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76A607-CE817 10-60
APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY
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FOR APPLICANT TO FILL IN NEAREST J
CROSS ST.
NUMBER FIXTURE OR ITEM r
OWNER
ta-
WATER CLOSET MAIL 4
BATH TUB ADDRESS
CITY r TEL. NO.4V
SHOWER
LAVATO CONTRACTOR
Lrti M I-Ajo
SINK ADDRESS 1
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DISHWASHER CITY TEL. NO. 6
COSTA3
LAUNDRY TUB BENO.NO.
COUNT ❑
CLOTHES WASHER DISTRI O. GROUP ZONE P OCES D B
WATER HEATER �� o/�Q -' G/`�
GAS SYSTEM � 'I S INDUSTRIAL JJ
WASTE APPROVAL y
INSPECTION RECORD a
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@ $iER ITEM
ORR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE 6 2—F
T� ROUGH PLUMBING
—H 6!� GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER I
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE AL OWyER OF THE ABOVE GAS TEST
DESCRIBED RESID L PROP
_ UTILITY CO. NOTIFIED
SIGNATURE
OF PERMIT T 4'
FINAL
` VALIDATION ROBERT A. WOOD
Jf CK. M.0. cgsHSUPERVISING MECHANICAL ENG'R
4 8 0 4c..." SEP 26 5 D 6.15" '