HomeMy Public PortalAbout4962 SERENO DR_Plumbing__ TGAUTC (CK-61 79) -!/TE VES Li(i(/L
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TY PEI BUILDING �nv 2
NUMBER FIXTURE OR ITEM ® FEE AO DRE SS F.
WATER CLOSET LOCALITY
BATH TUB NEAgESi
CROSS ST C ,1
SHOWER OWNER PO T J
LAVATORY MAIL G A Q
ADDRESS
SINK CITY ® TEL NO -0Fj
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO
LAWN SPRINKLER SYSTEM
STATE LIC
WATER HEATER LICENSE NO CLASS
DISTRICT NO IGROUP ZONE OCE D BY
GAS SYSTEM OUTLETS ✓ O� j_— ` CT
OUTLETS OVER D A?-
5
�
B PER SYSTEM YJ ` t
WASTETAPPR OVAL yVj
d
INSPECTION RECORD �
Plan check fee
PLUMBING PERMIT ISSUING FEE $ JL/
TOTAL FEE
Plan check applicant
NameZhamr APP LS DATE (HSI R ! l1 GNATUBE
•' UNDER ORK &]� .. _
Address N
ROUGH PLUMBING
City Ly ^ Tel N0�8G,.06 /J GAS PIPING
i HEREBY ACKNOWLEDGE TH 1 HAV! READ THIS APPLICATION GAS VENT
AND !TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND !TATE LAWS REGULATING HOT WATER HEATER
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSlD A! RlOU I RED BY LO! ANGELES COUNTY AND STAT! OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROP Im UTILITY CO NOTIFIED
SIGNATU RE
OF PERMITTEE FINAL �ZS
PLAN CHECK VALIDATION CK M 0 CASH P RMIT VALIDATION cN M 0 CASH
O_ V .1 •5A 22.5Oat