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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER '
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS 14536 Bo e
JOHN A. LAMBIE. COUNTY ENGINEER g'
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY Temple cit
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. 'I
NUMBER FIXTURE OR ITEM EACH FEE ,OWNER Noel Baldwin
2 WATER CLOSET $1.25 2150 MAIL
1 BATH TUB 1.25 1 25 ADDRESS
1 SHOWER 1.25 1 25 CITY TEL. NO.
2 LAVATORY 1.25 2 50 CONTRACTOR (wen Bros Plumbing
1 SINK 1.25 1 25 ADDRESS 4265 NO. Baldwin
1 DISHWASHER 1.25 1125 CITY El Monte TEL. NO. 443-0078
CONTRACTOR'S 184 STATE
197 C
LAUNDRY TUB 1.25 REGISTRATION NO. 7 COUNTY
CLOTHES WASHER 1.25 2 DISTRIC .NO. GROUP ZONE PRO ESSED BY
9
WATER HEATER 1.50 1 0 j
1 GAS SYSTEM 5OUTLETS a 1.50 1 50 INDUSTRIAL J r
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
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APPROVALS DATE INSPECTOR'S IGNATURE
PERMIT $ 2 O0 UNDER SLAB WORK
12 ROUGH PLUMBIN , t --� A A
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST ry r
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO 7P"( Il i
RESIDE IN,THE AB DE IBED RESIDENTIAL PROPERTY. UTILITY CO NOTIFIED --
SIGNATURE
OF PERMITTEE
FINAL
LIDATION ROBERT A. WOOD U
CK M O CASH SUPERVISING MECHANICAL ENG'R -
16.� 5
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