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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGI=
DITASTMNT OF COUNTY ENGINEEH
BUILDING AND�SAFETY DIMON ADDRESS G S qA:
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a aeaeaa a mamoLOCAL= TFOE APPLICANT TO FELL IN NUMBER FIXTURE OR ITEM
WATER CLO>� OW1O'9BATH TUB AADE= JCI�HCRHOWII CRT C TEN. LTO.
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LRU DRY TUE REEGISTRATION N O /Lo/�_3 CLOTHE$WAS DISTRI OUP T
WATER EMATER O L A - J
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APPROVALS
W W PER 1TENQ / 60
Q O DATE INS ECTOR S SI NATURE
OR PD[TOHE UNDER SLAB WORK
PERMIT f �I 00 ROUGH PLUMBING
TOTALFEE -�" 6O GASPIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAR VENT
AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES
1
HE
CERTIFY THAT I AM PROPERLY REGISTERED AND/-
LICE" GAS TEST
SED AS REQUIRED By LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITYCO NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY
SIGNATURE FINAL
OF PERMITTE }
92L IN ROBERTAWOOD ,
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COUNTY OF LOS ANGELES TEMPLE CITY p 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS PL 0508 1401140021
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID I FEES PAID I BUILDING ADDRESS
ON FILE ( - 1 5152 SERENO DR I
FEE DESCRIPTIO!' QUANTITY DOM AMOUNT TEMP CA 917803041 1
(ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET I
15388-011-007101 PERMIT ISSUANCE FEE •27 Ba I THOMAS PAGE 596 GRID H5 LOCALITY TEMPLE CITY CAI
05 BACKFLOW DEVICES) 1 00 DEV 16 20 1
TENANT 25 IAVAIORIES/SINKS- 2 00 FIX 32 40 (ISSUED ON PROCESSED BY PLAN BY
45 WATER CLOSET/URIjlAL 1 00 FIX 16 20 101/14/14 SR
I I TOTAL FEES 92 60 1
(OWNER TEL NO I I F14AL DATE FIW AY RODE
1CHAO, HENRY (626) 614-8665-
15152 SERENO DR I �/' \'t
1TEMIP 917803041 1 IDtSCRIPTION OF WORK
I I IREPLACE SINK FOR KITCHEN AND BATHROOM CHANGE OUT 1
I I IBATHTUB AND TOILET I
(APPLICANT TEL NO I I 1
CORREA MANUEL - I II
I I ISPECIAL CONDITIONS I
I I I
CONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE I
IS X D CONSTRUCTION (626) 786-2347- 1
12509 EUCLID CRSS E LIC NO I (UNDER SLAB WORK I
I I
(UPLAND CA 91784 627142
I I WATER SERVICE I
I I 14LASTIC YIN METAL YIN
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1 LIC NO IROUGH PLUMBING I
1 IGILS PIPING
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I IHOT WATER HEATER I
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I IPLUMBING FIXTURES
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UTILITY COMPANY NOTIFIED
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