HomeMy Public PortalAbout4901 GOLDEN WEST AVE_Plumbing__ D.B.S.17 25M SETS 7_4' APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING 1COUNTY OF LOS ANGELES
WM.J. FOX.CHIEF ENGINEER
NATURE OF INSTALLATION / DISTRICT NO. GROUP ZONE PERMIT O.
ROUGH FIXTURES COMPLETE !� "
HEATER CESSPOOL I—I SEPTIC TANK „—� RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
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APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
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CERT.NO. EXPIRES;;-. W NAME -
LOCATION OF SEPTIC TANK, OR SSPOOL z MAIL
3 ADDRESS
NORTH O
CITY TEL.No.
IAM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
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PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
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3 OWNER
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CORRECTIONS
SOUTH
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DESCRIPTION OF WORKAv
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BATH TUB FURNACE
SHOWER DISHWASHER 0
LAVATORY REFRIGERATOR
KITCHEN BINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN
� DATE INSPECTOR'S NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I I
METER`=GAB -------SODA FOUNTAIN 6A8 PIPING
OUTL
GAS VENT I I
CESSPOOL
TOTAL NUMBER OF FIXTURES - - I I
SEPTIC TANK
CESSPOOL SEPTIC TANK -- SEWER
$ 1: UTILITY CO.NOTIFIED
TOTAL FEE
FINAL
76A667 (CE-817) - 1/75 !� W70
APPLICATION OR P MBIN ERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
MAKE CHECKS PAYABLE TO: ADDRESS L4 01 No. Golden West Ave.
HARVEY T. BRANDT, COUNTY ENGINEER
LOCALITY Temple City
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
NUMBER FIXTURE OR ITEM FEE CROSS ST. La Rosa
WATER CLOSET 2.00 OWNER
Ranily Hays
BATH TUB 2.00 MAIL
ADDRESS 01 No. Golden West Ave.
SHOWER 2 00 CITY Temple City TEL. NO. 2 2
LAVATORY 00 CONTRACTOR
SINK 00 D,o ADDRESS 426 N. Baldwin Ave.
DISHWASHER 00 Q� CITY TEL. NO. 0
Monte
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CLOTHES WASHER 00 Ao"
LICENSE TATE NO. '231 1�7 41 LIC C LASS (�3�20
SWIMMING POOL RECEPTOR 2, p
DISTRICT NO.GROUP NE PR CESS D BX
LAWN SPRINKLER SYSTEM 2. 0 L L u
WATER HEATER 00INDUSTRIAL
WASTE APPROVAL i
GAS SYSTEM OUTLETS .00 INSPECTION RECORD V
OUTLETS OVER
5 PER SYSTEM 30 , PJ✓f' CD
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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;"J/ !"
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. No. GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I 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
PLUMBING. GAS TEST Ulf {
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE Dg- CRD RESIDENTIAL PROPERTY. FINAL -
SIGNATURE
OF PERMITTEE � V`>. •���`•\
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M.0. CASH
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