HomeMy Public PortalAbout4922 HELEO AVE_Plumbing__ 76 1k667 - C-'!E 817.7-69..
AISIrUCATI®N FOR . PLUMBING PER
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING Z
JOHN A. L•AMBIE, COUNTY ENGINEER ADDRESS
CoLEMAN.W. JENKINS. SUPT. OF"BUILDING~ LOCALITY
FOR-APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST -
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET 1.50 f MAIL 1wM1 Vim' �7V.
BATHTUB 1.50 tADDRESS
SHOWER' 1.50 CITY' TEL. NO.
LAVATORY, 1.50 0 CONTRACTOR C,
SINK 1.50 �o ADDRESS
DISHWASHER 1.50 CITY A 6�L TEL. NOQa
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO.<L43, 101 CLASS 3
SWIMMING POOL RECEPTOR' 1.50
DISTRICT NO. GROU ZONE P O 5 D BY
LAWN SPRINKLER SYSTEM 2.00 s
WATER HEATER 1.50 INDUSTAL 0
WASTE AP ROYAL
�•
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD
OUTLETS OVER .30 O
5_PER SYSTEM ..
W
N
Plan.check fee 25% of,above. See reverse.
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FEE 00
_ APPROVALS DATE I SPECTO 'S SIGNATURE
Plan Check applicant UNDER.SLAB WORK -
Name ROUGH PLUMBING
Address e GAS PIPING
GAS VENT
City. Tel..No. HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT 1 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.[ AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED -
o LICENSED AS REQUIRED BY LOS ANGELES 'COUNTY AND STATE OF .
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESI EN IAL PROPEL. FINAL
SIGNATOR �1�����1 �" ���I'� / -
JACK R. ALLEN, SU PER'V ISIN CH ANICAL EN G'R.
OF PERMI
- PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M o CASH