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APPLICATION FOR PLUMB1 G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE' COUNTY ENGINEER ADDRESS 6/ 7
/ r
COLEMAN W. JENKINS, SUPT OF BUILDING - LOC TY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OW
WATER CLOSET $1.25
BATH TUB 1,25 MAIL
ADDRESS -
SHOWER 1.25 C Y TEL. q��
LAVATORY 1.25 CONTRACT
SINK 1.25 ADDRESS �—
DISHWASHER 1.25 CITY�Ze� ' TEL.
LAUNDRY TUB 1.25 CONTRACTOR'S REGISTRATION NO.
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE P OCE S D BY
WATER HEATER 1.50 sP4 h
GAS SYSTEM--/—OUTLETS— 1.50 INDUSTRIAL
WASTE APPROVAL d
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
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W
d
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Z
APPROVALS DATE INSPECTOR'S SIGNAT Y RE
PERMIT 2 00 UNDER SLAB WORK 9 JIB ��e
ROUGH PLUMBING v r
TOTAL FEE 12A, GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -
AND STATE AT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
'WITH ALL UNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBIN ,�� -
I If r T kvat+�g ye�E�oR PLUMBING FIXTURES
LICENS ED 4 ���1'f✓` D ST E OF GAS TEST
CALIF RNIA OR THAT I AM E LEGAL OWNER OF AND INTEND TO _
RESIDE I"ABOVERIBED RESIDENTIAL P RTY. UTILITY O. NOTIFIED `
SIGN ,��iG ,W
OF
/ LIDATION ROBERT A. WOOD
cK M o CASH SUPERVISING MECHANICAL ENG'R
L?io 5 4 o_ 1 P B 5 D 6.25—
rsAee, ;y g-ag LTJ APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
6
h COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE JPERMIT NO.
PLUMBER I IIVIAQIAI(� �n RECEIVED BY READY FOR DATE ISSUED
VALLEY BOULEVARD €L � FIRST INSPECTION
ADDRESS 90b'EAST_ VQI LCV
t� 1310 BUILDING
CITY ROSEMEAD TEL. NO-• Act_ rf719 ADDRESS
COUNTY n� G� LOCALITY
LICENSE NO. 93M EXPIRES ��(���/
NEAREST
PERMIT FEES cRoss ST.
NUMB_ 1 TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET (TOILET) @ 0.50 do00 ADDRESS- �
BATH TUB @ 0.50 I ® CITY L. NO.li.01
SHOWER @ 0.5011 HEREBY A NOWLEDGE THAT t HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 I� D APPLICATION AN/ STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ 0.50 I STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
J I LAUNDRY TUB OR TRAY @ 0.50 I ANGELES COUNTY LICENSE. OR t AM THE LEGAL OWNER
OF THE RESIDENTIAJO PROPERTY DESCRIBED ABOVE.
�I GAS SYSTEM OUTLETS @ O.SOI '
SIGNATURE OF
WATER HEATER @ 0.50 I PERMITT
I SLOPSINK @ 0.501 INSPECTION RECORD
FLOOR SINK @ O.50
FLOOR DRAIN a 0.501
IDISHWASHER @ 0.501�
IDRINKING FOUNTAIN @ 0.501
IURINAL @ O 501 1 „J
I•HOUSE SEWER @ 0.501 I Q
! MISCELLANEOUS I (7
1� O
I
1 1
I
APPROVALS
1 DATE INSPECTOR'S NAME
ROUGH PLUMBING I /j I•
GAS PIPING
GAS VENT
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: I SEPTIC TANK •I n
DRAIN ( ) PIT ( ) @ .1.001 I SEWER
HERMIT : I 1.00 GAS TEST
TOTAL FEE �00UTILITY CO. NOTIFIED/�5
FINAL