HomeMy Public PortalAbout5239 KAUFFMAN AVE_Plumbing__ 76A667C ICE-8178) -9/75 -
APPLICATION FOR PLUMBING PERMIT.
BUILDING SAFETY DIVISI
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING `. �• -
NUMBER FIXTURE OR ITEM @ FEE ADDRESS -
WATER CLOSET- ` LOCALITY
BATH TUB NEAREST
CROSS ST. G L=
SHOWER OWNER
-
LAVATORY MAILADDRESS :S ti P '
SINK CITY �TEL. NO.
DISHWASHER -
CONTRACTOR eln 43!A//
CLOTHES WASHER V
ADDRESS G/
SWIMMING POOL RECEPTOR
p �� L �
CITY&4N CY // TEL. NO. �IY(s'l7S2,
LAWN SPRINKLER SYSTEM _
+� STATE � LIC
WWATER HEATER 3 LICENSE NO 3/ //o 13 CLASS G a
DISTRICT NO. GROUP NE � pCESS D BY
OUTLETS GAS TEM OVER OUTLETS U� �(
5 PER SYSTEM INDUSTRIAL l`J•Y-
WASTE APPROVAL W
d
• INSPECTION RECORD Cl)
N07- /1Gf�Y �an'z T0. �•
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant
Name APPROVALS DATE 'IN5PECyTOR'S.SIGNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel No. GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VNjb _
AND E "=
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY "� "¢^" ; 4
WITH ALL COUNTY ORDIMANC ES AND STATE LAWS REGULATING HOT WATER HEATER •:��'� •� ° ;'
PLUMBING. - '
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES, " q ., '
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST -12 77 N�
CALIFORNIA OR THAT I A�E LEGAL OW. ER OF, AND INTEND TO
RESIDE IN THE ABOVE D S RI�ED RESIDEN AL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE ! FINAL '
PLAN CHECK VALIDATI CK. M.O. CASH PERMIT VALIDATION CK.' M.O. CASH
3 7-44-IJAW 26, S U 'J.J
7CA667 (CE-817) - 5/73
APPLICATI N FOR PLUMBING- PERMW,
COUNTY OF LOS ANGELES
.DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING ^`
a ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST..
NUMBER FIXTURE OR ITEM @ FEE
` WATER CLOSET 1•75 OWNER
,MAIL ,
BATH TUB 1.75 'ADDRESS'
SHOWER 1.75 CITY TEL. NO.r
/ LAVATORY 1.75 S" CONTRACTOR
SINK 1.75 ADDRESS O ZB
DISHWASHER 1.75
• CITY •1� TEL. NO..y�.. O•
CLOTHES WASHER 1.75 STATE LIC ,
'LIC ENSE,NO. [� CLASS,•
SWIMMING POOL RECEPTOR 1.75
DI ITR NO. 'GROUP NE OC ES ED ply
LAWN SPRINKLER SYSTEM 1.75 . �--�
WATER HEATER 1.75 INDUSTRIAL
WASTE APPROVAL a
GAS-SYSTEM OUTLETS 1.75 INSPECTION RECORD O
U
OUTLETS OVER 30 oc
5 PER SYSTEM
O
W
CL
P166'check fee See Reverse
PLUMBING PERMIT ISSUING FEE .S 3 '00
TOTAL FEE (J
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant, UNDER SLAB WORK
:Name ROUGH PLUMBING
Address ' GAS PIPING
Clfy 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
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 IN_THE ABOVE DESCRIBED RESIDENTIAL PROPER FINAL �
- =�3
SIGNATURE `
OF PERMITTEE
PERMIT VALIDATION CK. M.0. CASH
PLAN CHECK VALIDATION K. M.0. CASH
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