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TEMPLE CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER Lot #8 Tract #31181
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
ADDRESS 4836 Kauffman Ave.
HARVEY T. BRANDT, COUNTY ENGINEER
LOCALITY Tem le City
FORAPPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST_
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSETC)Ioo MAIL
00OWNER J. B. Weber Deviopment
1 BATH TUB .00 3 OO
ADDRESS 5926 Temple City Blvd.
2 SHOWER .00 6 OO CITY Temple City TEL. NO.444-0971
3 LAVATORY .00 9,00 CONTRACTOR Valley Plumbing Co.
SINK .00 ADDRESS 442 W. Fleetwood Place
DISHWASHER .00 3LOO CITY Glendora TEL. NO.335_1293
1 CLOTHES WASHER .003 OO STATE LIC
LICENSE NO. 209431 CLASCi36;SCi42/20
SWIMMING POOL RECEPTOR .00
DISTRICT NO.GROUP ZONE CESSED BY
LAWN SPRINKLER SYSTEM 1.00 � _( —7
v 7A
1 WATER HEATER .00 3.00 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS .00 INSPECTION RECORD 0
OUTLETS OVER30 G
; J �
5 PER SYSTEM �� r C �� �v a =
v O
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Plan check fee See Reverse n
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE 46 O
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING �c
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 GAS TEST 'w'.�`
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REOU I RED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE INTHE ABOVE SCRIBED RESIDENTIAL PROPERTY. FINAL
SIGNATURE!
OF PEMITTEE VV�-�
PERMIT VALIDATION iCK 'MO:' CASH
PLAN CHECK VALIDATION CK. M.O. CASH GG A11pp (
/// ✓ 6;�.