HomeMy Public PortalAbout4900 ENCINITA AVE_Plumbing__ 76A6 177 12 54 APPLICATION FOR PLUMBING PERMIT
DBS
DIVISION OF BUILDING AND SAFETY 1
Department of County Engineer '
County of Los Angeles
BUILDNG
WM J FOX, COUNTY ENGINEER ADDRESS 4900_N.�T
, Encinita
CASSATT D GRIFFIN, SUP T OF BUILDING
LOCALITY Temple City
FOR APPLICANT TO FILL IN NEAREST �t7
L, CROSS ST
OWNER Roland SholtDISTRICT NO GROUP I READY FOR INSPECTION
ADDRESS
MAIL 1295 Dominion .r I_ZONE
4
INDUSTRIAL
CITY Pasadena TEL NO WASTE APPROVAL
PLUMBER Belvedere Plumbing Co . - - INSPECTION RECORD
ADDRESS 11900 E . Garvey Ave.
CITY E1 hionte TEL NO FO 89836 'S14 ell,
LICENSE NO 2 L iT_RL t 4t e<u
NUMBER TYPE OF FIXTURE OR ITEM FEE /
$1 WATER CLOSET (TOILET) 680
1 BATH TUB 80
SHOWER
1 LAVATORY (WASH BASIN) 180
1 KITCHEN SINK 80
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
1 dis-oosal 80
TOTAL NO 6 @ 0 so 80 APPROVALS
DATE IN PECTOR S SIGNATURE
AS SYSTEM_3_OUTLETS @ 100 _
1 ay WATER HEATER @ 1 00 1 OO UNDER SLAB WORK
_ ROUGH PLUMBING 3 _ �•^
PERMIT 5 I OO GAS PIPING +
TOTAL FEE 0 GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING (1
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO NOTIFIED
CALIFORNIA OR THAT I_ AM THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDENTIAL PROPERTY
SIGNATURE
OF PERM IT'TEE ' FINAL tti u
WILLIAM J FOX, COUNTY ENGINEER VALIDATION
LAC00 4 3 3 UP FEB 1"1 3 7.8 0
BY
DEPUTY f
® 61