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78A667-CE0817 4-67
APPLICATION FOR PL MBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS �DC i
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST ,
CROSS ST. rs
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
DAW
WATER CLOSET $1.25NAM �J
BATH TUB 1.25 ADDRESS LIsC
SHOWER 1.25 CITY TEL. NO. D
LAVATORY 1.25 CONTRACTO
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL.NO.
STATE LI C'
LAUNDRY TUB 1.25 LICENSE NO. CLASS
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCES E BY
WATER HEATER 1.S0 jj 1157 1
GAS SYSTEM OUTLETS "So -' INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER S PER SYSTEM 30 S TION RECOO C
57 0Z
CD
O
R N
• t
eL �
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
'7 ROUGH PLUMBING
TOTAL FEE ��v GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 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 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF.AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
OCK.
ALIDATION JACK R. ALLEN
M.0. CASH SUPERVISING MECHANICAL ENG'R.
,BA6B7L- APPLICATION FOR PLUMBING .PERMIT.
VISION OF BUILDMG AND SAFETY
Department of County Engineer
County Of LOS AngelesBUI
• LDING
JOHN A.L.AMBIE, COUNTY ENGINEER ADDRESS•
CASSATT D,GRIFFIN,SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN I NEAREST
CROSS ST.
OWNER L•r +., DISTRICT NO. GROUP READY FOR INSPECTION
AIL � .I : I . ZONE
ADDRESS - i/
INDUSTRIAL
CITY Cs TEL.NO.. WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS
CITY TEL.NO.' h c
LICENSE NO
NUMBER TYPE OF FIXTURE OW ITEM FEE
WATER CLOSET(TOILET) @ $1.00 �. If ��• _ C.�,,;rte '� A..
BATH TUB Q.- $1•,00'
SHOWER @ $1.00
LAVATORY.(WASH BASIN') @ -$1.00
KITCHEN SINK @ $1.00
DISHWASHER @ $•1.00
LAUNDRY TUB:ORTRAY. @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER $1.00
GASSYSTEM @ $1.00 s
r APPROVALS
DATE INSPECTORS SIGNATURE
UNDER;SLAB WORK
PERMIT $ I 1. 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE GAS.VENT
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE 18 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 PROPERTY.
SIGNATURE.
OF PERMITTEE - FINAL
OHN A.L.AMBIE,COUNTY ENGINEER VALIDATION - ROBERT A.WOOD,.CHIEF PLBG. INSPECTOR
CH.
M:o. sx
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS-
PL 0508 1005170013
BUILDING AND SAFETY /'LAND DEVELOPMENT TEMPLE CITY CA 91780
{ PHONE: (626)' 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS: I
TR: 11218 IT: 1 BL: D I 9056 RANCHO REAL RD I
IFEE DESCRIPTION: QUANTITY: AMOUNT:1 TEMP CA 917803030 I
15388-005-001101SOR
NUMBER: 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 5966 GRID: HCROSS STREET: 4NA LOCALITY: TEMPLE CITY, •CI
I 107 BATHTUBS/SHOWERS • 3.00 FIX 48.60 1 I
ITENANT: 11 CLOTHESWASHER(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY:
113 DISHWASHERS) 1.00 FIX 16.20 05/17/10 SR 1
125 LAVATORIES/SINKS 3.00 FIX 48.60 I
(OWNER: TEL. NO: 145 WATER CLOSET/URINAL 2.00 FIX 32.40 FINAL DATE FINAL BY: CODE: I
IKELTY, ELEAINE (626) 230-4540- 147 WATER HEATER(S) 1.00.WTH 16.20 I
19056 RANCHO REAL RD 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 I
(TEMP 917803030 164 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 IDESCRIPTION OF WORK 1
1 TOTAL FEES 238.35 IPLUMBING FOR INTERIOR REMODEL 1
{ I I I
1APPLICANT: TEL. NO: i
IWESTGATE, ROBERT (626) 230-4540- 1, 1
19056 RANCHO REAL RD. I ISPECIAL CONDITIONS:
ITEMPLE CITY CA 91780 1 1
I I
(CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE I
IWESTGATE, ROBERT (626) 230-4540- I
19056 RANCHO REAL ROAD LIC. NO 1UNDER'SLAB WORK 1 I I
ITEMPLE CITY, CA 91780 NONE I I
I IWATER:SERVICE
I I 1PLASTIC YIN T Y N 1 /�
ARCHITECT OR ENGINEER: TEL. NO: 1 I I
- I IROUGH1PLUMBING 1
iLIC. NO: I 1 1(GAS PgPING
1 { IGAS VENT 1 I
1 I 1HOT WATER HEATER I I 1
I { I I I I
I 1PLUMBING FIXTURES I I 1
I i I
1-1 I
1 (LAWN SPRINKLERS I I
IGAS TEST
i (UTILITY COMPANY NOTIFIED(! 1� I i
I' GRAY WATER SYSTEM I I 1
1 i I I I
•i - i I I
IREPORT ID: DPR263 ROUTE TO: BS0508 I I 1