HomeMy Public PortalAbout4852 TEMPLE CITY BLVD_Plumbing__ 75AB67 (CE-817)-4/72
APPLICATION FDR' PL MBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO BUILDING `
ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER LOCALI A:
FOR APPLICANT TO BILL IN (PRINT OR TYPE) CROSS ST O i -00f 11
NUMBER FIXTURE OR ITEM ® FEE
WATER CLOSET 1 75 OWNEfl
MAIL
BATH TUB 1 75 ADDRESS
SHOWER 1 75 CITY TEL NO
LAVATORY 1 75 CONTRACT
SINK 1 75 ADDRESS
DISHWASHER 1 75 CI /9
CLOTHES WASHER 1 75 LICENSE QEF( G LIC (,r 3,H6SWIMMING POOL RECEPTOR 1 75
DISTRICT NO I GRORR�IP Z NE OCE ED V
LAWN SPRINKLER SYSTEM 1 75 g RIq
WATER HEATER 1 75 / WASDUTETAPPgOVAL
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD -
OUTLETS OVER 30 I -
5 PER SYSTEM Q
W
101-
Plan
Plan Check fee Snn RIII
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR + SIGNATURE
Plan Check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel No GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THCABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUM SING GAS TEST
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE
DESCRIBED RE9107T1 BOP[R TY FINAL
SIONATU RE
OF ISFIRMITTSkOW
PERMIT IDATIONGK 0 CASH
PLAN CHECK VALIDATION CK M 0 CASH
I ACo 1 3 1 073 4 5 D 6.5 0- v