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APPLICATION FOR PLUMBING PERMIT
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WILLIAM A.JONSEN, •uTT O�,RUILo. �a�r
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WaarE AYPROVAL
DCMPWflOW RECORD
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6 • � s 6 APPROVALS PATIV IRSPE R'S SIGNATURE
PERMIT ; 2 oo UNDER B'Q09-VCORK
TOTAL FEE RouGH PLUMBINo
DAH PIPING
I WRIST ACKNOWUD01 THAT 1 RAVE SAD THS APPUCA71gQII
All E YYY![STATE '�1 AAppI• CORNJM IIID AS= TO OD; T GAB VENT
VM ALL COUNTY ORU1Itk!CXS AIrD -STAT'I LAWS R1QULAnKG HOT WATER HEATER
I HERKMT CERTIFY THAT I Al ; PKR T ii#7KMU) AID/OR PLUMBING FIXTURES ir
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�• VALIDATION ROBERT A. WOOD.
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` APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 9559 Garibaldi
WILLIAM A. JENSEN. SUPT OF BUILDING LOCALITY Temple City
FOR APPLICANT TO FILL IN NEAREST oyia� C' p� L7
CROSS ST. ` / " U
NUMBER FIXTURE OR ITEM EACH FEE
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OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR
1 SINK 1.25 1 25 ADDRESS 7$21 E. Garvey Ave.
DISHWASHER 1.25 CITY S.San Gabriel TEL. NO. AT 05349
LAUNDRY TUB 1.25 1 25 CONTRACTOR'S 134935 C-36 STATE
REGISTRATION NO. COUNTY ❑
1 CLOTHES WASHER 1.25 1. 25 DISTRICT NO. GR PZONE PROCESSED BY
WATER HEATER 1.50 S•0 R�
GAS SYSTEM OUTLETS 1.50
1.50 INDUSTRIAL O
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
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APPROVALS DATE INSPECTOR'$SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 7 2S 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 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 A THE LEGAL OWNER AND INTEND TO
RESIDE IN, THE ABOVE D IBED RESID TIA ROP RTY. UTILITY CO. NOTIFIED
SIGNATUREi
OF PERMITTEE „' I,
FINAL _
VCK. ALIDATION ROBERT A. WOOD
M.0. CASH SUPERVISING MECHANICAL ENG'R
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