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HomeMy Public PortalAbout6203 A & B TEMPLE CITY BLVD_Plumbing__ 76A667A CE 817(REV.11/78) CCSS APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESSq��/!1 NUMBER FIXTURE OR ITEM ® FEE jo LOCALITY WATER CLOSET NEAREST BATH TUB CROSS ST.. SHOWER OWNER LAVATORY MAIL ADDRESS SINK CITY TEL.NO. DISHWASHER CONTRACTO CLOTHES WASHER ADDRESS© gp SWIMMING POOL RECEPTOR CITY TEL.NO LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEMI ROUGH PLUMBING GAS PIPING V GAS VENT eh HOT WATER HEATER PLUMBING FIXTURES �p 6 GAS TEST N Plan check fee UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ TOTAL FEEFINAL Plan check applicant PLAN CHECK VALIDATION Name Address City Tel.No. o I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE G O r O THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBINGv PERMIT VALIDATION #-- - 5 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 0 0 1 0.00 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. O O O 1 O O O V SIGNATURE , 0 /6 1 6-8 0 OF PERM ITTEEA;��VA"Iega DISTRICT NN�7O.(� P CESSED BY INDUSTRIAL WASTE APPROVAL 76A667,CE61790-57 APPLICATION FOR,PLUMBING PERMIT 1 COUNTY OF LOS.ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS203.-6203- JOHN A. LAMBIE, COUNTY ENGINEER j Temple City B CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS SHOWER CITY TEL.NO: LAVATORY CONTRACTOR Fontana r-, SINK ADDRESS 13329 -R- Vntnr DISHWASHER CITY TEL.NO. LAUNDRY TUB CONTRACTOR'S STATE LJ REGISTRATION NO. C 6- 6 6 COUNTY E CLOTHES WASHER D.ISTR.ICT NO. GROUP ZONE I READY FOR INSPECTION WATER HEATERl 11P 7-1 GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD //lHF 194r17-1_4 F X s : �/ -72 -- APPROVALS @ $1.00 PER ITEM JJ DATE INSPECTOR'S SIGNATURE OR FIXTURE $ //7 UNDER SLAB WORK " �,'� II-011 ROUGH PLUMBING - PERMIT S 1 00 GAS PIPING TOTAL FEE GAS VENT I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER ►Z� (�j AND STATE THAT THE ABOVE 15 CORRECT AND .AGREE 'TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES =t PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST i LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL. OWNER OF THE ABOVE UTILITY CO. NOTIFIED _2,9 S DESCRIBED RESIDENTI P OP R SIGNATURE ! OF PERMITTEE FINAL kmiiii�ii __ ROBERT A.WOOD, e VALIDATION SUPERVISING MECHANICAL ENG'R. CK. M.O. CASH LACOO7s1R MAY 12 3 A 15.00 I