HomeMy Public PortalAbout5534 1/2 PAL MAL AVE_Plumbing__ °A87APPLICATION FOR PLUMBING PERMIT 1
DIVISION OF BUILDING AND SAFETY
Depoatment of County Engineer
County of Los Angeles BUILDING tis ?A 11,
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS V J/- Q�-
CASSATT D. GRIFFIN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS BY.
OWNER . DISTRICT NO. GRn^o ZONE READY FOa INSPECTION
MAIL 0 3
ADDRESS
CITY INDUSTRIAL TEL. NO. O WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS Q,6
CITY ICl/ TEL. NO. M
LICENSE NO. ( _ 3 6 - / _3 ,7S-6 6
NUMBER TYPE OF FIXTURE OR ITEM FEE >•.Q ICA
WATER CLOSET (TOILET) @ $1.00 S O
BATHTUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00 C
KITCHEN SINK @ $1.00 - — -
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00 V 1
CLOTHESWASHER @ $1.00
WATER HEATER @ $1.00 OO
GAS SYSTEM @ $1.00 O CJ
APPROVALS
DATE INSPECTOR 5 SIGNATURE
UNDER SLAB WORK
PERMIT j I Do ROUGH PLUMBING L.I9
GAS PIPING
TOTAL FEE Od
GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
---
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ---�
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL OP TY.
SIGNATURE
OF PERMITTEE FINAL
(JOHN A. LAMOIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLSG. INSPECTOR
CE. M.B. CASH
C4987-� DEC10 3
majecallas APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Doporument of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
m CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN CROSS SST
LEGAL OWNER
DESCRIPTION LOT NO Q 2. d w SD N
BLOCK TRACT E' ADDRESS sa3S So. 6Ay4f SiE.
USE
NO OF BLDG!
81ZE OF LOT NOW ON LOT CITY C � TEL NO �
OF 65 Q
DI
BUIDISTRICT NO GROUP YAP
BK PB
CONTRACTOR L Q d /— /..7— 's'
ADDRES! CONNECTION DATA
CITY TEL NO STATION 'DEPTH
/ MANHOLE REFERENCE UPPER
& STATE
REGISTRATION NO G— 1 3 �6 G ❑ COUNTY LOWER
C
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO T CURB PNff
Y L TO P L
PUBLIC SEWER 0 $3 50
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® S S 00
OVERFLOW SEEPAGE PIT DRAINFIELD P NO
EXTH ,CESSPOOL DRYWELL,YANHOLE ® S3 00 CO INP NO SOB 0
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 0 51 00 TRUNK PERMIT NO ROAD PERMIT N
CONNECT ADDITIONAL BLDG OR STATE ENCROA EN
WORK TO HOUSE SEWER 0 S 100 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 0 31 00 WASTE APPROY
CHARGES
CONNECTION CHARGE FEE
OWNEB'S PMUOT s I 00
AUTHOB=TION TO AL FEE OQ REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AS ENT SEPTIC TANK,SEEP,PITS)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYW ELL❑
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AY PROPERLY REGISTERED ANO/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUG AND
CALIFORNIA OR THAT I AY THE LEGAL OWNER OF THE ABOVE
WER
DESCRIBED RESIDENTIAL PRTY BACKFILL SEPTIC TANKS❑
SIGNATURE BEEP PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBO INSPECTOR
CC Y 0 GFH
1&0 0 3 6 I Jm 2 4-A 2.0 0 M