HomeMy Public PortalAbout9234 LA ROSA DR_Plumbing__ 76A667A 1AE 6178)- 11/76
APPLICATION FORPLUMBING PERMIT'.
BUIL�ANDSS�AFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 2 L a Rosa
a
NUMBER FIXTURE OR ITEM ® FEE ADDRESS 93
WATERCLOSET LOCALITY Tem le City-
NEAREST'
BATH TUB CROSS ST
SHOWER OWNER A . -ford
LAVATORY MAIL 9234 La Rosa
ADDRESS
SINK CITY, Tem le City TEL NO 286 222
DISHWASHER CONTRACTOR Valley Heat tri Co .
CLOTHES WASHER ADDRESS 1116 ,S San Gabriel -Blvd.
SWIMMING POOL RECEPTOR
LAWN SPRINKLER SYSTEM CITYSan Gabriel • TEL NO 285 3818
STATEWATERHEATER LICENSE NO 147899 C�SS C20
GAS SYSTEM 1 OUTLETS DISTRICT NO GROUP ZONE OCESSED
OUTLETS OVER __-j ` C'? �-
5 PER SYSTEM INDUSTRIAL
WASTE APPROVAL O
INSPECTION RECORD V
C9
0
- W
Vl
Z.
Plan check fee -
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
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
AND-STATE LAWS REGULATING PLUMBING HOT WATER HEATER
I HEREBY CERTIFY-THAT I AM PROPERLY'REGISTERE AD ND/OR LCENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES CO TY AND STATE OF CALIFORNIA OR TIjAT I AM yjlE GAS TEST '
LEGAL OWNER OF,AND INTEN TO RESIDE IN THE�6OVE DESCRIBED RESIDE IAL
PROPERTY TILITYCO NOTIFIED
SIGNATURE -
OFPERM ITT EE- INAL
PLAN CHEOWALsUFlRS COM PENSATWN' PERMIT VALIDATION cK. M o CASH
60 -E-DEC 5 ;� s7.5 0 ®�Z
POLICY HOLDER: � ®�
_ - POLICY NUMBER
76AS67 OBS 17 11-513 APPLICATION FOR PERMIT
DEPARTMENT BUILDING AND SAFETY
COUNTY
OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
DIBTRTCT NO. GROUP ZONE PERMIT NEJ.
FOR APPLICANT TO FILLINS 1 1
7 Gfe—/4
PLUMBER ' _`'—"�'� RECEIVED BY READY FOR DATE ISSUED
/ f FIRST INSPECTION
ADDRESBUILDING
S /f �I
CITY TEL. NqO �° rdll ADDRESS �"
COUNTY LOCALITY
LICENSE NO. / EXPIRES �0 ��
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE
OWNER
MAIL
WATER CLOSET(TOILET) 0.50 # ADDRESS " 4 -
BATH TUB @ 0.50 CITY TEL. Nn.
SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
GAS SYSTEM--T--DUTLETSOF THE RESIDENTIAL DESCRIBED ABOVE.
@ 0.50 ^ �
SIGNATURE ore, � !f✓yG
WATER HEATER @ 0.50 PERMITTEE
SLOP BINK @ 0.50 INSPECTION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN 0.50
DISHWASHER @ 0.50
DRINKING FOUNTAIN 0.50
URINAL @ 0.50 J
Q
HOUSE SEWER @ 0.50 _Z
MISCEL NEOUS 5
IY
O
APPROVALS
/DATE INSPECTOR'S NAM[
ROUGH PLUMBING / ..�.✓
GAS PIPING
GAS VENT
b✓ L
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT . . I 1.D0 GAS TEST
UTILITY CO.NOTIFIED
TOTAL FEE ✓
FINAL
V .
76A667-CE#817 6-65 l-e
APPLICATION FOR PLUMBING PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING S
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS J�. J
COLEMAN,W JENKINS SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE n
OWNER O /L-D
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 DREG
SHOWER 1.25 CITY 2 TEL. NO.
LAVATORY 1.25 CONTRACTOR � �
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
LAUNDRY TUB 1.25 STATE LIC
LICENSE NO f✓19 CLASS '
CLOTHES WASHER 1.25 DISTRICT NO. G 7 Z P B
WATER HEATER 1.50 1
GAS SYSTEM OUTLETS 1'50 INDUSTRIAL CL
O
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
V
LU
CL
N
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE SO GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE\TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS GULATING HOT WATER HEATER.
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED NO/OR PLUMBING FIXTURES
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STA OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL ER OF,AND INTEN TO
RESIDE IN, THE ABOVE DESCRIBED RESID NTIA ROP Y. UTILITY CO. NOTIFIED
SIGNATURE I
OF PERMITTEE
FINAL -10JW f'7
AUDATION
v
M O. CASH
� k 6 '5 3,E'- MR17 5 0 4.50