HomeMy Public PortalAbout10139 LA ROSA DR_Plumbing__ 968669 DB919 n-so rN J APPLICATION FOR PERMIT
DEPARTMENT OF Bi7IItUING AND SAFETY PLUMBING
COUNTY OF LOS:ANGELES
WILLIAM J. FOX..DHIEF ENGINEER
FOR APPLICANT TD' FILL IN
DISTRICT GROUP ZO R O.
Jr /6�/
PLUMBER: VALLEY i F RECEIVED BY READY FOR DATE ISSUED
. l/ � � FIRST INSPECTION / D
ADDRESS I/VWV S
ROSEMEAD reL NO. AT: 2--2719 BUILD1Na ev
CITY ADDRESS
COUNTY
NO. 93M
LICENSE - i LOCALITY� y�;,,{-jI f i _
EXPIRES 6-30> j 2.77 '
NEAREST
PERMIT FEES CROSS ST. {^p C 11 •�{t'1 /r
NOMBER TYPE OF FIXTURE OR ITER l FEE OWNER / A yT w 1/
MAIL a B �V 6
I WATER CLOSET(TOILET) Q 0.50 S I �/J ADDRESS
� l Cr+/�7/�e�{ �! <Y ✓T'
B
AT,
TUB Q D.SO J AQ, CITY (� i'il)(/�/Y rr` TEL No.
SHOWER 0.50 �'./ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Q 0.50 Ou APPLICATION AND STATE THAT THE ABOVE IB CORRECT
ee AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
' I KITCHEN SINK O.SD (J AND STATE LAWS REGULATING PLUMBING.
t CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY (100.50 U ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL P�f�DPERTY DESCRIBED ABOVE
GAS SYSTEM OUTLETS @ 0.50 / //]y� t
SIGNATURE OF z �/ ,/ A` �. � ��.
WATER HEATER Q 0.50 � PERMITTE fj
SLOP SINK a 0.50 INSPECTION RECORD
FLOOR SINK D.50
FLOOR DRAIN Q 0.50
DISHWASHER 0.50 �Y /
DRINKING FOUNTAIN 0.50 L E)�� �L L CO Q
�/O 7-
iPA off. -- 1
URINAL ® p.SO Q
HOUSE SEWER @ 0.50 _Z
_ MI9C ELLAN EDU9 /1
13
APPROVALS
DATE INOPPECTOR•9 NAME
ROUGHPLUMBING
GAS PIPING
GAS VENT
CESSPOOL Q 1,00 CESSPOOL
SEPTIC TANK• SEPTIC TANK
DRAIN ( ) PIT ( ) CD 1.00 SEWER
PERMIT I 1.0o GAS TEST
r UTILITY CO. NOTIFIED .!
TOTAL FEE S D� 1
lFINAL