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76A667 -CE#817 2-62
APPLICATION FOR PLU BING PERMIT
COUNTY OF LOS ANGELES ��s�
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING r<7�
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN. SUPT OF BUILDING
LOCALITY =!1 1 an
FOR APPLICANT TO FILL IN CROSS ST. Ia
NUMBER FIXTURE OR ITEM EACH FEE
OWNER t
WATER CLOSET $1.25 .5-0 MAIL
BATH TUB 1.25 ADDRESS
! SHOWER 1.25 ! CITY SEL. NO.
LAVATORY 1.25 CONTRACTOR L }'
SINK 1.25 ADDRESS 14 o '�3Ax
DISHWASHER 1.25 CITY Lo gS'r ODO•\ 3,.& TEL. NO.,
CONTRACTOR'S STATE
LAUNDRY TUB 1.25 7 REGISTRATION NO. l r `.�j COUNTY El
CLOTHES WASHER 1.25 •/ •J DISTRICT NO. GROUP Z NE PR C D BY _
J WATER HEATER 1.50 1 c� ✓ �l
/ GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL -
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD m
0
c?• ( >-1 1.1 SPO c°'
Lu
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./U c ����.,3.-_ 14 wne e v�In
APPROVALS DATE INSPEC-OR•S SIGN_TiU RE
PERMIT $ 2 00 UNDER SLAB WORK ` y
�v ROUGH PLUMBING 1 PIrl
TOTAL FEE J (s)(-- GAS PIPING 94 ! `11-1 �
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION '
AND STATE THAT THE ABOVEAS CORRECT AND AGREE TO COMPLY GAS VENT
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT 1 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 •�ZZ- P..`
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO NOTIFIED
SIGNATURE i / I !1
OF PERMITTEE -'"- �-'�� W ��'�-"�`
FINAL
LIDATION ROBERT A. WOOD
CK M O CASH SUPERVISING MECHANICAL ENG'R
7
AW 5 00 71 jAN 2 9 5 � 1 5.G 01 a
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0208070036
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 11290 LT: 24 BL: C 10520 FREER ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803445
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: EL MONTE
8585-023-060 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY
13 DISHWASHERS) 1.00 FIX 16.20
TENANT- 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
47 WATER HEATER(S) 1.00 WTH 16.20 08/07/02 JK 02/03/03
51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20
OWNER: TEL. NO: TOTAL FEES 92.55 FINAL DATE Y: CODE:
HIROTO JEFFREY S;CAROL G -
10520 FREER ST tAPIRED
TEMP 917803445 DESCRIPTION OF WORK
PLUMBING FOR ADDITION
APPLICANT: TEL. NO:
JACK QUEMADA -
5122 E BEVERLY SPECIAL CONDITIONS:
LOS ANGELES 90022
CONTRACTOR: TEL. TO-
APPROVALS: DATE INSPECTOR SIGNATURE
J Q CONSTRUCTION GENERAL CONTRACTOR (626) 450-0031
2322 MACDEVITT LIC. NO '// ✓ ���' ����
WEST COVINA, CA 91790 570652 B UNDER SLAB OR d�'r� t� �� ��
WATER SERVICE
;VJ
PLASTIC Y/N METAL Y/N
ARCHITEC OR ENG
------INEER: TEL. NO: / `Y i j� �•
ROUGH PLUMBING
LIC. NOS;':
7 ' 7lly, `I GAS PIPING
- -- -- GAS VENT
HOT WATER HEATER
- - - - - PLUMBING FIXTURES
��• t,� � •_ ,- ,� LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
CWV
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: SS0508