HomeMy Public PortalAbout5010 ENCINITA AVE_Plumbing__ 7BAPPLICATION FOR ,,PLUMBING PERMIT 1
DBS-17 9-SS
•17
DIVISION OF BUILDING AND SAFETY
Deportment of County 'Engineer
County of Las Angeles
WM.J. FOX, COUNTY ENGINEER BDRESS UILDING AD )/� -
/ /�/•lL-
CASSATT D. GRIFFIN, SUPT OF 6Ua.ING -' /'
LOCALITY-,;!-m" ,b/.- (f;-X/
FOR APPLICANT TO FILL IN NEAREST %� � �%S'4)CROSS ST IL area T,
OWNER �1 (�9 DISTRICT NO GROUP ZONE READY FOR INSPECTION
MAIL
ADDRESS "a�D / �I!�•/ .��� I jN�1
/ ��' INDUSTRIAL
7-e `I
CITY � ��� /CJ �N� TEL NO WASTE APPROVAL I
PLUMBER ' INSPECTION RECORD
ADDRESS!/7d��L�1�•'^ �L�a�llJ 1�� ",TSI
CITY Cr e., /T / TEL NO
LICENSE NO L G
NUMBER TYPE OF FIXTURE OR ITEM FEE
I WATER CLOSET (TOILET) $
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER '
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO @ o so APPROVALS
'DATE INSPECTOR'S SIGNATURE
GAS SYSTEM OUTLETS 1 00
•r WATER HEATER (0 1 00 1
UNDER SLAB WORK //yy
ROUGH PLUMBING
GAS PIPING
► S� _S[/1 <<- �-..�
. PERMIT 5 1 00
'4 TOTAL FEE 3 10
GAS VENT
I HEREBY ACKNOWLEDGE THAT'I 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.
-
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTI ROPE TY.
SIGNATURE ���� • ---
OF PERMITTEE .' � - FINAL
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION R.A'.WOOD, CHIEF PLBG. INSPECTOR
6,i .1U oEc 6 3 , 3.40 91