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76A667-CE817 6-60 Job 176
APPLICATION FORP UMBING PERMIT
COUNTY OF LOS*ANGELES
'DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 9851 E. La Rosa Ave.
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY Temple Cit
FOR APPLICANT TO FELL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER J. E. Ronstad
2 WATER CLOSET MAIL
1 BATH TUB ADDRESS 2636 So. Baldwin Ave.
CITY Arcadia TEL NO. xi 6-4495
1 saoweR
2 LAVATORY CONTRACTOR Belvedere PlumbingCo.
1 ADDRESS 11900 E. Garvey Ave.
SINE
DISHWASHER CITY E1 Monte TEL No. GI 89836
LAUNDRY TUB CONTRACTOR'S
EGISTRAC IONSNO. 179568 COUNTY
1 CLOTHES WASHER DISTRICTNO. I GROUP ZONE PR CESSED BY
1 WATER HEATER CJ I ,T:L 1 I
1 GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
00
s q I
a 71.00 PER ITEM S I4.91A.1
11 OR FIXTURE S 11.00 APPROVALS DATE ` INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER WORK
TOTAL FEE1 GO ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY GAS VENT .f/
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER 1 or
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i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST Q r ,t ' ✓
CALIFORNIA OR THAT 1 AM THE LEGAL 0 ER OF THE ABOVE
DESCRIBED RESIDE IAL PROPERTY. UTILITY CO.NOTIFIED r
SIGNATURE I OI
OF PERM ITT
FINAL 174 ' 1
®r OVALIDATION ROBERT A. WOOD,
rs.
M.0. CAAtl SUPERVISING MECHANICAL ENG'R
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