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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN;PRINT OR TYPE, BUILDING
ADDRESS
NUMBER FIXTURE OR ITEM ® FEE -'
LOCALITY
WATER CLOSET
NEAREST
BATH TUB LL CROSSST.
SHOWER OWNER .,
LAVATORY MAIL
ADDRESS
SINK CITY TEL NO.
„�. DISHWASHER I
�% "�� CONTRACTOR
�. CLOTHES WASHER ADDRESS'
SWIMMING POOL RECEPTOR
CITY' ' TEL NO.-
LAWN SPRINKLER SYSTEM
rROUGH
( ,�.. LIC.
.. WATER HEATER s O. CLASS
GAS SYSTEM OUTLETS ;� PROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER AB WORK 6
5 PER SYSTEM WMBING O
G VWER HEATER r
PLUMBING FIXTURES
Q
GAS TEST
O
LAPPROVAL
check fee UTILITY CO.NOTIFIED a
f
PLUMBING PERMIT ISSUING FEE$ W
TOTAL FEE J ) FINAL ~
heck applicont PLAN CHECK VALIDATION
ss
Tel No.
HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AND STATE P '!�t �.
THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES Y' A
TATE LAWS REGULATING PLUMBING. PERMIT VALIDATION �. •.. • • r
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR LICENSED AS
IRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE ; • f Ff'(.r
L OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL /. L(
ERTY.
ATURE
PERMITTEE ' ! _'l r
2`
DISTRICT NO. PROCESSED BY
RIAL
APPROVAL
COUNTY OF UJS ANGELES TEMPLE CITY p 0508 PLUMBING PERMIT
DEPARTMENT OF P&SLIC WORKS 9701 IAS TUNAS PL 0508 1105020006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
ILEGAL ID 1 FEES PAID BUILDING ADDRESS
I ON FILE
511B SERENO DR
1
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803055
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
15388-011-013 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID H5 LOCALITY TEMPLE CITY CI
127 PRESS REG DEVICE(S) 1 00 DEV 16 30 1
ITENANT 164 WATER PIPNG <� 1 1/2 1 00 LIN 16 30 ISSUED ON PROCESSED BY PIAN BY
1 TOTAL FEES 60 40 105/02/11 SR
OWNER TEL NO IFINAL DATE FI�p�,�By CODE
1518GoLDFARB
BRAD DANIEL HARRIET L (626) 357-1124- 1 /M
1518 BRADBURY RD �'7 1A`/
1MROV 910163705 I DESCRIPTION OF WORK
IWATER MAIN AND ONE PRESSURE REGULATOR
I �
1APPLICANT TEL NO
ISAIOME TEODOCIO VARGAS (213) 392-1640-
14172 S NORMANDIE AV SPECIAL CONDITIONS
LOS ANGELES 90037
I I
� I
CONTRACTOR
AVAROAS PLUMBING TEL NO APPROVALS DATE INSPECTOR SIGNATURE
(323) 292-7683-
14172 NORMANDIE AVENUE LIC NO IUNDFR SLAB WORK
LOS ANGELES, CA 90037 772347 C36
I (WATER SE ICE
PLASTIC Y N METAL Y/N 1 1
ARCHITECT OR ENGINEER TEL NO
1 LIC NO 1 IROUGH PLUMBING
(GAS PIPING
GAS VENT
HOT NATER HEATER
I �
PLUMBING FIXTURES
I I �
LANK. SPRINKLERS I 1
GAS TEST
1UTILITY COMPANY NOTIFIED(
I I _ 1CWV 1 1 1
IGRAY WATER SYSTEM
1 I I I I I
I 1 I I I I
I I I I
(REPORT ID DPR263 ROUTE TO BSO508