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APPLICATION FOPLUMBING PERMIT
COUNTY OF LOS-ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
ADDRESS
,. HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
FFORPPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS STFIXTURE OR ITEM @ FEE2.00 OWNERR CLOSET 6!JMAIL TUB 2.00 ADDRESS.
WER 200 3 CITY TEL. NO
LAVATORY 2.00 CONTRACTOR
SINK 2.00 ADDRESS
DISHWASHER 2.00 �i�—
CITY TEL. NO. !!
CLOTHES WASHER 200 STATE �' CLASSI "
LICENSE NO. "� _
SWIMMING POOL RECEPTOR 2.00 13
DISTRICT
�SNO.GROUP /SONE PR CESS BY
' RILAWN SPRINKLER SYSTEM 2•00 U y '7-- /Vj\� I t
WATER HEATER 2.00 INDUSTRIAL
WASTE APPROVAL a
GAS SYSTEM OUTLETS 2.00 3 O D INSPECTION RECORD V
OUTLETS OVER
5 PER SYSTEM •30 CD
F—
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W
CL
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. NO. GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ •THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUM Bi NG. GAS TEST rr
I HEREBY CERTIFY THAT I' AM PROPERLY REGISTERE UTILITY CO. NOTIFIED
LICENSED AS REQ R BYtE
NTY AND TtD/.R
E OF
CALIFORNIA OR T AT 1 AMOF, AND NO TO
RESIDE IN TD SCPROPERTY FINAL 77
SIGNA
RE" _
OF P
PERMIT VALIDATION CCKH
PLAN CHECK VALIDATIO CK. M.O. CASH
0.5 .0 r nrT 8 u 1 6.5 0
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1212210007
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID FEES PAID I BUILDING ADDRESS.
ITR: 11290 LT: 15 BL: B I I 10543 FREER ST
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT. ( TEMP CA 917803446
(ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET: 1
18585-021-051 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE- 597 GRID: C4 LOCALITY: TEMPLE CITY CAI
1 125 LAVATORIES/SINKS 1.00 FIX 16.20
ITENANT: I TOTAL FEES 44.00 (ISSUED ON. PROCESSED BY: PLAN BY.
112/21/12 SR I
I I I I
IOWNER: TEL. NO: FJNATpPr-
FINAL BY: CODE.
(YEN, ESHIN D (818) 448-1896-
110543 FREER ST I I
ITEMP 917803446 I IDtSCRIPTIOK OF WORK I
I IPLUMBING FOR KITCHEN REMODEL
I I I I
(APPLICANT TEL NO: I I I
ISAME AS OWNER -
I I ISPECIAL CONDITIONS:
I I I I
(CONTRACTOR- TEL. NO: - (APPROVALS DATE INSPECTOR SIGNATURE �----
ISAME AS OWNER
LTC. NO (UNDER SLAB WORK
I I I I I I
I (WATER SERVICE
I IPLAS'TIC YIN METAL YIN
(ARCHITECT OR ENGINEER: TEL. NO: I I
- I IROUGH PLUMBING 1
LIC. NO: I I I I 1
I IGAS PIPING 1 1
I IGAS VENT
I I I
I IHOT WATER HEATER I I
I I I
I IPLUMBING FIXTURES I I I
I I I I I I
I ILAWN SPRINKLERS
I I I I I I
1 IGAS TEST I I I
1 1-1 1
I (UTILITY COMPANY NOTIFIED( I I
I I I I I I
I ICwv I I I
I I I I I I
(GRAY WATER SYSTEM 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
I I I I I I
I I I I I I
I I I I I I
I I I I I I
IREPORT ID: DPR263 ROUTE TO: BS0508 1
1 1 I 1 1 I