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71BA647C (CX-!17M) -9/75
' APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TYPE) gUILDING /
NUMBER FIXTURE OR ITEM FEE ADDRESS lob//'�L�lee t:., S T
WATER CLOSET LOCALITYNEARE �Gstf��C j
BATH TUB C ROSS 8 ee'10'l/Jit'2
CROSS ST. c to
SHOWER OWNER /7
LAVATORY MAIL
ADDRESS /ow/ ,E
` SINK CITY l 4 TE 4. NO. VVJP A'p'3
DISHWASHER CONTRACTOR �d Ae f�/� .✓
CLOTHES WASHER
ADDRESS y y a ����,�
SWIMMFNG POOL RECEPTOR
CITY ' TEL. N,0.
LAWN SPRINKLER SYSTEMSTATE // _
LIC WATER HEATER LICENSE NO. (l �s CLASS ��� o
GAS SYSTEM OUTLETS
DISTRICT NO. GROUP JZONF� OC ED BY U
� O Q
OUT-LETS '5--" 0
ETS VER CJ
5 PER SYSTEM INDUSTRIAL w
WASTE APPROVAL a
INSPECTION RECORD 2
Plan check fee
PLUMBING PERMIT ISSUING FEE 9
TOTAL FEE /
Plan check appli-cant
Name APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel. NO. GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IlCORRECT AND AINR[[ TO COMPLY
WITH ALL COUNTY ORDINANCES AND STAT[ LAWS R[}ULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AAD/OR PLUMBING-FIXTURES
LICENSED AJ R[OUI RED BY LOl AAS[LEE COUNTY AND STAT[ OF GAS TEST
CALILINTHE
THA I AM THE LEGAL OWNER OF, AND INTEND TO
REBIABOV¢ DISCR D SID[ TIAL oPERTY, UTILITY CO. NOTIFIED
3I OOTTEE FINAL 'r
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION 0 -.0.
CASH
r
8.6 6,--M--24 6 10.5 0A96
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUKBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 9905050003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 10111 GREEN ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803334
ASSESSOR INFORMATION NUM1BER: NEAREST CROSS STREET: BALDWIN
8585-003-035 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY
07 BATHTUBS/SHOWERS 1.00 FIX 16.20
25 LAVATORIES/SINKS 1.00 FIX 16.20ISSUED ON: PROCESSED BY: PLAN BY: IRES .
45 WATER CLOSET/UIINAL 1.00 FIX 16.20 05/07/99 VG 11/03!99 .
TOTAL FEES 76.35
OWNER: TEL. NO: F I kAL DAT E FI GUIDE:
BERG STEPHEN (818) 448-78W-
1011i GREEN ST
TEMP 917803334 DESURLPTIN OF WORK
PLUMBING FOR NEW SHOWER AND REP LAV AND TOILET
APPLICANT: TEL. NO:
SAME AS OWNERSPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DA7 INSPECTQ&-'SIGMATURE
-
o p,NGELES T
SAME AS OWNER y
LIC. NO
PLASTIC Y/N METAL Y/N
LIC. NO GAS PIPING
111111
GAS VENT
FU'H-'-UC WorKS PLUMBING FIXTURES
j U LAWN SPRINKLERS
0 0
o ❑ . I GAS TEST
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REPORT ID: DPR263 ROUTE TO: BS0508