HomeMy Public PortalAbout9417 LA ROSA DR_Plumbing__ 76A867-CE9817 5/63AA r
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APPLICATION FOR .-PLUMBING, ERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING n
JOHN A. LAM IE. COUNTY ENGINEER ADDRESS OJ q
WILLIAM A JENSEN, SUPT OF BUILDING
LOCALITY
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FOR APPLICANT TO FILL IN CROSS T 0 1/C_ '
NUMBER FIXTURE OR ITEM EACH FEE OWNER 11
WATER CLOSET. $1.25 MAIL ,O
BATH TUB 1.25 ADDRESS
CITY TEL NO.
SHOWER 1.25
LAVATORY 1.25 CONTRACTO
SINK 1.25
ADDRESS Z
DISHWASHER 1.25 CITY
CONTRA TOR'S STATE ❑
LAUNDRY TUB 1.25 REGISTRATION NO.'• COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP SONE PR ESSED BY
WATER HEATER 1.50
I.50 INDUSTRIAL d
GAS SYSTEM OUTLETS O
WASTE APPROVAL '
UTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD }
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APPROVALS DATE/ INSPECTOR'S SIGNATURE
PERMIT 5 2 00 UNDER SLAB WORK
ROUGH PLUMBING J ,
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT Y
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST _ \
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN, THE ABOVE DZSCRIBE;R:X PROPER UTILITY CO. NOTIFIED IL
SIGNATURE
OF PERMITTE FINAL
LIDATION ROBERT A. WOOD V
CK M O CASH SUPERVISING MECHANICAL ENG'R
Oi1:1'S�. X15 5 -D 3-.25~
76A667C (CE-81713) -9/75 -
`APPLICATION FOR PLUMBING PERMIT
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BUILDING D SAFETY DIVISIIOO
FOR APPLICANT TO FILL IN (PRINT OR TYPEI BUILDING
UILDIN C.e' rZoa� DM r
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
�lJ WATER CLOSET 2 LOCALITY
BATH TUB IJ NEAREST '
CROSS ST. LLJ
SHOWER OWNER LA4 1 ��(7'�r4®�'
LAVATORY MAILL-7
ADDRESS lJ
SINK CITY ` L TEL. NO.
DISHWASHER - CONTRACTOR
CLOTHES WASHER r
ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL. NO.
r LAWN SPRINKLER SYSTEM
STATE LIC
WATER HEATER 2 LICENSE NO. CLASS y
-J a
DISTRICT NO. GROUPZONECESS D BY
GAS SYSTEM OUTLETS �j
OUTLETS OVER
5 PER SYSTEM (3INDUSTRIAL I.-
WASTE APPROVAL C->
LLJC
INSPECTION RECORD CO
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant _
Name APPROVALS DATE INSPECT.O,R'S SIGNATURE
UNDERflZWORK 'f ^•--r
Address ROUGH PLBING
City Tel. NO. 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 REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES '
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIB D REST ENTIAfL PROPERTY UTILITY CO. NOTIFIED C
SIGNATURE
OF PERMITTEE FINAL
PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATION M.0. CASH
6 3 4 r SPR 13 5 ® 2 5.5 0 A56
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1303140006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: 1 FEES PAID 1 BUILDING ADDRESS: I
ITR: 13620 LT: 3 1 I 9417 LA ROSA DR 1
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803840 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: HELEO 1
18590-011-003 101 PERMIT ISSUANCE FEE 27.80 1 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY CAI
1 164 WATER PIPNG <= 1 1/2 1.00 LIN 16.20
(TENANT: I TOTAL FEES 44.00 11SSUED ON: PROCESSED BY: PLAN BY: 1
1 103/14/13 SR .1
I I I I
(OWNER: TEL. NO: IFINAL-14ATE FIN BX: CODE: 1
(BURTON MICHAEL E;VIRGINIA L (626) 287-3028.– I 1 1
19417 LA ROSA DR I I I
ITEMP 917803840 I 1DESCRIPTION OF WORK 1
I I (REPLACE WATER MAIN 1
(APPLICANT;. TEL. NO: 1 1 I
-ISAME AS OWNER
I ry, I ISPECIAL CONDITIONS:
(CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE
(SAME AS OWNER – I
I
I; LIC. NO 1 (UNDER SLAB WORK 1 1
I I I I I
�ERSVICEPL /N METAL YIN
(ARCHITECT OR ENGINEER: T_ L. N0:
I – U.'_H PLUMBING 1 I I
LIC. NO: I I 1 I
IGAS PIPING 1 I I
I ?. IGAS VENT I I I
IHOT WATER HEATER 1 1 I
I n 1PLUME ING FIXTURES 1 1 I
I LAWN SPRINKLERS 1 I I
1 IGAS TEST I I 1
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1-1
;Y 'I 1UTILITY COMPANY NOTIFIED( 1 1 _
1-1
I ICWV I I I
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I (GRAY WATER SYSTEM 1 I 1
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IREPORT ID: DPR263 ROUTE TO: BS0508 I I
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