HomeMy Public PortalAbout5127 GOLDEN WEST AVE_Plumbing__ 711.ek.6E70 (Fi�T�)�j/75
APPLICATION FOR PLUMBING PERMIT
B�ASAI-'ETY DIVISI
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ']�
NUMBER FIXTURE OR ITEM m FEE ADDRESS Q /
WATER CLOSET
LOCALITY L f
BATH TUB NEAREST
CROSS ST. S
SHOWER OWNER
LAVATORY �� MAIL
ADDRESS
SINK CITY TEL. NO.
DISHWASHER CONTRACTOR RLl`
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
s
LAWN SPRINKLER SYSTEM CITY Ira- TEL O.dfo
STATELIC
WATER HEATER LICENSE NO. <-(,a 74,16 CLASS o
DISTRICT NO. GROUP NE CESS BY c.D
GAS SYSTEM OUTLETS
� O
OUTLETS OVER
6 PER SYSTEM INC
WA TTEE AA PPPPRR$USTRIAL w
OVAL
INSPECTION RECORD
2/ O
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant
NameLAPPROVALS ATE INSPECTOR'S SUGHATURE� UNDER SLAB WORK
Address ROUGH PLUMBING �C
City Tel. NoSyp p GAS PIPING
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE ID CORRECT AND AGREE TO COMPLY
WI PH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR PLUMBLNG FIXTURE
LICENCED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST -tel✓
CALI FO RNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED REn IAL P OPERTY. UTILITY CO. NOTIFIED
SIaNATU RE -
OP PERMITTEE FINAL
PLAN CHECK VALIDA CK. M.O. CASH PERMIT VALIDATION ( c M.O. CASH
8267 522.50 '
76A667-CE817x6B1 iF1 0� P
APPLICATION FOR PLUMBING PERMIT
60trNrr QF LOS ANGEI£S
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONBUMDERO
D
JOHN A. LAMBIE. COUNTY ENGINEER
H= ,,4r/,2;-��-(. L, )e 7-7
COLEMAN. W. JENKiNS. SUPT. Or BUILDFNG LOCALrrr
XZAEM
FOR APPLICANT TO FILL IN TR0 TYPE CROW R•f.
NUMBER FIXTURE OR ITEM EACH FELE
O WldR
WATER CLOSET 1.50
BATH TUB 1.50 ADDIS
SHOWER _ 1.50 TEL !f0
AVATORY 1.50 cownuwTdF
LT
SINK 1.50 ADDRM
DISHWASHER 1.50 rSTA /• SII- X
CLOTHES WASHER 1.50 STATE LIC
�j� CLASS
SWIIA�QG POOL RECEPTOR L.50 O. G Ur N[ / SSED BY
ZOCK
LAWN BPRINKLER SYSTEM 2.00 L+'c/'WATER HEATER 1.50 JA AL
GAB SYSTEM OUTLETS 1.50 RECORD
OUTLETS OVER
5 PER SYSTEM .30 , i
Plan check fee 25%of above. See reverse.
PLUMBING PERMIT ISSUING FEE Z 200
TOTAL FEE APPROVALS PATE INOP[CTOR••SIGNATURE
Plan Check applicant UNDER BLAB WORT(
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel. No. HOT WATER HEATER
I FfZ10Y ACKNOWL.[OQ[ THAt I HAVE REAP
AD THIS PLICATION
HS
AHD STAT[ TAT THE ABOV15 CO RRZCT AND AGREE TO COMTLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AHD STATE LAWS MKOULATINS GAS TEST
FLUMSING.
1 H cirpmpY THAT I AM F"Ol[RLY RZOIS7LMD "DOR UTILITY CO.NOTIFIED
LICITI Sm AS RZOUIRm IVYl.W ANGELES COUNTY AND STAT[ OF
CAUFORNUI OR THAT 1 AM THE LKSAL OWNER OF,AND INTEND TO
RE*I DE IN,THE A1oVL DLoCPHSLD IKS L PROPERTY. FINAL D
SIGNATURE JACK R. ALLEN, su ERvIN CK.sING CHANICAL ENn'R.
OF rZRMITTEN L
PERMIT VAIDATIOM.0. CASH.
PLAN CHECK VALIDATION CK. M.O. CASH
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