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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES ' " BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY
—31 NEAREST _
BATH TUB CROSS ST i
SHOWER —3 L
OWNER
LAVATORY MAIL
ADDRESS
SINK CITY TEL NO
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL N06 Z S1
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER LICENSE NO 7 7/� CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INSP R S SIGNATURE
OUTLETS OVER UNDER SLAB WORK 1 _
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING 0
GAS VENT tj
HOT WATER HEATER 0
PLUMBING FIXTURES
GAS TEST
Plan check fee UTILITY CO NOTIFIED
PLUMBING PERMIT ISSUING FEE$ m
TOTAL FEE FINAL
PLAN HECK VALIDATION
Plan check applicant !,
Name C -7 9��� d Jr- 2i
Addressfj
° �'�� / Q�7—
Gty Tel No
1 HE EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAT ON AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING I PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE b b 2 3 A
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY
LO
NATURE # 0 0 0 0 0 5
F PERMITTEE Zt
2 - 0 2 5 0 0
DISTRICT NO
f� PROCESSED BY
0 0 0 25005
C�
INDUSTRIAL
WASTE APPROVAL
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d y 1
D B S 17 25M SETS 12 44 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND, SAFETY ��������
COUNTY OF LOS ANGELES
Wm J FOX CHIEF ENGINEER
NATURE OF INSTALLATION DISTRIC O GROUP ZONE PERMITx
ROUGHFIXTURES 1__�COMPLETE
RECEIVED BY �—
READY FOR DATE 1 SUED
HEATER _CESSPOOL SEPTIC TANK FIRST INSPECTION y'/��
AS MISCELLANEOUS i
I n
APPLICANT (FILL IN HEAVILY OUTLINED
�PORTION ONLY
JoeK NAME
ADDRESS Jt (�.6a`V L!>n �� LOCALITY
^ /, NEAREST
y CITY �S TEL NO i CROSS ST
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COUNTY / t
CERT No EXPIRES m NAME p/(V f`/f,� �j/�/l.( f1/,✓j1,
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
3 ADDRESS / )�/✓��
NORTH O
r s
{ CITY TEL No
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION
-I
PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE
- OWNER
_ CORRECTIONS
I '
1 I
I �
SOUTH
DESCRIPTION OF WORK f
BATH TUB FURNACE GS
--SHOWER DISHWASHER _ O
LAVATORY REFRIGERATOR
—KITCHEN SINK WATER SOFTENER
FLOOR SINK RAND TRAP
LOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR S NAMQ
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING
I
-METER—GAS SODA FOUNTAIN
OUTL GAS PIPING
4 GAS VENT
a
CESSPOOL
TOTAL NUMBER OF FIXTURES SEPTIC TANK
6
CESSPOOL SEPTIC TANK SEWER
f
TOTAL FEE UTILITY CO NOTIFIED
� �
FINAL