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76AS67 OBS 17 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING 1
WILLIAM J. FOX, CHIEF ENGINEER
DISTRICT NO. GROUP ZONE PERMIT Nu.
FOR APPLIC T TO F LL IN4/ 6
PLUMBS ��� / � REQ LVED BY READY FOR DATE ISSUED
/ J FIRST INSPECTION
BUI DI NG
ADDRESS 1D''11 I �
CITY
[� !7" L TEL No OP/ i ADDRESS 7�Z
COUNTY /�j^/ ( OCALITY
LICENSE NO. �` 1 EXPIRES _J
NEAREST
PERMIT FEES
—CROSS BT _ yl�l '1��
e ,
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER �f 4�s—dmcv
MAIL
WATER CLOSET(TOILET) 0 O 50 # ADDRESS
BATH TUB O 50 V v CITY TEL No
SHOWER 050 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) 1350 v APPLICATION AND BATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 050 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS TH;0111BED
OVE VALID LOS
LAUNDRY TUB OR TRAY a O 50 ANGELES COUNTY LICENSE, OR 1 AlE LEGAL OWNER
OF THE RESIDENTI L O�ERTY DE ABOVE.
GAB SYSTEM OUTLETS O 5D C/(�!
SIGNATURE
WATER HEATER @ 050 PERM ITTE
SLOP SINK Q 050 INSPECTION RECORD
FLOOR SINK @ O 50
FLOOR DRAIN 0.50
DISHWASHER 0.60
DRINKING FOUNTAIN 0.50
URINAL 0.50 J
a
HOUSE SEWER 050 =
MISCELLANEOUS 5
O
APPROVALS
OR
TE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ) PIT ) @ 1 OD SEWER
PERMIT I 1.00 GAB TEST
UTILITY CO NOTIFIED
TOTAL FEE s s sz
001 FINAL
76A667 (CE-817) - 5/73
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�APPLICATIO FOR P MBING_ PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO BUILDING
ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER
LOCALITY �L� �r
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM @ FEE
1 75 OWNER
WATER CLOSET MAIL
BATH TUB 1 75 ADDRESS (�
SHOWER 1 75 CITY ?(� TEL NO
LAVATORY ` 1 75 CONTR .JIW
t RO�)L
SINK 1 75 ADDRESSY /Ij_,C f
DISHWASHER 1 75 CITY TEL NOY
CLOTHES WASHER 1 75 STATE LIC
6 Jp�
SWIMMING POOL RECEPTOR 1 75 LICENSE NO CLASS
DISTRICT NO GROUP NE OCESSE BY
LAWN SPRINKLER SYSTEM 1 75 —J�d
WATER HEATER 1 75 INDUSTRIAL •L—
WASTE APPROVAL d
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD
U
OUTLETS OVER 30 oC
5 PER SYSTEM
O
r
U
W
CL
C/7
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR 5 SIfNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
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 REOUI RED BY LOS ANGELES COUNTY AND STATE OF r �/ r
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO / �Z O
RESIDE IN THE ABOVE DESCRIBED RESID NTIAL PROPERTY FINAL
SIGNATURE ( `
OF PERMITTEE
:C'4-MAy-
T ALI6ATION cK M 0 CASH !
PLAN CHECK VALIDATION CK M 0 CASH 9 5 1 5' 0 1 3.5 0 Ayd ,t