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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUILDING '- [C-y.�
NUMBER FIXTURE OR ITEM a FEE ADDRESS `(>
WATER CLOSET LOCALITY T(fm Ie
NEAREST
BATHTUB CROSSST ea4D W
SHOWER OWNER
LAVATORY ADD(RESS o j.Q/Q /fiNC
SINK CITY' nj C� CAQCf/ TEL NO,�..G 7V
DISHWASHER CONTRACTOR sa l"F
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY ' TEL NO
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER LICENSE NO CLASS
GASSYSTEM OUTLETS APPROVALS AT E SSIGNATURE
OUERETS OVER UNDER SLAB WORK
PP $T R0UGH PLUMBING
GAS PIPING O
GAS VENT V
HOT WATER HEATER S
PLUMBING FIXTURES G
b GAS TBT
Plan check fee UTILITY CO NOTIFIED _
PLUMBING PERMIT ISSUING FEE$ l/
TOTAL FEE FINAL
Plan check applicant PLAN CHECK VALIDATION
Name
Address
City Tel No
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE ISCORPECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES 4 7 7.3 A
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR LICENSED AS # e r� e C
J
REWIREDCOUNTY AND BY LOS ANGELES COUAND STATE OF CALIFORNIA OR THAT I AM THE
LEGALOWNER OF AND INTEND TO BESIDE IN THE ABOVE DESCRIBED REBID$MTIAL
TY' 2 . • 1 q 0 0
SIGNATURE .'/ e e 019,005
OF PERMITTEE
DISTRICT NO PROCESSED 8Y r 0606-79
.SRI DUSTRIAL z.
WASTE APPROVAL r
onsil EE APPLICATION FOR PLUMBING PERMIT
DMSION OF BUILDING AND SAFETY
DepoTtueat of Counts Engineer -y eS 0
Counts of Los Angeles
WM J FOX COUNTY ENGINEER BUILDING / N
ADDRESS
DABBATTD GRIFFIN euP ioP BUILDINe
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
c ROSs T
OWNER S DISTRICT NO !Tp 0y RUDY FOR INSPIRIOM
wooREsa �D M V N Od bt/
INDUSTRIAL
CITY TEL NO Fa WASTE APPF
PLUMBER AA O. //N INSPECTION RECORD
_ADDRESS I 3 WI I� /B w e!h f
_CITY r.0 t-f�a- y TEL NO A0 ,C 7/O7'*
LICENSE NO O z4 I
NUMBER TYPE OF FIXTURE OR ITEM PEE
WATER CLOSET (TOILET) $ O
BATH TUB O
SHOWER
LAVATORY (WASH BASIN) D
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO o Bo v APPROVALS -
OAS SYSTEM OUTLETS loo Q DATE INSPECTOR SSIGNATURE
WATER HEATER 100 Q UNDER SLAB WORK
ROUGH PLUMBING
PERMIT S i 00 GwS PIPING 1 (.
TOTAL FEE 60 GAS VENT
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES /
PLUMBING
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST S�
LICENSED AS REQUIRED BY LOS ANGELES C UNTY AND STATE OF
CALIFORNIA OR THAT 1 Aid THE JFEGAL NER OF THE ABOVE UTILITY CO NOTIFIED 14
DESCRIBED RESIDENTIAL PER
SIGNATURE
OF PERMITTEE FINAL V1
WILLIAM J FOX COUNTY ENGINEER VALIDATION R A WOOD CHIEF PLBG INSPKCTOR
� osrn oEc 6 3 81.60 0
COUNTY OF LOS ANGELES T84PLE CITY C 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0203270004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT:
LEGAL ID: FErs PAID BUILDING ADDRESS
ON FILE 5450 SURA MAR LM
FEE DESCRIPTION QUANTIFY. UOM. AMOUNT TEMP CA 917803224
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET BROADWAY
8588-022-D25 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY TEMPLE CITY
51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20
TOTAL FEES 43.95 ISSUED ON PROCESSED BY PLAN BY: EXPIRES ON
03/27/02 JK D9/23/02
OWNER. TEL. NO. DATEFINAL BY CODE:
MACRO CAL OM ST
J (818) 287-0367-
9207 WEDGEW000 ST �7 , L
TEMP 917802437 6E9aFrprrawz
INSTALL CENTRAL HVAC
APPLICANT TEL NO:
SAME AS OWNER -
SPECIAL CONDITIONS.
OS PNGELES Co
CONTRACTOR APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER — j-
LIC NO UNDER SLAB WORK
WATER SERVICE
ARCHITECT OR ENGINEER TEL NO PLASTIC Y/N METAL Y/N
ROUGH PLUMBnW—
LIC NOGAS PIPING
1111111
PUBLIC WORKHOT WATER HEATEF—
S
FrWNG FIXTURES
LAWN SPRINKLERS -
#
,jGAS TEST
.NPS
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REPORT ID' OPR263 ROUTE TO OS0508