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76A667ZCE#8172.62 TEMPLE CDTV
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A.LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A.JENSEN, SUP'T OF BUILDING i
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRES Jit
SHOWER 1.25 CITY TEL. N
LAVATORY 1.25 CONTRACTOR
SINS 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NQ CONfRACTOk'S STATE
LAUNDRY TUB 1.25 EGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE :EBBED BY
WATER HEATER 1.50
GAS SYSTEM—/--OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE r GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANDJOR PLUMBING FIXTURES ���,,.[ 2,-
LICENSED AS REQUIRED BY LOS A GELES COUNTY AND STATE OF
CALIFORNIA OR THAT I A THE GAL OWNER OF,ANO TEND TO AS TEST
RESIDE IN,THE ABOVE D GRI RESIDE L P PERT UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTE FINAL Q Id q
VALIDATI N ROBERT A.WOOD
CK. M.0." ca5r�i SUPERVISING MECHANICAL ENG'R
1. 6 6 AANkR16 5 D 8.75
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