HomeMy Public PortalAbout5164 SERENO DR_Plumbing__ TeAa 11 tcEarn- B/TB
r "
APPLICATION R PL BING PERMIT
COUNTY OF LOS ANGELES r �'
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO BUILI
iADDRESS /6F S5�011/C
HARVEY T BRANCIT. COUNTY ENGINEER LOCALITY �L5NO :rj,�;r/
7yp
FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEAREST
NUMBER FIXTURE OR ITEM ® FEE CROSS ST 10~ Ci
1 75 y OWNER Q� d
WATER CLOSET MAIL
BATH TUB 1 75 ADDRESS 6i
SHOWER 1 75 CITY � D.e� TELI-
LAVATORY 1 75 CONTRACTORSINK 1 75 ADDRESS
DISHWASHER 1 75 ' CITY TEL ANO
CLOTHES WASHER 1 75 STATE LIC
LICENSE NO CLASS
SWIMMING POOL RECEPTOR 1 75
LAWN SPRINKLER SYSTEM 1 75
DIS ICT NO GROUP ONE CESSED BY
US�IA Lv
WATER HEATER 1 7S WygSTE TARA CIVCAJL
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD
OUTLETS OVER
5 PER SYSTEM 30 i7e eovao &* G.♦/EYT 49S5:.4ibb O
W
d
N
2
Plan check fee See RRYGrGG
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR R fIrNATURE
Plan check applicant UNDER SLAB WORK G, I
Narne ROUGH PLUMBING
Address GAS PIPING
City Tel NO GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STAT! THAT THEABOVE 13 CORRECT AND AGREE TO COMPLY PLUMBING Fl!TURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
EN
LICSED AS REOUIRID BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM iHC WNlR OF INTEND TO
RESIDE IN THE ABOVE DESCRI R TIAL PERTY FINAL
SIGNATURE
OF PERMITTE '
PERMIT VALIDATION CK M CASH
PLAN CHECK VALIDATION CK M O CASH
2 2 Jf`MAR 16 5 0 5.7 5 ,&%t