HomeMy Public PortalAbout10105 LA ROSA DR_Plumbing__ 76A6.7A GE 6)701- 11/76
APPLICATION FOR PLUMBING PERMIT
EIUILDINYN�TY DIVISI N
FOR APPLICANT TO FILL.IN(PRINT OR TVPEI - BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
10109 T-A HOSIA DR -
WATER CLOSET LOCALITY
NEAREST
BATHTUB CROSS ST.
2 SHOWER _ OWNER LONNIE
DEVITO
15 LAVATORY MAIL
ADDRESS16109 LA RoC;A DR .
SINK 3 CITYTEMp 'EPTTY TEL.NO.
1 DISHWASHER 3 CONTRACTOR -J&D PLUMBING
CLOTHES WASHER ADDRESS
414S0 . SAN G BRIEL BLVD
SWIMMING POOL RECEPTOR
Cli TEL.NC.?.
LAWN SPRINKLER SYSTEM SAN
STATE LIC.
WATER HEATER ^J LICENSE N0.30776] CLASS Q . 6
no
GASSYSTEM OUTLETS 3 DISTRICT NO. GROUP NE CESS BY
OUTLETSOVER �' � Y
5PER SYSTEM INDUSTRIAL 6
WASTE APPROVAL O
INSPECTION RECORD V
Z3 �.��esr 68 wfrs�s 7G' c
nK
Plan check fee �L 6C ✓wrll/NC- LOeAT erf
PLUMBING PERMIT ISSUING FEE 8
TOTAL FEE .J ��
Plan check applicant -
APPROVALS DATE INSPE OR'S SIGNATURE
Name
UNDER SLAB WORK 6577 �A
Address ROUGH PLUMBING 1Z-Z�'�7 /!�LlT.—J
City Tel,No. GAS PIPING /Z—Z0.7 C�Ttti�
1 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
AND STATE LAWS REGULATING PLUMBING. .HOT WATER H EATER
I'HEREBY CERTIFYTHAT I AM PROPERLY REGISTERED PND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF.CALIFORNIA OR THAT AM THE GAS TEST
LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
'PROPERTY - UTILITY CO.NOTIFIED
SIGNATURE { j
OFPERMITTE r' FINAL .
_.. .. .. i
PLAN CHECK VALIDATION CK No. CASA PERMIT VALIDATION vMo. usH
`.'KERS COMPENSATION(
M.5 I;SEP 16 2 5 D 4 3.5 0 w o
POLICY HOLDER: , 5
76A 667A
CE BI]IFE V.6/761 C L_Y/y_// IIUII
' @ APPLICATION OR PLIBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING O S S^
A
'NUMBER FIXTURE 02 ITEM ® FEE ADDRESS
LOCALITY
WATER CLOSET
NEAREST
BATHTUB CROSS ST.
SHOWER OWNER
LAVATORY MAIL LT c
ADDRESS
SINK CITY- TEL.NO:
DISHWASHER CONTRACTO
U
CLOTHES WASHER I ADDRESS O C
ir6
SWIMMING POOL RECEPTOR
CITY lq TEL.NO.
LAWN SPRINKLER SYSTEM STATE P110142'T `-�
WATER HEATER (CENSE NO. � CLASS
GAS SYSTEM OUTLETS APPROVALSa DATE INSPECTOR 5 SIGNATURE
OPTLETSOvINER UNDER SLAB WORK -711f/A OD /mva--c
ROUGH PLUMBING r
GAS PIPING d
O
GAS VENT V
HOT WATER HEATER F0F
!ISSUING
PLUMBING FIXTURESGAS TEST S � (Aa.Plan check fee IIIIII
uralTrco.NonHEO 't ' - ' '�' ZPLUMBING PEREE$ _FEE FI AL /
Plan check applicant PLAN.CCH�E.CCKyVALIDAT16N
Name a-� y
Address wev 0'T1 Ut9
City - Tel.No.
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY W ITH ALL COUNTY ORDINANCES
AND 57ATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 251 39A
I HEREBYOERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE # • • • • 1 5
LEGAL OWNER OF,AND INTEND TO RESIDE IN TM BOVE DESCRIBED R NTIPL ' '
PROPERTY. /`/J O 1 600 O O
SIGNATURE L O O
OF PERMITTE -0 1 (6] O
DIST Ti0 PROCESSED BV 1 0 62 5'-79
y
INDUSTRIAL - -
WASTE APPROVAL