HomeMy Public PortalAbout4921 ENCINITA AVE_Plumbing__ fDEPARTMENT OF COUNTY ENGINEER PLUMBING 1
' DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY EN13INEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY �s
BUILDINGNEAREST � C ,q
ADDRESS CROSS ST cJ/J
DISTRICT NO GROUP yyy--ZyyyONE PEERMIT NO
LOCALITY �. • A� / ��
NEAREST / Q
CROSS ST !� p1ye y. 4-t 14X4_ /C/ RE EIV BY Ready for Inavectlon DATE ISSUED
OWNERI)ri YG( 1 /T Sk G -
MAIL t DUST RIA
ADDRESS WASTE APPROVAL
clrY p TEL No — INSPECTION RECORD
PLUMBER J14C4 C;
ADDRESS S& / W&-
CITY
&CITY y. 0... TEL NO 4�O"7'•Z, r s ,
Z.
[]STATE
LICENSE NO / ❑ COUNTY J
PERMIT FEES Q
_z
4UMPER T/PE OF FIXTURE OR ITEM FEE ('
WATER CLOSET(TOILET) @ 080 $
O
BATHTUB @ 080
SHOWER @ 080 Q
LAVATORY(WASH BASIN) @ 0 80
KITCHEN SINK @ 0 80
LAUNDRY TUB OR TRAY @ 0 80
SLOP SINK @ 0 80
FLOOR SINK @ 080
FLOOR DRAIN @ 080
DISHWASHER @ 0 80
DRINKING FOUNTAIN @ 080
URINAL @ 080
GAS SYSTEM -OUTLETS @ 1.00 /�
WATER HEATER @ 1 00 //
MISCELL NEOIJ,S
,a A APPROVALS
V D TE INSPEC OR'S SIGNATURE
UNDER SLAB WORK 1 $ �� r6ae.CQi►✓'
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 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 p `
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT IAM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF v,• J ,s�L ol_ _ _ _ 1 /�n ��
FINAL iro 411 � .LP..(:ct.�
7CA667 DSS 17 1/53