HomeMy Public PortalAbout10040 OLIVE ST_Plumbing__ 75A667 (CE-8171- 5/73 / BU �-CVt�
APPLICATION FOR PLU ING PERMIT
DEPARTMENT OF COUNTY ENGINEER
.BUILDING AND SAFETY DIVISION
-MAKE CHECKS PAYABLE TO: ADIDRESS 10040 Olive
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY Te a Cit
FOR APPLICANT TO FILL IN (PRINT OR TYPE) JAl
NEAREST
T. -
NUMBER• FIXTURE OR ITEM @ FEE
WATER CLOSET OWNER TIITil13 am Van Iwaarden
11 3— AIL
BATH TUB 1.
ADDRESS 10158 Nadine Ste
SHOWER 1.15 CITY Temple City TEL. N0. 7.351
LAVATORY 1. 5 CONTRACTOR Owen BTOS• Plumbing, Ino.
SINK 1 5 ADDRESS 4265 N. Baldwin Ave.
DISHWASHER 117.5 CITY A TEL. N0.
44-1-00 78
CLOTHES WASHER 1 75 STATELICENSE NO. 231 741 LIC CLASS C36, -2O
SWIMMING POOL RECEPTOR 1 75
DISTRICT NO. GROUP ZO E OCESSED BY
LAWN SPRINKLER,SYSTEM 1 75
WATER HEATER 1 75 DUSTRIAL
WASTE APPROVAL per•
GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD v
OUTLETS OVER
5 PER SYSTEM I •30 O
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
APPROVALS DATE INSPFa CiQ R'9 SIGNATURE
Plan Check applKant UNDER SLAB WORK r/-2 /
Name ROUGH PLUMBING
Address. GAS PIPING
City Tel. NO. GAS VENT
HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
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
LICENSED "AS• QECIUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA 'OR THAT i AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN ThE ABOVE DE RIB D RESIDENTIAL PROPERTY. FINAL
SIGNATUR�E• �.:
OF PERMITTEE -
PERMIT VALIDATION (?j M.0. CASH
PLAN CHECK VALIDATION CK. M.O. CASH ,p_ ��
6 2 8 ti MOV 6 5 :D 1 9.55 0"AJ8