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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAM IE. COUNTY ENGINEER ADDRESS r
WILLIAM A JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE OWNER f
WATER CLOSET $1.25
BATH TUB 1.25 ADDRESS 1�1`
SHOWER 1.� CITY Q L. NO3 7 /
LAVATORY 1 u CONTRACTOR
SINK - 1.25 ADDRESS4-01
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DISHWASHER 1.25 CITY TEL. NO.
CONACTOR'S STATE
LAUNDRY TUB 1.25 REGISTRATION ION NO. COUNTY 0
CLOTHES WASHER 1.25 DISTRICT NO GROUP ZONE PRO SSED BY
WATER HEATER 1•� L , r
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
o
W
Z
APPROVALS DATE INSPE OR S SIGNATURE
PERMIT s 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE . GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 'GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL 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 THEA.EGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBE RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE L
OF PERMITTEE
FINAL
VALIDATI ROBERT A WOOD
CK M O CA H SUPERVISING MECHANICAL ENG'R
LALO 0 6 6 6 klAR 2 2 5 D Jr,'7 S
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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0506060007
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 _
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
TR 5904 LT 253 6141 LOMA AV
FEE DESCRIPTION: QUANTITY UOM AMOUNT: TEMP CA 917801633
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LONGDEN
5384-010-018 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID: H2 LOCALITY TEMPLE CITY, C
13 DISHWASHER(S) 1 00 FIX 16 20
TENANT 25 LAVATORIES/SINKS 1 00 FIX 16 20 ISSUED ON PROCESSED BY: PLAN BY EXPIRES ON
TOTAL FEES 60 15 06/06/05 JK 12/03/05
OWNER TEL NO FIaTBL D �! FIN BY CODE
LIAO, ANDY (626) 221-8412- 'AI{/J7/
6141 LOMA AV
TEMP 917801633 D2SCRIPTION OF WORK
PLUMBING FOR KITCHEN REMODEL
APPLICANT TEL NO
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC NO UNDER SLAB WORK
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER TEL NO
ROUGH PLUMBING
LIC NO:
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS,
GAS TEST
UTILITY COMPANY NOTIFIED
CWV
GRAY WATER SYSTEM
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REPORT ID DPR263 ROUTE TO BS0508