HomeMy Public PortalAbout5826 TEMPLE CITY BLVD_Plumbing__ 76A667-CES17 12159 TEMPLE, Cg*,V
.APPLICATION FOR PLUMBING PERMIT �
: COUNTY OF LOS ANGELES
DEPARTMENT 1O�mF COUNTY ENGINEER
B�JiLDINGLAtuis�,SA�FETY ]�IVISION sInLDTNG •
OHN A. 1 CUNTY NGINEER ADDRESS
WILLIAM A.JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM.
OWNER AAl
WATER CLOSET
L OF
ADDRESSYit
' �SATH TUB '
CITY TEL.NO. '
SHOWER
CONTRACTOR
LAVATORY
Sm ADDRESS
DISHWASHER CITY TEL NO . ��
CONTRA R'S a STATE
LAUNDRY TUR REGIS ON N0. (r COUNTY .p
CLOTHES WASHER DISTRICT NO. GRROUP _ON PRO SSED HY
. _
WATER HEATER '# 'J' T �?
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD. H
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OR 0rDam $ I d-O
APPROVALS DATE IRSPECTOR'S SIGNATURE'
PERMIT $ 2100- UNDER SLAB.WORK
TOTAL FEE O ROUGH PLUMBING
GAS PIPING
1 .HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED .AND/OR PLUMBING.FIXTURES
LICENSED AS REQUIRED BYS ANO ES COUNTY AND STATE OF GAS TEST ..
CALIFORNIA OR THAT 1 A THE L OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P PER UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTE / s
OINAL
�p VALlDATI ROBERT A.WOOD.
pSUPERVISING.MECHANICAL ENG'R
17 � p
MOB 8, 4 4 Z t&V 3.00