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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
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FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
e1A vile 01 101
WATER CLOSET LOCAL( ,
NEAREST
BATH TUB CROSS ST
SHOWER OWNER CZ
LAVATORY MAIL
ADDR
SINK CITY at
A G TEL
DISHWASHER CGNTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER 3 LICENSE NO CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INW SSIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM
ROUGH PLUMBING
GAS PIPING
Q
GAS VENT Y
d
HOT WATER HEATER 0
PLUMBING FIXTURES
GAS TEST - L/
Plan check fee UTILITYCO NOTIFIED _
PLUMBING PERMIT ISSUING FEE E
TOTAL FEE FINAL
Plan check applicant PLAN CHECK VALIDATION
Name ciem-wEr --a'► ,.o-ct?jr-zr*i - 414h9
Address plp"hi^tf (� %34 r� o -I�
Gty Tel No
I HERESY ACKNOWLEDGE THAT I HAVE READ IS THAPPLICATION AND STATE
THAT THE MOVE a CORRECT AND AGREE TO CCHMKY WITH ALL COUNTY ORDINANCES
A"STATE LAWS REGULATING PLUMBING PERMIT VALIDATION 4 4 4.8 A
I HEREBY CERTRY THAT I AM PROPERL ISTE OR LICENSED AS AN • • • • • G
REOOIRED BY LOS ANGELES COU" AND S f AOR THAT 1 AY THE M J
LEGAL OWNER Of AMD INTEND T RES. E SCRIBED RESIDENTIAL
PROPERTY 2 • • 1 9,00
SIGNATURE • • • 19006
OFPERMITTEE
CI � P ED BY 0 5 1 8-7 9
INDUSTRIAL
WASTE APPROVAL
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APPLICATION FOR PLUMBING
COUNTY OF LOS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 0U6DN5G w
JOHN A LAMBIE COUNTY ENGINEER .DDI RR1631
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COLEMAN W JENKINS SUPT OF BUILDING LOCALITY
FOR APPLICANT TO F= IN NEAECROSs sx d
NUMBER FIXTURE OR ITEM EACH IEE p
.PO
WATER CLOSET SI35 OWI
BATH TDs 125
.DIY
T
SHOWER 125 CTTT TEL No ,Z
LAVATORY 135 CONTRACTOR jw
Rnm 135 ADDRESS
DISHWASHER 1 ss c17Y TEL NO
LAUNDRY TDB 125 STATE LIC
LICENSE NO CLASS
CLOTHES WASHER 135 DISTRICT NO GROUP it PROCESSED BY
WATER HEATER 150 //� Z
-GAS SYSTEM OUTLLTB 1 SR WDUSTRIAL
WASTE APPROVAL d
OUTLETS OVER 5 PER SYSTEM 50
INSPECTION RECORD
s
0
H
U
W
G_
� Z
APPROVALS DATE NSPECTOR E EIGHATURE
PERMIT S 2 OG UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE
GAS PIPING
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS ."LIGATION GAS VENT
ANO
STATE THAT THE ABOVE I\ COIIR[CT AND AOR[[ TO COMPLY
WITH
ALL COUNTY ORDINANCE[ AND STATE LAWS REGULATING HOT WATER HEATER
PLUM•INO
I HeREEY CERTIFY THAT I AM PROPERLY RCGIETEIQD AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND RAT[ OF GAS TEST
GLIFORNIA OR THAT 1 AM THE IEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED AZAIOt NTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE _
FINAL �y^
• VMMATK)Fir, JACK R. ALLEN
CK M G (�wBN SUPERVISING MECHANICAL ENG'R
LHL,o4 8 9 7b sEP2 2 5 D 3.50— d
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APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM 6 FEE ADDRESS
WATER CLOSET LOCALITY
BATH TUB NEAREST r
CROSS ST.
SHOWER OWNER S,
LAVATORYMAIL
ADDRESS `,
SINK Gtt TEL NO �-1'4%
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO
LAWN SPRINKLER SYSTEM
STATE LIC
WATER HEATER LICENSE NO CLASS
GAS SYSTEMOUTLETS DISTRICT NO RO
GUP ZONEety�OED BY
pUT` pyE
5 PER SYSTEMR INDUSTRIAL
WASTE APPROVAL C
INSPECTION RECORD CD
s N%1L G+'N6L J70n/S
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Plan check fee
PLUMBING PERMIT ISSUING FEE E
TOTAL FEE O
Plan check OPPIKGnt
Name APPROVALS DATE INSPECTOR S SIGNATURE
t..A:�'�'� UNDER SLAB WORK
Addreu ROUGH PLUMBING
Clty� Tel No , GAS PIPING
I HEREBY A NOWLEDGE THAT I HA AM THIS AMLKATION ANDS ATE GAS VENT
MATTHEABOVE ISCOARECTANDAGREE TO OYPLYWTMALLCWNWOROINANCES
MID STATE LAWS REGUUTING PLUYBUIG HOT WATER HEATER
I""BY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR LKENSED AS PLUMBING FIXTURES
REWIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA 011 THAT I AY THE GAS TEST
LEGAL OWNER OF AND INTEND TO RESIDE IN ME ABOVE DESCRIBED RESIDENTIAL.
PROPERTY UTILITY CO NOTIFIED
SIGNATURE
CIP Pl RMITTE FINAL
PLAN CHECK VALIDATION CK 140 CASH PERMIT VALIDATION CK D CASH
6 2 O-MAY 24 5 0 1 0.0 0 Amt
COUNTY OF LOS ANGELES TEMPLE CITY p 0506 PLUMBING PERMIT
DEPARTMENT OF PUBLIC FORKS 9701 LAS TUNAS PL 0508 0702280023
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ON FILE 1 6317 TEMPLE CITY BL 19 I
PEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917801431
(ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
5382-022-060 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID S2 LOCALITY TEMPLE CITY Cl
107 BATHTUBS/SHOWERS 1 00 FIX 16 20 I
TENANT 25 LAVATORIES/SINKS 1 00 FIX 16 20 ISSUED ON PROCESSED BY PIAN BY EXPIRES ON 1
45 WATER CLOSET/URINAL. 1 00 FIX 16 20 02/28/07 JK 08/27/07 1
47 WATER HEATER(S) 1 00 WIN 16 20
OWNER TEL NO 151 LOW PRS GAS 5 OUTLET 1 00 SYS 16 20 FI�7AL FI BY CODE
FAKHRO GRASSAN Y,RANA G KHAL.ED (626) 309-0680- 1 TOTAL FEES 108 75 !) 1
6317 TEMPLE CITY SL �'1
ITEMP 917801431 DESCRIPTION OF WORK
PLUMBING FOR NEW BATHROOM
(APPLICANT TEL NO
KHANWIAN (818) 242-1431-
8 11
42-1431-811 PELANCONI AVE SPECIAL. CONDITIONS
Gr ENDALE CA 91202
I
I CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
IFAKHRO GHASSAN (626) 309-0680-
16317 TEMPLE CITY BLVD LIC NO UNDER SLAB WORK
ITEMPLE CITY, CA 91780 NONE I
1
WATER SERVICE I
PLASTIC YIN METAL YIN 1
1ARCHITECT OR ENGINEER TEL NO I I
ROUGH PLUMBING
LIC NO I
GAS PIPING
CIAs VENT
HOT WATER HEATER
I
PLUMBING FI%TURES I
1
LAWN SPRINKLERS 1
1 GAS TEST
UTILITY COMPANY NOTI FIEDI
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IGRAY WATER SYSTEM
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REPORT ID OPR263 ROUTE 740 BSO508 I 1 1 I