HomeMy Public PortalAbout4961 LOMA AVE_Plumbing__ 76A667•-CE16#817 2-6Y TEMPLE`/LL16 LE CHT
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 7 4 � Iv, o
JOHN A LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN, SUP T OF BUILDING 11
LOCALITY
/
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE N
_ OWNER H
WATER CLOSET $1.25 it MAIL
r BATH TUB 1.25 � ) ADDRESS
CITY TEL. NO.
SHOWER 1.25
}� CONTRACTOR/ r/,LAVATORY 1.25 r 1. i
SIN% 1.25 ADDRESS 14 O S f )
DISHWASHER 1.25 CITY • �j TEL. NO. j-5:L-o<,`G J~
LAUNDRY TUB 1.25 CONTRACTOR'S STATE
REGISTRATION NO. f Q S-/L- COUNTY
CLOTHES WASHER 1.25 _ DISTRICT NO GROUP ZONE P SSED BY
WATER HEATER 1.50
GAS SYSTEM `� OUTLETS 1.50 S'Ci INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTIONIRECO_RD An 4
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tiU Ix 00-
W
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' APPROVALS DATE ,,INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING ✓�
TOTAL FEE / JEF
GAS PIPINGIHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLGAS VENT
ANDSTATE THAT THE ABOVE IS CORRECT AND AGREE TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGUHOT WATER HEATER
PLUMBINGHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STGAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTRESIDE IN, THE ABOVE DES IBED RESIDENTIAL PROPERTYUTILITY CO NOTIFIED _
SIGNATURE r '
OF PERMITTEESdAFINAL � �
.w
LIDATION ROBERT A"WOOD
C. M O CASH SUPERVISING MECHANICAL ENG'R
ijiCo 4 4 4 8-0 JAN 1 5 5 D 1 1.2 5J N IT
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