HomeMy Public PortalAbout5342 GOLDEN WEST AVE_Plumbing__ ,76A667 t'EE-8171 - 1/75 ,
APPLICATION FOR PLUMBING-PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
•MAKE CHECKS PAYABLE TO
HARVEY T. BRANDT, COUNTY ENGINEER
�>
FOR APPLICANT TO FILL IN (PRINT OR TY PEI
NUMBER FIXTURE OR ITEM @ FEE
2 0 i OWNER
WATER CLOSET
MAIL
BATH TUB 204 ADORE
SHOWER 2 Of CITY TEL NO.
LAVATORY • 20 CONTRACT R
SINK 2 ADDRESS11-11Z 121V1
DISHWASHER 2. 0 CITYl TEL. NO.
CLOTHES WASHER 2 0 ST TE trT LIC . e
LICENSE NO v CLASS
SWIMMING POOL RECEPTOR 2.(0
DISTRICT NO.GROUP ONE C PRO SSED BY
LAWN SPRINKLER SYSTEM 2 0 � v i
WATER HEATER 2+0 '7 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS INSPECTION RECORD
OUTLETS OVER \ 30
5 PER SYSTEM
O
U
W
LL.
N
I
Pian check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00•
TOTAL FEE
APPROVALS DATE INSPECTOR 9 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING ,
Address GAS PIPING r
City Tel. NO. GAS VENT
HOT WATER HEATER
IHEREBY 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 GAS,TEST '
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REOUI RED BY LOS ANGELES COUNTY NO
STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF NO INTEND TO di
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL P P TY. FINAL
SIGNATU RE
OF PERMITTE
PERMIT VALIDATION �sKr M.O. CASH
PLAN CHECK VAL ATION CK. M 0, CASH 1 1.75 A98
� �/ 6
76A667-CE817 12/59 / V /e-
APPLICATION
VAPPLICATION FOR PLUMBING PE,RM9I`T.
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING ANDEPAFETY QIVISION BUILDING
JOHN A. LAMBI COUNTY NGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY c T
FOR APPLICANT TO FILL IN NEARSROSS TT. C9 le u
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET MAIL
ADDRESS
BATH TUB
CITY TEL. NO.
SHOWER
LAVATORY CONTRACTOR e
ADDRESS "Ct
$ v li
DISHWASHER CITY G TEL. NO. a/D .3
CONTRACTOR'S f STATE
LAUNDRY TUB REGISTRATION NO. 4 COUNTY ❑
CLOTHES WASHER DISTRICT NO. GROUP ZO E PROCESS BY
WATER HEATER �/
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
P.
ac
v v
w
P.
' m
z
$1.00 PER ITEM
OR FIXTURE. $ I / 17 APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ .100 UNDER SLAB WORK
TOTAL FEE ®a ROUGH PLUMBING _
GAS PIPING �.�y��•
1 HEREBY ACKNOWLEDGE THAT I 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
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES Alt
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPE Y. UTILITY CO.NOTIFIED
SIGNATURE i .moi
OF PERMITTE FINAL I& 17Y cof 7
®rVALIDATION ROBERT A. WOOD,
cK. m:0. CASH SUPERVISING MECHANICAL ENG'R
LACcC 5 9 9 6 )'SPR ?5 5 D 12 .0 0