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APPLICATION FOR PLUMBPERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN. SUPT of BUILDING LOCALITY ec
FOR APPLICANT TO FILL IN CROSSSST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25
ADDRESS
CITY TEL. NO.
SHOWER 1.25
LAVATORY 1.25
. CONTRACTOR n
SINK 1.25 , ADDRESS ��f^ - a-
DISHWASHER 1.25 CITY 7 i TEL. NO.CoNftRACTOWS SATE
S L ❑.
LAUNDRY TUB I.2S REGISTRATION NO. CSL /LI t` S�9 COUNTY
CLOTHES WASHER 1.25 J DISTRICT N GR ZON P OC S BY
WATER HEATER 1.58 ,
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL d
WASTE APPROVAL Q
OUTLETS OVER 5 PER SYSTEM .28 / INSPECTION RECORD ) V
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APPROVALS DATE )ISPECTOR's sl NATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING v j
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORm N ANCEB AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING. A
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN, THE ABOVE DESCRIDE!IJIESIDENT.AL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE %- I ,� /
OF PERMITTEE FINAL
ge✓ALIDATION ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
N: 00 8 6 23 PR23 5 D 1 0.00
COUNTY OF LOS ANGELES TEMPLE CITY 4 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1105050003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 5904 LT: 291 ON: .002 1 6125 ENCINITA AV
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917801637
ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET:
15384-012-024 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, CI
113 DISHWASHER(S) 1.00 FIX 16.30
(TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.30 (ISSUED ON: PROCESSED BY: PLAN BY:
I TOTAL FEES 60.40 105/05/11 SR
I �
OWNER: TEL. NO: IFIINN_AL DATTEE1 FINAL BY: CODE:
1QI, WEI 626) 231-6240- 1 `�� ` ( ' \ 1
16125 ENCINITA AV 4
ITEMP 917801637 SCRB£-RITION OF WORK
REPLACE DISHWASHER AND SINK FOR KITCHEN REMODEL
(APPLICANT: TEL NO:
SAME AS OWNER _
SPECIAL CONDITIONS:
I I I
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I
00AOTEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE
SAME
ME ASS OWNER - I I I
LIC. NO (UNDER SLAB WORK
IWATER SERVICE I
PLASTIC YIN METAL YIN
ARCHITECT OR ENGINEER: TEL. NO:
ROUGH PLOMBING
LIC. NO:
I
I I 1GA5 PIPING I I
1GAS VENT
1HOT WATER HEATER
I
IPLUMB ING FIXTURES
LAWN SPRINKLERS
GAS TEST
1 I I
IUTILITY COMPANY NOTIFIEDI I
CwV
GRAY WATER SYSTEM
I I I
I I 11 11 11 I
I I I I 1111
I I I I I
I I 111 111 111 I
IREPORT ID: DPR263 ROUTE TO: BS0508
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