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HomeMy Public PortalAbout6203 KAUFFMAN AVE_Plumbing__ 76A887A (CE 81791 -4/77 APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION �l FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / / NUMBER FIXTURE OR ITEM ® FEE ADDRESW o tq q 3 WATER CLOSET 00' LOCALITY > C / BATH TUB v NEAREST . b CROSS ST `-("j /� SHOWER OWNER 'MAIL ``(f '�/1st �[J LAVATORY p ADDRESS 4O;1-DAJ SINK3.e CITY �?;Y1 +l+� C! C. TEL NO '2-'8 _J DISHWASHER 0 V CONTRACTOR �Re CLOTHES WASHER D p ADDRESS SWIMMING POOL RECEPTOR ��7' CITY J jO/V 40 U I`P� - TEL NO LAWN SPRINKLER SYSTEM STATELIC _ry i WATER HEATER S 0 LICENSE NO �f4L 1�' / CLASS C^ GAS SYSTEM OUTLETSD© DISTRICT Nr/O GR UP^ ZONE P CESSE BY OUTLETS OVER �•� 3 C S PER SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD CI.- U W Plan check fee gq�71? Lam' � ttS . �� �° 1f�J47iZ SOT PLUMBING PERMIT ISSUING FEE$ 7-o TOTALFEE Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING ' City Tel No GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES F107 WATER HEATER L,Fs,'Jjji c AND STATE LAWS REGULATING PLUMBING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT.1 AM THE GAS TEST "7 LEGAL OWNER OF.AND I E�D TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO.NOTIFIED SIGNATURE OF PE RMITTE�,�►Cx•"'� A /��g AL OPP�AN"ZA.EC�'K�AL7DA�Ot�PEN SAT Qbl H; 3',r--AUGR IT V' LIWTION c tM. CASH ,1 �€�^ 4 l� LICY HOLDER:4 � ' L1CY NUMBER:Wd./79�'—y/ 17z7 76A667A '•_ '" - •� -• CE 8j51REV.6,�7b) I _ ts APPLICATION""F=• PLUMB G PERMIT COUNTY OF.LOS ANGELES-' BUILDING AND.SAFETY FOR APPLICANT TO FILL,IN(PRINT OR TYPE(' BUILDING r ADDRESS NUMBER XTURE OR ITEM ® FEE FI W • ATER OCLOSET LOCALITY �' • NEAREST BATH TUB CROSS ST �►� SHOWER 'OWNER LAVATORY MAIL 'ADDRESS C SINK CITY' ` �, , TEL NO �4 'DISHWASHER CONTRACTOR, S u' Y CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY'. TEL NO LAWN SPRINKLER„SYSTEM STATE e— LIC WATER HEATER L CENSE NO. C CLASS C_ LSC GAS SYSTEM' OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING *GAS PIPING GAS VENT v HOT WATER HEATER 0 PLUMBING FIXTURES 'loU GAS TEST Plan Check fee UTILITY,CO NOTIFIED PLUMBING PERMIT,ISSUING FEE$ TOTAL_FEE FINAL. VWCA Plan check applicant y"' PLAN CHECK VALIDATION , Name Address A City Tel No, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS,APPLICATION'AND STATE THAT THE ABOVE IS'CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING Y ,PERMIT VALIDATION , I HEREBY.CERTI=To, RESIDE PfEGISTERED AND/OR LICENSED,AS ` Q 17.3 A' ,REQUIRED BY LOS ANGOF CALIFORNIA OR THAT I AWTHE - - LEGAL OWNER OF.ANEdABO0DESCRIBED RESIDENTIAL # b O O O O 5 ,PROPERTY q .SIGNATURE _ Z-O O 1'O,O O OF PERMITTEE _ DIST CT NO •, ° PROCE D BY o 0 0 1,O,O 0 v �j� � X911 -78 INDUSTRIAL „ WASTE APPROVAL "