HomeMy Public PortalAbout9168 FORTSON DR_Plumbing__ ZSA667A
CE 817(REV 11/78)
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
LOCALITY '
WATER CLOSET NEAREST `
BATH TUB CROSS ST
SHOWER OWNER SC'L�i
7 LAVATORY MAIL r
(� ADDRESS
/ SINK CITY TEL NO
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY ` r �/r TEL NO �`:>S L
LAWN SPRINKLER SYSTEM
STATE LIC
WATER HEATER 3 LICENSE NO y 74� CLASS
` GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK �/-
S PER SYSTEM
ROUGH PLUMBING
GAS PIPING � A V
GAS VENT C1
HOT WATER HEATER
PLUMBING FIXTURES - / ,- id
GAS TEST ;Z -
Plan check fee 36 UTILITY CO NOTIFIED
PLUMBING PERMIT'ISSUING FEE$
TOTAL FEE
FINAL 111-7
m
Plan check applicant PLAN CHECK VALIDATION
Name
Address
City Tel No e 0'6 9.8 A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANC?S # O O O O O 5
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGIS
D--',ND/OR LICENSED AS 2'p p 3 7.0 O
REQUIRED BY LOS ANGELES OUNTY A ,STATE OF CA FORNIA\OR THAT I AM THE
LEGAL OWNER OP•AND INTEN To
SIDE IN THE ABOV ESCRI ED RESIDENTIAL O O O 3-7,
O
PROPERTY 1
SIGNATURE ` '
OF PERMITTEE •�` ' `/ e 0 — O
DIST ICT,Na7 PR
^ ESSED BY
ks k /
INDUSTRIAL
WASTE APPROVAL
1
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76A667-CE817 6-60 `7�ef (�-`�-'�' J ob lo4APPLICATION FOR PLUM ING PERMIT
,
RTFOTG
DEPARTMENT OCUNYENGINEER
BUILDING AND SAFETY DIVISION FADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER 9168 Fortson Dr.
WILLIAM A. JENSEN, SUPT OF BUILDING
Tem le CiFOR APPLICANT TO FILL IN
NUMBER FIXTURE OR ITEM OWNER H. M. Holtz
1 WATER CLOSET MAIL
BATH TUR ADDRESS
CITY TEL NO.
SHOWER
1LAVATORY CONTRACTOR Belvedere Plumbing Coo
1 SINK
ADDRESS 11900 E. Garvey Ave.
DISHWASHER CITY El Monte TEL. NO. CU 31691
CONTRACTOR'S STATE
LAUNDRY TUB REGISTRATION NO. 179568 COUNTY
1 CLOTHES WASHER M DISTRIIC NO. GGR{O-.UP ZONE OCESSED BY
Z WATER HEATER -67/7
l GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
,// /
7 rm fl LC_y7` dPr C1lO Y / f�n e— V
1.00 PER ITEM
7 OR FECTURE I 7.00
$ APPROVALS D.4TEj INSP,ECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK /l"I'Al— A,�_
TOTAL FEE ROUGH PLUMBING �a ,® �&
g nn GAS PIPING h/ I /rJ 61,
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 ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES !/
LICENSED AS REQUIRED BY LOS ANGELES C NTY AND STATE OF GAS TEST �/ ��rvl
CALIFORNIA OR THAT I AM THE LEGAL ER OF THE ABOVE
DESCRIBED MRAL PROPERTY. UTILITY CO. NOTIFIEDSIGNATUR
OF PERM
FINAL
Or VALIDATION ROBERT A. WOOD.
cK. B.0. CASH SUPERVISING MECHANICAL ENG'R
f�!,o 5 0 9 3 0 5 D
;t � 1 ,� U ;