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APPLICATIOI\i FOR PLCDMBI1tiiG PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILD •
TOHN A.LAMBIE, Count sneer ADDRESS
CASSATT D. GR1FM.Supt of .wilding LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM ..
OWNER
WATER CLOSED MAIL OAS Ar- #a edel!ng
BATHTUB ADDRESS
SHOWER
CITY TEL NO.
' -
LAVATORY CONTRACTOR
SIN1: ADD `
DISEXAMIER CITY TEL NO. ^a �r
CONTRXCTOWS STATE'
LAUNDRY TUB REGISTRATION NO. COUNTY
' CLOTHES WASEM DISTRICTNO. OUP ZO P O
HECESSEDBY
WATER ATER
GAS SYS= I NDUSTRUM
WASTE APPROVAL
INSPECTION RECORD
G .$1.00 PER ITEM
OR FDLTUSE APPROVALS DATE INSPECTOR'S SIGNATURE;.
PERMIT $ 2 00 `: UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING -
AHEREBY ACKNOWLEDGE THAT 1 HAVE.READ THIS APPLICATION
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT'
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING i PLUMBING. HOT WATER HEATER `
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/011 PLUMBING FIXTURES -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE. OF GAS TEST
CALIFORNIA.OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE -
OF PERMI
L
�r /^►VATION ROBERT A.WOOD,
/
M.0, am SUPERVISING MECHANICAL ENG'R
���/// LA 69 4 4 8 k- APR 5 A 3.0 0 � _.
-r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0308290003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL D: FEES PAID BUILDING
TR: 13935 LT: 19 5651 PERSIMMON AV
FEE DESCRIPTION: QUANTITY: LION: AMOUNT: TEMP CA 917802809
ASSESSOR INFORMATION EMERY- NEAREST CROSS STREET: LIVE OAK
8573-001-017 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY
07 BATHTUBS/SHOWERS 1.00 FIX 16.20
TENANT: 21 HOSE BIBB(S) 2.00 FIX 32.40 ISSUED 0PROCESSED : P EXPIRES ON:
25 LAVATORIES/SINKS 1.00 FIX 16.20 08/29/03 JK 02/25/04
45 WATER CLOSET/URINAL 1.00 FIX 16.20
OWN: TEL. NO: 47 WATER HEATERS) 1.00 WTH 16.20 FINAL DATEINAL BY' CODE:
PETERS;RANDY L (626) 445-1827- 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 4--a-2-
5651 PERSIMMON AVE TOTAL FEES 141.15
TEMPLE CITY 91780 DESCRIPTION OF WORK
PLUMBING FOR 3/4 BATH IN GARAGE
APPLICANT: TEL. NO:
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR S G ATURE
SAME AS OWNER -
LIC. NO UNDER SLAB WORK
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR G .
LIC. NO: 0 G 8 G GAS PIPING ORD:
�
S VENT
HOT WATER H ER
PLUMBING FIXTURES
LAWN
SPRINKLER-
S TEST
UTILITYOM A NOTIFIED
CWV
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508