HomeMy Public PortalAbout5339 GOLDEN WEST AVE_Plumbing__ LxSA887A,f.CE 817B) -4/77
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APPLICATION FOR PLUMBING PERMIT
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BUILDING AND SAFETY DIVISI
FOR APPLICANT TO FILL IN(PRINT OR TYPE( BUILDINGS-339
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NUMBER FIXTURE OR ITEM ® FEE ADDRESS ((� A
WATER CLOSET LOCALITY / e.
BATH TUB NEAREST /
CROSS ST
SHOWER OWNER
LAVATORY MAIL
ADDRESS ? Iv
SINK CITY TEL NO
/ DISHWAS41 CONTRACTOR
CLOTHES WASHER
ADDRESS /
SWIMMING POOL RECEPTOR –�
CITY TEL NO
AWN SPRINKLER SYSTEM STATE L
WATER HEATER LICENSE NOCLASS
GAS SYSTEM OUTLETS DIS ICT NO GROUP ZQNE ROCESS BY
OUTLETS OVER U —� ( v
5 PER SYSTEM INDUSTRIAL
WASTE APPROVAL 1=
INSPECTION RECORD CD
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Plan check fee
PLUMBING PERMIT ISSUING FEE$ <j v
TOTAL FEE
Plan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UN DER SLAB WORK
Address ROUGH PLUMBING
City Tel No GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REOU IR ED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABO D SCRIBED RESIDENTIAL
PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
PLAN CHE ALIDA ON CK M O CASH PERMIT VALIDATIONcK VCM o CASH
1 1 �h J fd
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176A667 (C'E-817) - 5/73
. , . APPLICATIO FOR_ PL- BI+NG• PERMIT "
COUNTY OF LOS ANGELES
DEP,ARTMENT•OF COUNTY ENGINEER
BUILDING'AND-SAFETY DIVISION
MAKE CHECKS PAYABLE TO BUILDING_
, r/ � ADDRESS S �' ` / •Q X91-.. �L'C' � ,
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN'(PRINT OR TYPE) NEAREST
CROSS'ST V�.
NUMBER FIXTURE OR ITEM @ FEE r
�, �•�Qr r.
WATER CLOSET 1.75 � OWNER.
MAIL
BATH TUB 1.75 ADDRESS
,SHOWER 1.75 7� CITY A e TEL'' NO,
/ LAVATORY ,1.75 CONTRACTOR
SINK 1,75 ��.' ADDRESS
DISHWASHER• 1.75 "Cd TY t •,a +' TEL NO
CLOTHES WASHER ' 1.75 1
STATE, LIC
LICENSE-NO• CILASSA t, "
SWIMMING POOL RECEPTOR 1.75 {
DI CT NQ GROUP ° NE CESSED-BY s
LAWN SPRINKLER SYSTEM 1.75 r0 4 },
!, WATER HEATER 1.75 INDUSTRIAL >
WASTE APPROVAL n.
'GAS SYSTEM" f. OUTLETS 1.75 } INSPECTION RECORD v
OUTLETS OVER
5 PER SYSTEM .30
Plan'Check fee See Reverse
a ,
PLUMBING PERMIT ISSUING FEE S' 3 00 "y
• TOTAL FEE � � •
- - APPROVALS DATE INSPECTOR S SIGNATURE ¢
Plan Check appllCantUNDER SLAB WORK
Name of ROUGH PLUMBING
AddressS�3 �`p�q�p,r, GAS PIPING_
6ty �.�� �P �/ i Tel NO GAS VENT k
HOT WATER HEATER
I. HEREBY ACIrITOWLEDGE TH_V I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE CORRECT AND'AGREE TO COMPLY' PLUMBING FIXTURES
WITH, ALL COUNTY ORDINANCES AND 'STATE LAWS 'REGULATING
PLUMBING GAS TEST'
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY C.O' NOTIFIED 't
LICENSED AS REQUI RED BY LOS ANGELES .000NTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND-,INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
�7 FINAL' ''
SbG NA TU RE CV _�- - �✓ _ �_
OF PERMITTEE �LCrGGei
PERMIT VALIDATION CK 'M.0 ''ICASH
PLAN CHECK VALIDATION CK M.O CASH '
76A607-CE817 10-60 C�
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. �C 1
NUMBER FIXTURE OR ITEM OWNER
S
WATER CLOSET MAIL
BATH TUB ADDRESS
CITY TEL. NO.
SHOWER l
CONTRACTOR (1 E'� Ph '��G
� LAVATORY
SINS ADDRESS
DISHWASHER CITY L6 No.f- L! l�Gf
LAUNDRY TUB REGISTRATION NO. f ` Q TE
COUNTY
WATERCLOTHEHEATTE5RIER DISTRICT No. GROUP_ `� E� r �EB(EX`
GAS SYSTEM INDUSTRIAL
JI
WASTE APPROVAL }
INSPECTION RECORD a
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U
w
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F-
V
W
G.
N
Z
$1.00 PER ITEM
OR FIXTURE $ APPROVALS j,a :DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AfPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE tO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER r
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE GAS TEST
DESCRIBED RESIDENTIAL P`RROPERTY.
UTILITY CO. NOTIFIED
SIGNATUR PERMITTEE
FINAL
ALIDATION ROBERT A. WOOD
CK.
M.0. CASH SUPERVISING MECHANICAL ENG'R
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