HomeMy Public PortalAbout5827 MYDA AVE_Plumbing__ 76A567 (CE-817)- 5/73 ��y� x4
APPLICATION FOR PLUMB NG PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEARESTIIII.
.�
NUMBER FIXTURE OR ITEM @ FEE CROSS ST
WATER CLOSET 1,75 OWNER
MAIL
BATH TUB 1.75 ADDRESS J C�
SHOWER 1,75 CITY k.
-LEL. NO.
LAVATORY 1.75 CONTRACTOR
L
SINK 1.75 ADDRESS/6
DISHWASHER 1.75 CITYTEL. NO. h/
CLOTHES WASHER 1.75 STATE LIC
LICENSE NO. CLASS p2�
SWIMMING POOL RECEPTOR 1.75
DI TRICT NO GROUP I,ZQNEI,/ PROCESSED BY
LAWN SPRINKLER SYSTEM 1.75 � �. /
WATER HEATER 1.75 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD O
OUTLETS OVER v
5 PER SYSTEM .30 CC
O
t;
W
CL.
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEES 131 00
TOTAL FEE 14/12
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. No.
GAS VENT
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ! ,,,.• �, r
FINAL
SIGNATURE (� �� r• 1� ' � r,�J i1�/ t���
OF PERMITTEE �•� �� �b_Z� J v
PERMIT VALIDATION OK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
4 01;jug a2 5
4.75 s�.�
76AG67C (CE-617EI) -9/7S
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
�J�� L (1� 1ryV
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET
LOCALITY � � 7 e
NEAREST /
BATH TUB CROSS ST V
SHOWER OWNER
LAVATORY MAIL
ADDRESS 7�
SINK CITY TEL.JY 0.
DISHWASHER CONTRACTO
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CI TEL. NO 7C'
LAWN SPRINKLER SYSTEM
STATE C
WATER HEATER LICENSE N0. 6s�C/' CLASS
U
DISTRICT NO. GROUP WZO;N��PRSSED BY
GAS SYSTEM OUTLETS C 0 c pp .OVL � F-
5 PER SYSTEM INDUSTRIAL LULI
WASTE APPROVAL N
INSPECTION RECORD �^ 11
/,,, Z
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
Address
ROUGH PLUMBING
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 HE LEGAL 9WINER OF, AND INTEND TO
RESIDE IN THE ABOVE DE BED R lg T AL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE !V',"r"+/�f/
OF PERMITTEE FINAL
v
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK.,jM.O. CASH
;sAF,4zD APPLICATION FOR PERMIT
S&E-6G3 3•SS
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D i SPOSA L
Department of County Engineer
County of Los Angeles FALDING
WM.J. FOX.COUNTY ENGINEER DREaSCASSATT CI.GRIFFIN,SUP'T OF BUILDING CALITYFOR APPLICANT TO FILL IN AREST /
LEGAL
DESCRIPTION LOT NO .� <'' —OWNER `-__---
BLOCK TRACT MAIL
�A.
NO. OF 13LDG5.
IZE OF LOT V NOW ON LOT CITY NO, '1 , 3t; ,
USE OF r
"DISTRICT NO. i GROUP. �; MAP
f
6KP
CONTRACTOR61
ADDRESS
ADDREss _ .1/ 1' CONNECTION DATA
— -
i
CI7Y._..,� � t "TE:L. NO.�' / � STATION j "a, r DEPTH
U PER
STATE MANHOLE REFERENCE
REGISTRATION NO, n COUNTY _ - teNn6R
NO DESCRIPTION OF WORK � FEE -- _��
_ TYPE -C-ONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO r.
_PUBLIC SEWER_ /a. $ 3.50 i i Y. t CURB'
_—P.Li—_hl 7fl P L.
HOUSE SEWER CONNECTING TO - ^�—
PRIVATE DISPOSAL SYSTEM 1.00 --- — --__
CONNECT ADD:T(ONAL BLDG,OR P. C. NO.
_ 1`lORK TO HOUSE SEWER1.00 'O. IMP. NO. :- ;'' JOELN
AL cR OR REPAIR EXISTING
^+ —
-- S�Y ER GRDISPOSAL SYSTEM 1.00 TRU14K PERMIT NO. ROAD PER+d:T 140.
D k�CON NEC AND 4NDON SEIRER STATE ENCROACHMENT
AND/OR DISPOSAL SYSi'Ei' 1_.0_0 PERMITNO.
i.) S T.0 TANK. SEEPAGE PIT OR
_ ICS AND/OR DRAINF!ELD INDUSTRIAL
CT;SSPOOL DRYWELL WASTE APPROVAL
I
SPECIAL CONDITIONS ONLY 2..00 CHARGES
CONNECTION CHARGE FEE
l'EIIMlT
OWNER'S �_. r oo — -------- --— — ------ 1
AUTHORIZATION TOTAL FEE I t l ,�; RckitoURSE`;ENT FEE _
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DEI
.DESCRIBED EXISTING DWELLING APPROVALS � DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER _�, ,.� ---- ---------
.,__. NEW HOUSE SEWER
SIGNED THIS 7—DAY Of
OWNER OR --- _ CONNECT
ADDITIONAL
� —'
OWNERS ACENI '..� ..:` ^" r� BUILDING OR WORK _ ,^
SEPTIC TANK, SEEP, PITS)
ADDRESS AND/OR DPF,INFIELD— -'---- ----, —.
I H, RE'PYP_ACKNOWLEDG€ THAT I HAUS REAQ THIS APPLICATION YCESSPOOL❑ DRYWELL 0
AND STATE THAT THE ABOVE IS COF ECT AND AGREE TO COMPLY
WITALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR SEWER 6R�—�
PLUMBING H AfJD SEWERS. SEWAGE D;SPOS SYST'EM
i I BY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR �- —" - "—
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA 01` THAT I AM THE LEGAL OWNER -OF THE ABOVE _ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL EROPERSY )
.: BACKFILL'SEPT'IC TANKS 4
SIGNATURE ' SEEP PIT(S) CESSPOOLS L:IT_
OF PERM!TTci ` '�,• d i
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLSG. INSPECTOR