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TEMPLE CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER Lot #12 Tract #31181
BUILDING AND SAFETY DIVISION
LD
MAKE CHECKS PAYABLE TO: ADDRESS 1}810 Kaufman Ave.
RANDT, COUNTY ENGINEER LOCALITY-
HARVEY T e T mple City '
FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEAREST
CROSS ST. Yit/
NUMBER FIXTURE OR ITEM @ FEE
00 6 O OWNER J. B. Weber velo ent:
WATER CLOSET MAIL
1 BATH TUB00 00 ADDRESS 26 Temple Cit Blvd.
1 SHOWER 00 OG CITY Temple City TEL. NO-444-0971
2 LAVATORY 00 6 oo CONTRACTOR Valley Plumbing Co.
SINK .00 3JO0 ADDRESS 442 W. Fleetwood Place,
1 DISHWASHER .00 3.00 CITY Glendora TEL. NO.
1 CLOTHES WASHER 00 3 0o STATE LIC
LICENSE NO. 209431 CLASSC36•SC42/20;
SWIMMING POOL RECEPTOR .00 .: 4, ""`^
DISTRICT NO.GROUP ZONE OCESSED BY
LAWN SPRINKLER SYSTEM .00
1 WATER HEATER 00OO WASTE A PROVAL a
1 GAS SYSTEM OUTLETS .00 3J0O INSPECTION RECORD V
OUTLETS OVER 7xp
5 PER SYSTEM .30 Z,O /i ®,/ULN/ fl. O
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ SO
TOTAL FEE 0 APPROVALS DATE INSPECTOR'S SIGNATURE
Plan Check applicant UNDER SLAB WORK c •
A y �
Name ROUGH PLUMBING . 1T 7�
Address GAS PIPING
City
Tel. NO. GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I 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
PLUMBING. GAS TEST rl.+?'�O ,�.�,.s=��
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSEDAS REOUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOV E.D SCRIBED RESIDENTIAL PROPERTY. FINAL
SIGNATU RE
OF PERMITTEE
PERMIT VALIDATION cK. M.O: CASH
PLAN CHECK VALIDATION CK M.O. CASH
25 4N:949P1 4 -5 0 - -37.5 G 698
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1109260022
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: - FEES PAID I BUILDING ADDRESS: 1
ITR: 31181 LT: 30 1 1 4810 KAUFFMAN AV
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917804244
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1
18589-019-030 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, Cl
107 BATHTUBS/SHOWERS 2.00 FIX 32.50 I I
(TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.30 (ISSUED ON: PROCESSED BY: PLAN BY:
145 WATER CLOSET/URINAL 1.00 FIX 16.30 109/26/11 SR 1
TOTAL FEES 92.90 1 I
(OWNER: TEL. NO: I 1FINAL DATE .FIN BY: CODE: 1
IDOUG TURN, ANNA TU (626) 688-9759- I 1
14810 KAUFFMAN AV .I 1 L
ITEMP 917804244 1 ID SCRIP ION OF WORK 1
I I IPLUMBING FOR NEW BATHROOM 1
(APPLICANT: TEL. NO: 1 1
IGIEP VAN LE (323) 537-5874- 'I
12971 RANDOLPH ST. 1 ISPECIAL CONDITIONS: 1
1HUNTINGTON PARK I I
ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE I
IGOLDEN AGE CONSTRUCTION INC. (626) 536-1886- 1 I
1186 E. CAMINO REAL AVENUE LIC. NO 1 1UNDER SLAB WORK 1 I
IARCADIA, CA 91006 820728 1 1 I I
IWATER SERVICE
(ARCHITECT OR ENGINEER: TEL. NO: iPLASTIC Y/N METAL Y/N
1 1
1 IROUGH PLUMBING 1 1
1 LIC. NO: I
(GAS PIPING I I-
I
1 IGAS VENT 1
I IHOT WATER HEATER I
I I I
1 IPLUMBING FIXTURES I I
1 (LAWN SPRINKLERS 1 1
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I IGAS TEST 1
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1UTILITY COMPANY NOTIFIEDI I I
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I 1GRAY W TER SYSTEM I I 1
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IREPORT ID: DPR263 ROUTE TO: BS0508 1 1 I
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