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37 f7 15-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
PLUMBING 1
WILLIAM J. FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTR T NO. GROUP ZONE PERMIT NO.
;severe ae vice %rp. � y�7
PLUMBER RECEIVED BY READY FOR DATE ISSUED
p FIRST 141$,jCTION
ADDRESS 11811 `reale St. �,y ry jVUW
CITY Culver pp%'City TEL. NO. `D( !-2151 ADDREISS 5525—N. Aleasancro Ave.
LICUNTYENSE NO. �1.L7 7� EXPIRES v-3o 51 LOCALITY Temple City
NEAREST Live ak Ave.
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER H. A. 19rler
MAIL L
WATER CLOSET (TOILET) @ 0.50 I$ I ADDRESS Same 8S above
IBATH TUB @ 0.501 CITY TEL. NO.
I SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
LAVATORY (WASH BASIN) @ 0.50 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM —OUTLETS @ 0.501 SIGNATURE OF
WATER HEATER @ 0.50 I_-1- PERMITTEE_
SLOP SINK @ 0.50 I I INSPECTION RECORD
FLOOR SINK @ 0.501
FLOOR DRAIN @ 0.501
DISHWASHER @ 0.501
DRINKING FOUNTAIN @ 0.5011
URINAL @ 0.501
HOUSESEWER @ 0.501 I Q
Z
MISCELLANEOUS I I p
W Softener � 50 0
I
I
( I
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
I � GAS PIPING
GAS VENT
CESSPOOL @ 1.00 CESSPOOL �I
SEPTIC TANK: I-F- SEPTIC TANK
DRAIN ( ) PIT ( @ 1.001 I SEWER
PERMIT . . . I 1.00 GAS TEST
UTILITY CO. NOTIFIED
TOTAL FEE: $ 1 50
FINAL