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APPLICATION FOR PLUM ING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 4,44 1 �
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET MAIL
BATH TUB ADDBES /E(/
CITY P NO.
SHOWER
CONTRACT /
LAVATORY
ADDRESS C
SINS
DISHWASHER CITY TEL NO.7fT 7-7 IT
CO STA
LAUNDRY TUB REG CTO 3 COUNTY
CLOTHES WASHER DISTRICT NO. I GROUP E P SEED BY
WATER HEA'1R c 1 �( Q
INDUSTRIAL
_ — GAS SYST$M• WASTE APPROVAL v
INSPECTION RECORD w
O
u
W
N
@ $1.013 PER ITEM i
OR FIXTURE $ A' APPROVALS T- E
/.
INSPECTOR;B'BIGNATURE
PERMIT /
2100 UNDER SLAB WORKlL6(�
TOTAL FEE /t ROUGH PLUMBING 1
v GAS PIPING r
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AJAPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING. '
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 'A
LICENSED AS REQUIRED BY LOS ANGELES COUNTY TATE D SOF GAS TEST
CALIFORNIA OR THAT 1 AM THE AL WNER THE ABOVE -
DESCRIBED RESIDENTIAL PRO ;7
UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE FINAL
6VALIDATION ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENG'R
u"01 7 3 7 r„"r, 30 5 D 4.50
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9806150009
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
EG ID: FEES PAID BUILDING-ADDRESS:
ON FILE C620-4- OLDEN WEST AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: T-EMP-CA7917801704
ASSESSOR INFORNUMBER: NEAREST CROSS STREET: FLAHERTY
5385-025-019 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CTIY
07 BATHTUBS/SHOWERS 1.00 FIX 16.35
TENANT: TOTAL FEES 44.10 ISSUED 0 PROCESSED BY: PLAN BY: EXPIRES
06/15/98 UT 06/15/99
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
GROHS, AGNES (626) 447-4716-
6204 GOLDEN WEST
TEMP 91870 DES RIP-T-ION-OF-
� PLUMBING-FOR-KI-TCHEN_AND_BATHREMODEL
APPLICANT: TE O:
SAME AS OWNER
- SPECIAL CONDITIONS:
CONTRACTOR: TEL. N0:
APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO /�j� 3 °� UNDER AB WOR
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT-OR EER: TEL. NO:
ROUGHPLUMBING
LIC. NO:"
GAS PIPING
S VENT
HOT WATER HEATER
- - - - - - BIN IXTUR
LAWN SPRINKLERS
GAS TES
UTI COM NOTIFIED
CWV
-- GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508