HomeMy Public PortalAbout5452 PERSIMMON AVE_Plumbing__ 76AGG7r(CC 8178) -4/77
APPLICATION FOR PLUMBING PERMIT
BUILD1 SAFETY DIVISI2A�
FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUILDING r
NUMBER FIXTURE OR ITEM ® FEE ADDRESS��r/ �k 12;cf/ lf"dtj V-Z
WATER CLOSET LOCALITY
BATH TUB NEAREST
CROSS ST. - / .✓�',St
SHOWER OWNER /'j'L, �/C/ �f�/,y/1-J4,Al MAIL
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LAVATORY ADDRESS A 0l S/����3 i� 4/1 ll
SINK CITY U,5/ 4W6 TEL.NO.d&j
DISHWASHER CONTRACTOR IfA ;;Ea
CLOTHES WASHER ADDRESS P3 r3 CJ AJ. /fy �f6JC,
SWIMMING POOL RECEPTOR 37',4/ 'zn
fz. // i20 TEL.NO.6l
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LAWN SPRINKLER SYSTEM CITY;5rr��
STATE
WATER HEATER "�`�� LICENSENO. 36) Z4 Z CLASS
GAS SYSTEM OUTLETS DISTRICT NO. GROUPJE I P CESSED Y
OUTLETS OVER �! Q c
5 PER SYSTEM INDUSTRIAL
WASTE APPROVAL C
INSPECTION RECORD
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CL
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Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
Plan check applicant
Name /�j s /�� APPROVALS DATE INSPECTOR'S SIGNATURE
Al. �+ UNDER SLAB WORK
AddressSOV Al11AW4 111J.'jZ —/Y-;9 ROUGH PLUMBING
City ��� ���. Tel.No.&/// ,�ry GAS PIPING v `
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREETO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE GAS TEST
LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVEEEE,,�,DDDDEEEESCRIBED RESIDENTIAL
PROPERTY. ^ UTILITY CO.NOTIFIED
SIGNATURE /��G/v+�
OFPERMITTE �} FINAL
oll
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PLAN CHECK VALIDATIO ex--M o. 11 PERMIT VALIDA 4 K M.� U c -xa
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POLICY HOLDER."/
I'Os ICY NUMBEP.e
76A667A
CE 877 IF:C,V.6/•761• w - -
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::-IAPIPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY'
FOR APPLICANT.,TO.FILL IN!PRINT OR TY.,PO BUILDING
ADDRESS `
NUMBER FIXTURE OR ITEM. FEE
WATER CLOSET 'LOCPLITY C,
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER AljLL A.J
LAVATORY MAIL
ADDRESS
SINK CITY TEL NO..
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS-
SWIMMINGPOOL.RECEPTOR CITY TEL.NO.7 d'Or
LAWN SPRINKLER'SYSTEM A
WATER HEATER LICENSE NO. 4 J / CLASS
GAS SYSTEM OUTLETS (PJ APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5.PER SYSTEM ROUGH PLUMBING
GAS PIPING
GAS VENT
as
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
ub
Plan Check fee UTILITY CO.NOTIFIED Fg
PLUMBING PERMIT ISSUING FEE$ o
TOTAL FEE. FINAL .�.f
Plan check applicant PLAN CHECK VALIDATION
Name
Address
City Tel.No. 2 0 3 9.7 A
I HEREBY'ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION AND STATE # O O a a O 5
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 2 O O 1'G O O
I HEREBY CERTIFY THAT 1 AMI PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE O O O 1 a O O U
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. r
09,22-7$
SIGNATURE
OFPERMITTEE
DISTRICT NO. OCESSED BY
INDUSTRIAL
WASTE APPROVAL
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0203280043
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 13613 LT: 13 5452 PERSIMMON AV
[21
E DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802803
ASSESSOR 0 MA 0 N B R: NEAREST CROSS STREET: DAINES
8573-005-001 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY
BATHTUBS/SHOWERS 3.00 FIX 48.60
TENANT: HOSE BIBB(S) 1.00 FIX 16.20 IS ED : P OCESSE A P 0 :
LAVATORIES/SINKS 2.00 FIX 32.40 03/28/02 JK 09/24/02
45 WATER CLOSET/URINAL 2.00 FIX 32.40
OWNER: TEL. NO: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 FINAL TE FINAL BY: CODE:
DI PANE BRYAN L;LINDA A (626) 443-6144- TOTAL FEES 173.55 D `!
5452 PERSIMMON AV bO
TEMP 917807530 DE9 0 WO
PLUMBING FOR ADDITION
PPLI .
SAME AS OWNER -
SPECIAL CONDITIONS:
�,RIGELES CO
CONTRACTOR: TEL. NO: - ��S �nV'•� APPROVALS DATE INSPECTOR SIGNATURE
SAME LIC. NO SLAB K T8�
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: L. 0:
ROUGH PLUMBING
LIC. N0:
111 111 GAS VE TS PI N
FU B L�� Iv�vl rt OT A R HEAT R
P ING FIXTURES
0 +y All EAWN SPR NKLE S
GAS TEST
❑ 5UTILITY COMPANY OT F D
46��C at�ct C
Service Tha
AER SSE
REPORT ID: DPR263 ROUTE TO: BSO5O8