTE APPROVAL
CITY TEL NO INSPECTION RECORD
PLUMBER belvedere Plumbing Co. Q 3 i
ADDRESS 11900 E. Garvey Blvd. A P SAA
CITY El Monte TEL.NO iv,D 89836 md 4,- A GG . c9le
LICENSE NO 2 f1 6 ❑STATE C� e',L;�$ v-n -r-,.,S '7'--e A.P c4.4.
LICENSE - �, � ���§ J
' PERMIT FEES Q
NUMBER TYPE OF FIXTURE OR ITEM FEE
A-6.A 0 j z
1 f WATER CLOSET(TOILET) Q 0 80 S 80 ����� � ��� ��
_��' o
1 BATHTUB Q 080 Q _ _
SHOWER @ 080 S v Cn Ade v—
LAVATORY(WASH BASIN) @ 0 80 80
1 KITCHEN SINK @ 0 80 Q
LAUNDRY TUB OR TRAY @ 0 80 80
SLOP SINK @ 0 80
FLOORSINK @ 080
FLOOR DRAIN @ 080
DISHWASHER @ 0 80
DRINKING FOUNTAIN @ 080
URINAL @ 0 80
GAS SYSTEM 3 OUTLETS @ 1 00
WATER HEATER @ 1 00
MISCELLANEOUS
APPROVALS
PAT.E INSPEC OR'SSIGNATURE
UNDER SLAB WORK b * �-
PERMIT $ I 00 ROUGH PLUMBING 9/,r fl,_
TOTAL FEE '7 �� GAS PIPING
IHEREBY ACKNOWLEDGE-THAT I 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 �✓ -��+
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- p_p
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPER Y UTILITY CO NOTIFIED t y / S�/ /GrCJ•19�1 a„�
SIGNATURE e j!g .
OF PERMITTEE S 4 / FINAL
76A667 DBS 17 1/53 181