HomeMy Public PortalAbout5100-5102-02 1/2 SERENO DR_Plumbing__ 7MbNA r c
CE 817(RFV 11/78) - 1S
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUILDING ��`
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NUMBER FIXTURE OR ITEM 8 EE ADDRESS r _
Al
WATERCLOSET LOCALITY
NEAREST
BATH TUB CROSS ST
SHOWER OWNER J'0 ffAj
LAVATORY' ADDRESS
ADDRESS
J SINK CITY491-3
TEL NO
DISHWASHER CONTRACTO ----fiic...///�
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL N
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LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER LICENSE NO CLASS
GASSYSTEM OUTLETS APPROVALS DATE IN PECTOH S SIGNATURE
OUTLETSppVER UNDER SLAB WORK JL-M A
5 PERSYS'tEM ROUGH PLUMBING
GAS PIPING O
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GAS VENT d
HOT WATER HEATER
PLUMBING FIXTURES
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Plan check fee UTILITY CO NOTIFIED ?
PLUMBING PERMIT ISSUING FEE E
TOTAL FEE FINAL
Plan check applicant A PLAN CHECK VALIDATION
Name �—
Address
City Tel No
1 HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AND STATE 9 29 1 A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION #v • • • 5
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AHD/OR LICENSED AS p
REQUIRED BY LOS 6ELE5 COUNTY AND STATE CALIFORNN OR THAT THE L • • 90 0
LEGAL O ER OF INTEND TO OE IN THE E ESCRIBED RES _
PROPERTY
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GE 817( 11/7B) 11
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT i0 FILL IN(PRINT OR TYPE( BUILDING SIOa Q �O
ADDRESS
NUMBER FIXTURE ORITEM ® FEE
WATER CLOSET LOCALITY
NEAREST
2 BATHTUB CROSSST
-71 SHOWER OWNERMAIL
►r77 ��jj
•?/ LAVATORY ADDRESS rJ O S L
SINK il CITY S T NO bz_�
DISHWASHER CONTRA
Z CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO
LAWN SPRINKLER SYSTEM
STATE LIC
WATER HEATER LICENSE NO CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE
pU{LETSOVER UNDER SLAB WORK -/1-,F%
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING O
u
UFINALlfx
EATER
TURES
S y�
Plan check fee OTIFIED Z
PLUMBING PERMIT ISSUING FEE E /
TOTAL FEE /Plan check applicant ECK VALIDATION
Name
Address 9 2 9 2 A
City Tel NO 7.--/ # • • • • 5
HE:ISCMRECT
NOWLEDGE THAT HAVE READ THIS APPLICATION AND STATE
THAT THE MRECT AND AGREETa COMPLY WRH ALL COUNTY ORDINANCES 2 . . 6100
AND STATEGUUTING PLUNBiNG PERMIT VALIDATIONF� J
HETIFY THAT AY PROPERLY GISTEREO ANO/OR LIC SED AS • • • 6OlIH'REpU1RE0NGELE OUNTY ANO T T CALIFORNIA OR THAT N TME
LEGAL OWND EN 0 RESIDE A DESCRIBED RESI TIAL • OZ 1O-8O
PROPERTYU I VSIGNATUNO PROCESSED BY
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INDUSTRIAL
WASTE APPROVAL