HomeMy Public PortalAbout9167 FORTSON DR_Plumbing__ 76A667A
CE 817(REV 11/78) I
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET LOCALITY
NEAR EST
BATH TUB CROSS ST
SHOWER OWNER
LAVATORY MAIL
ADDRESS
SINK CITY TEL NO
DISHWASHER CONTRACTOR
944,
CLOTHES WASHER ADDRESS
lgp
G
SWIMMING POOL RECEPTOR
CITY � G TEL NO f
LAWN SPRINKLER SYSTEM
STATE 2 2 LIC
WATER HEATER LICENSE NO 3 7� CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING1311 C
GAS PIPING �j 0
GAS VENT Q6
HOT WATER HEATER 0
PLUMBING FIXTURES
GAS TEST
Plan check fee UTILITYCO NOTIFIED U
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL --
Plan check applicant PLAN CHECK VALIDATION
Name 20'9 .1, 9, 1 A
Address #;o'o�o 0 o 5
City Tel.No 2 0 0 1 0 0 0
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES I0 10 1 0.O O U
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION p
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AN OR LICENSED AS O 9-V O
REQUIRED BY LOS ANGELES CO F ALIFOR R THAT I AM THE ,
LEGAL OWNER OF,ANDD RESIDE INT COVE D S IBED RESIDENTIAL
PROPERTY �.
SIGNATURE
OF PERMITTEE
DISTRICT NO PROCESSED BY
INDUSTRIAL
WASTE APPROVAL
• • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0708080020
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT: "-
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 14396 LT: 33 9167 FORTSON DR
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917801323
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: ENCINITAS
15382-016-013 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY, Cl
1 113 DISHWASHER(S) 1.00 FIX 16.20 1
(TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.20 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I
TOTAL FEES 60.15 108/08/07 SR 02/04/08
10WNER: TEL. N0: I 1FINAL DATFq, FIN CODE:
1ERICKSON JOHN W;MARTY (626) 287-1779- 1 1
9167 FORTSON DR
ITEMP 917801323 I (DESCRIPTION OF WORK
1 1 REPLACE SINK, DISHWASHER I
(APPLICANT: TEL. NO: I I
ISAME AS OWNER
I 1 ISPECIAL CONDITIONS: I
(CONTRACTOR. TEL. N0: I
1APPROVALS DATE INSPECTOR SIGNATURE
I
ISAME AS OWNER - I I
I LIC. NO I (UNDER SLAB WORK 1
1 IWATER SERVICE I 1
1 IPLASTIC Y/N METAL Y/N I 1
(ARCHITECT OR ENGINEER: TEL. NO: 1 I I 1
1 - 1 IROUGH PLUMBING 1 1
LIC. NO: I I 1
IGAS PIPING I I 1
IGAS VENT I I 1
IHOT WATER HEATER 1 I 1
1 IPLUMBING FIXTURES 1
1 ILAWN SPRINKLERS 1
IGAS TEST 1
I 1UTILITY COMPANY NOTIFIED( I
I I 1CWV I I
GRAY WATER SYSTEM 1 1
I I I I I I
IREPORT ID: DPR263 ROUTE TO: BS0508 1 1 1 1
I I I I I I
r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0704060009
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS: 1
1TR: 14396 LT: 33 9167 FORTSON DR
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917801323 1
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: ENCINITA
15382-016-013 101 PERMIT ISSUANCE FEE 27.75 1 THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY, Cl
1 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 1
(TENANT: I TOTAL FEES 43.95 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1
104/06/07 JK 10/03/07
10WNER: TEL. NO: 1 IFI ALAD
TE FIN BY: CODE: 1
IERICKSON JOHN W;MARTY (626) 287-1779- 1 Ij19167 FORTSON DR (�
(TEMP 917801323 (DESCRIPTION OF WORK
I I 1ADD (1) OUTLET TO ATTIC OF EXISTING GAS LINE 1
(APPLICANT: TEL. NO: 1 1 I
ICONNOR AIR (626) 286-3157- I I
14931 N. ENCINITA AVE 1 1SPECIAL CONDITIONS: I
(TEMPLE CITY CA 91780 I 1 I
I I
I
I I
(CONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE 1
ICONNOR AIR CONDITIONING (626) 286-3157- 1
14931 ENCINITA AVE LIC. NO 1 1UNDER SLAB WORK 1 I 1
(TEMPLE CITY, CA 91780 403735 C20 1 I I 1 1
1 1 (WATER SERVICE 1 I 1
I I (PLASTIC Y/N METAL Y/N
1ARCHITECT OR ENGINEER: TEL. NO: ( I I I
I - 1 (ROUGH PLUMBING 1 1 I
1 LIC. NO:
1 1 IGAS PIPING 1 1 1
I I I
1 1 IGAS VENT16 MA
1 1
I I I
1 1 IHOT WATER HEATER 1 1
I I I
1 1 1PLUMBING FIXTURES 1 1 1
I I I
1 1 ILAWN SPRINKLERS 1 1
I I I
1 1 IGAS TEST 1 I I
1 I 1UTILITY COMPANY NOTIFIED( I 1
I ICWv I I
I I 1GRAY WATER SYSTEM I I I
1 I I 1 I I
I I I I
I I I I I I
I I I I I I
I I I I I I
1 (REPORT ID: DPR263 ROUTE TO: BS0508
I I I I I I