HomeMy Public PortalAbout5941 GOLDEN WEST AVE_Plumbing__ 7APP LIVE TIO \9 FOR PPLUMBINGPERMI 0 -� 1
DBS-l710-55
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer,
County of Loa Angeles r
UILDING
JOHN A LAMBIE, COUNTY ENGINEER DDRESS p
CASSATT D GRIFFIN,SUPT OF BUILDING
OCALITY
FOR APPLICANT TO FILL IN - NEAREST
yy CROSS S7
OWNER y 9 DISTRIO. GROUP ZONE I READY FOR INSPECTION
MAIL, R
ADDRESS
INDUSTRIAL
CITY NO WASTE APPROVAL
PLUMBER cc INSPECTION RECORD
ADDRESS
CITY i• f0.
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $
BATH TUB @ $100
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00 _
KITCHEN SINK @ $1 00
DISHWASHER @ $100
LAUNDRY TUB OR TRAY @ $1 00
CLOTHESWASHER @ $100
WATER HEATER @ $100
@ $1 00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES
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1ICHEREBY CERTIFY THAT I SAM PROPERLY REGISTERED AND/OR GAS TEST 1111 'LA, 17--U-S-2
LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE VE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE
OF PERM TTE "<::�' FINAL
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG INSPECTOR
V cx M 0. CASH
5083 DEC13 3 3..00 M
A
bEP ARTMENT OF BUILDING APPLICATION FOR PERMIT ;
s
COUNTY OF: LOS ANGELES PLUMBING
NA OF I• ALLA ION DISTRICT NO. GROUP I No PERMIT NO.
ROUGH I ' 4
PLUMBING FIXTURES /COMPLETE/ 3_YYY
'/ READY FOR RECEIVE
¢¢¢yY DATEIS _
HEATER '� /CESSPOOL SEPTIC TAN FIRST INSPECTION-
BADrMISCELLANEOUS
r�'^ I �1 j,!N-,, PORTION ONLY A
NAME // fir/{ A v4_Awl A 40 /�-� �yp_[��l ADDRESS �/� / �/ �t�t./lA�-Q.Ii
ADDRESS
/�v �� �-}( �J v i7w MLf'7'4 LOCALITYNEAREST
dCITY /,/a Al TEL. NO. �� ' CROSS Tl"'7 iR.iLAbLsD
STATE COUNTY
LICENSE NO. REG NO. I J,O, m NAME '/ Al,
LOCATION OF SEPTIC TANK, OR CESSPOOL AMAIL
DDRESS/"
NORTH
CITY _ f/ TEL,NO.
CORRECTIONS
I
i
1 a
z_
SOUTH
DESCRIPTION OF WORK � o
BATH TUB FURNACE
RHOWER DISHWASHER
AVATORY REFRIGERATOR
'
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK _FLOOR DRAIN I {,d
�J�WASH TRAY _ URINAL -$• OVALS
y WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'3 NAMQ
_WATER HEATER - DENTAL LAVATORY ROUGH PLUMBING 7 `2` 17
.��MIBTER �CGAS OUTL SODA FOUNTAIN GAS PIPING
GAS VENT
CESSPOOL /7
TOTAL NUMBER OF FIXTURES SEPTIC TANK /
SEPTIC TANK
___�CESSPOOL SEWER
PERMIT FEE 100 UTILITY CO. NOTIFIED
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TOTA FEE FIN "�