HomeMy Public PortalAbout5650 MCCULLOCH AVE_Plumbing__ 78AG67A(CES17A) - 8/75
: n APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
ADDRESS
HARVEY T. BRANDY, COUNTY ENGINEER LOCALITY r
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FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM (� FEE
OWNER
WATER CLOSET
MAIL
BATH TUB ADDRESS C
SHOWER CITY TEL. NO.
LAVATORY CONTRACTOR QC
SINK ADDRES
DISHWASHER CITY
' TEL. N.O. Cl3 rL
CLOTHES WASHER STAT LIC
nC
SWIMMING POOL RECEPTOR LICENSE NO. CLAS
DISTRICT NO. GROUP 491, SSED PR BY
LAWN SPRINKLER SYSTEM � .0
WATER HEATER INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS INSPECTION RECORD
OUTLETS OVER
5 PER SYSTEM u
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W
H
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ f
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. N6. GAS VENT
HOT WATER HEATER
1 HEREBY.ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING'FIXTURES //�•
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. 'GAS TEST �+ " p
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED /OR UTILITY CO. NOTIFIED
LICENSED .AS REQUIRED BY LOS ANGELES COUNTY AND AT OF
CALIFORNIA OR THATI AM L AL OWNE OF, AND NTE TO
RESIDE IN THE•ABOVEb RISE (DENTIA ROPERT
SIGNATURE I!
OF PERMITTEE
Aw
E VALIDATION CC M.O. CASH
PLAN CHECK VALIDATION M.D. CASH
7.5 0 A98
DBS-17 9.BS APPLICATION FOR PLUMBING PERMIT
B5.17
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles
WM.J. FOX.COUNTY ENGINEER BUILDING r/
CASSATT D.GRIFFIN,SUPT OF BUILDING -ADDRESS "1T�n X-MC+C1111ock
00111111 9 LOCALITY Temple City
FOR APPLICAN TO FILL IN NEAREST
- CR
OWNER OSS ST.DISTRICT NO. GROUP READY FOR INSPECTION
MAIL 1'42N�
ADDRE
CITY TEL.NO. INDUSTRIAL
WASTE APPROVAL
_PLUMBER Earl Pat standle y pine o INSPECTION RECORD
ADDRESS 2019NN.Hoyt P 408
CITY El Monte
(^ TEL.NO. G1• 41559
LICENSE NO. 1 -9236
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET)
1 BATH TUB
SHOWER
1 LAVATORY (WASH BASINDo)
1 KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY 1.00
CLOTHES WASHER
TOTAL NO.. @ 0.80 APPROVALS
GAS SYSTEM OUTLETS @ 1.00
1 DATE INSPECTOR'S SIGNATURE
1 WATER HEATER @ 1.00 1000 UNDER SLAB WORK'
ROUGH PLUMBING /.f ' j
PERMIT 5 I 1 00 GAS PIPING v -(' r/
TOTAL FEE 8000 GAS VENT `
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER �-G� I,!/.., /•; r e�"
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES f�i
PLUMBING. / r"
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED pND/OR GAS TEST
LLICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO.NOTIFIED ����� /,•,/i fi• r•
CALIFORNIA OR THAT 1 AM THE LEGAL WNER OF THE ABOVECRIBED RESIDE L P PENATURF PERM( E FINAL 4
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION R.A.WOOD.CHIEF PLBG.INSPECTOR
? 3�9 ? 9V; NOV �, 3 8.0 0
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