HomeMy Public PortalAbout9916 WOODRUFF AVE_Plumbing__ 76 A 667 CE 817 468 _l
•" APPLICATION FOR PLUMBING PERMI
DECROMEUN"TYS'OOF OONYGGS
NEER
BUILDING AND SAFETY DIVISION FIG
I ;
JOHN A. LAMBIE. COUNTY ENGINEER SS 16 Tl000dra,ff
COLEMAN W. JENKINS. SUPT. OF BUILDINGLrnTemple City
FOR APPLICANT TO FILL IN PR NT OR TYPE) NEARSST. Temple City Blvd..
NUMBER FIXTURE OR ITEM EACH FEE OWNER Lucia Joslin
WATER CLOSET 1.50 MAIL
BATH TUB 1.50 ADDRESS 9916 Whoniff
SHOWER 1.50 CITY Temple City TEL. NO. 2$6-611l
LAVATORY 1.50 1 CONTRACTOR pacific Installers
SINK 1.50 ADDRESS 10920 E. Grand Ave.
DISHWASHER 1.50 CITY Temple Cit y TEL. NO. 2v O 0
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. 211598 CLASS C-20
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. Gr ONE P ES BY
LAWN SPRINKLER SYSTEM 2.00 2 �+ 0
WATER HEATER 1.50 �� INDUSTRIAL. U
WASTE APPROVAL
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD z
OUTLETS OVERr O
5 PER SYSTEM '30 ,L1p�/�t iia "r<<7e- -`a 'o.* `�� u
Lu
N
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Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE 8 2 100
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GASVENT
City Tel. No. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED
LICENSED AS REQUIRE. BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESC ED RESjDENT1AL ROPERTY. FINAL
SIGNATURE r JACK R. ALLEN, SUPERVISI HANI CAL EN'G'R.
OF PERMITTEE
PERMIT VALIDATIONCK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
5� <<�f12 5D 3.50NIT
76147A
rCE 0171REV.6/78)
®3 - _.
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / /y��V r�j
�'
NUMBER FIXTURE OR ITEM ® FEE ADDRESS'
WATER CLOSET LOCALITY
NEAREST nn
BATH TUB CROSS Si.
SHOWER OWNER �� A&)7
LAVATORY MAIL
ADDRESS ,S A9YlG
SINK CITY TEL.NO.
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY ge `C,�j � TEL.Nt
LAWN SPRINKLER SYSTEM ATE LIC.
WATER HEATER LICENSE NO. ��' / C ASS �fp
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING
U �
UC ��Tf .�Q �• GAS PIPING
GAS VENT
F� Lc�Fay `� �
HOT WATER HEATER
�qq PLUMBING FIXTURES prey
8 A/ a�L } GAS TEST
Plan check fee UTILITY CO.NOTIFIED g
PLUMBING PERMIT ISSUING FEE$ o
TOTAL FEE --- FINAL 9 A�
Plan check app'90.nt PLAN CHECK VALIDAT ON
Name c�"`�
Address ` 7 f 0
City O.
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH14 APPLICATION AND STATE
THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES ;2509.3A
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM P E LY GIS ED RR ICENSE AS $I 0 0 0 0 0 5
REQUIRED BY LOS A COUNTY ND OF IF NI H T TI THE
LEGAL OWNER OF, D INTE D TO ESID HE V E DR SI NTIAL 2 - - 1 (100
SIGNATURE O O O 1 a 0 0
OF PERMITTEE
DISTRICT NV P CE`+SS 0622-79
4
INDUSTRIAL
WASTE APPROVAL