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TOABBT •CEPS17 12-04
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING I1[ 1
BUILDING AND SAFETY DIVISION ADDRESS T
.JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPT OF BUILDING _ LOCALITY
FOR APPLICANT TO FILL IN NEAREST 7'�n
CROSS ST. AgR.ft�-(yX
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
I SHOWER 1.25 CITY TEL. NO.
]PPGqESSED
LAVATORY 1.25 CONTRACTORSINK 1,25ADDRESS DISHWASHER 1.25 CITY7EL. NO.LAUNDRY TUB 125 CONTRACTOR'S ��%/REGISTRATION NO. 5CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE
WATER HEATER 1.50 77
GAS SYSTEM S OUTLETS 1.50 INDUSTRIAL }
WASTE APPROVAL d
OUTLETS OVER 5 PER SYSTEM .30 O
INSPECTION RECORD V
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APPROVALS PATEI INSPECTOR S SIGNA 9R
PERMIT S 2 00 UNDER SLAB WORK V AS
ROUGH PLUMBING
TOTAL FEE
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT HAVE READ THIS g /CATION GAS VENT
ALL
AND BTHAT THE ABOVE 15 CORRECT ANO AGREE COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LBWS REO GV EATING HOT WATER HEATER
PLUMBING.
1 HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES A
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDEIN,THE ABOV DESC ED RESIDENTIA ROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
LIDATION ROBERT A. WOOD
M.o. CASH SUPERVISING MECHANICAL ENG'R
LAAO 6 6 3 4 e OCT 2 0 5 A 1625-
a
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1311210049
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 3623 LT: 115 8714 HERMOSA DR E
IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: 1 SGAB CA 917753009
ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET:
5387-006-035 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: G3 LOCALITY: TEMPLE CITY CAI
107 BATHTUBS/SHOWERS 2.00 FIX 32.40
(TENANT: 125 LAVATORIES/SINKS 3.00 FIX 48.60 (ISSUED ON: PROCESSED BY: PLAN BY:
145 WATER CLOSET/URINAL 2.00 FIX 32.40 111/21/13 SR I
160 DW REPAIR OR ALTER 1.00 SYS 16.20 1 1
10WNER: TEL. NO: I TOTAL FEES 157.40 IFINAL DATE FINAL\r�9/�) CODE: 1
1WONG, WAI MING (626) 696-7308-
18714 HERMOSA DR \\
1SGAB 917753009 1 IIESCRIPTIO OF WORK I
IBATHTUBS/SHOWERS, LAVATORIES, SINK, WATER CLOSET AND
DRAINAGE VENT
APPLICANT: TEL. N0:
SAME AS OWNER -
SPECIAL CONDITIONS:
111 CONTRACTOR: TEL. N0: JAPPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO1UNDER SLAB WORK
I 1 I I II
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
ROUGH PLUMBING /
LIC. NO:
111 GAS PIPING VA
GAS VENT
1HOT WATER HEATER
I
IRLUMB ING FIXTURES
LAWN SPRINKLERS
GAS TEST
(UTILITY COMPANY NOTIFIED(
CWV
• GRAY WATER SYSTEM
I I I I I I
I I I I I 11
II I I I I I
I I I I I 11
1REPORT ID: DPR263 ROUTE TO: BS0508
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