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TEMPLE CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER Lot #3 Tract #31181
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
ADDRESS 4819 KaufYnaTl Ave
HARVEY T. BRANDT, COUNTY ENGINEER`
LOCALITY Tem le City
FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEAREST
NUMBER FIXTURE OR ITEM @ FEE CROSS ST.
OWNER J. B. Weber 'Deeelopment
2 WATER CLOSET pp 6 00
MAIL
1 BATH TUB F.00 3.00 ADDRESS 5926 Temple ri ty 'RI yr]
1 SHOWER .00 3,00
CITY Tem le Clt TEL. NO. 444-ogyl
LAVATORYpp CONTRACTOR Valley Plumbing Co
1 SINK .00 3 00 ADDRESS 442 W. Fleetwood Place
1 DISHWASHER .00 3,00 CITY GlendoraTEL. NO.
1 CLOTHES WASHER .00 3.00 STATE LIC
SWIMMING POOL RECEPTOR .00 LICENSE NO. 20931 LASSC36;SC42/211
DISTRICT NO.GROUP ^ ZONE CESS D BY
LAWN SPRINKLER SYSTEM ,pp [ ^f' 1/_ r Z,D t3 �,
1 WATER HEATER, 00 3 00 INDUSTRIAL ✓ f/\ j
WASTE APPROVAL
GAS SYSTEM OUTLETS .00 3Loo INSPECTION RECORD C:)
OUTLETS OVER
5 PER SYSTEM .30 C)
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE 1 311,50
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
,Name ROUGH PLUMBING
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 4--0-'M
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED M.
o' LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE D �RESIDENTIAL PkO PER TY. FINAL
/o a6-26
SIGNATURE
OF PERMITTEE
- PERMIT VALIDATIONM.O: CASH
CK.
PLAN CHECK VALIDATION CK. M.O. CASH