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COUNTY OF LOS APPLICATION FOR PLUMBING PERMITANGELES
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DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT O. GRIFFIN. SUPT OF BUILDING LOCALITY d ��
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM �I
OWNER �U Cl_ :7 r'1-1 WILL
WATER CLOSET _ -
MAIL
BATH TUB ADDRESS �'� "t' I�� Pi�r� X t c J 4
SHOWER CITYu4)'�jO( TEL.NO. - -( ✓,ha ('
LAVATORY CONTRACTOA�„('
SINE ADDRESS C-,1_
DISHWASHER CITY4: (Z _ .3 1 VV,:0 TEL.NO. -f—&,'fl7J
LAUNDRY TUB CONTRACTOR'S STATE
REGISTRATION NO. L`c 1- / COUNTY ❑
CLOTHES WASHER DSTRI�*'NO. (GROUP ZONE x[AOY Foa u+9FLcrlox
WATER HEATER
GAS SYSTEM INDUSTRIAL
i WASTE APPROVAL
INSPECTION RECORD
APPROVALS
([ $1.00 PER ITEM DATE ., INSPECTOR'S SIGNATURE
OR FIXTURE S UNDER SLAB WORK a
PERMIT 5 t 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE 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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING.
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED A5 REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY,,
SIGNATURE �^ ��
OF ATURE TEE "✓1 FINAL b
ROBERT A.WOOD.
o, VALIDATION SUPERVISING MECHANICAL END R
CN: M.0, CASH
I AC01 0 7 11 S AY 2 0 -3A 2';0 0 9
' C�
,bass, 19 35M SETS T.{B APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY''.`_
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
M. C. TOOL FILL IN DISTRICTGR.O UP ZO 'PERMIT .�//
PLUMBER 1.1. C. NO IVT S -- -- 'T 7_5-
R/E�CEIVED BY READY FOR DATE ISSUED
$� � /-/vJsO FIRST INSPECTION /D— /l_ /
ADDRESS Z /4
CITETF.MAO /1
-�yEa� �C 'AD'DRESS jf
COUNTY O
LICENSE NO. EXPIRES LOCALITY r �/
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS, NEAREST O� k �
ANGELES COUNTY LICENSE. ICROS5ST.
q/qy�/ YI -/---/-_ d -R� t
/ /L�II i/d I�./1"ZL�'i1/ L'L/ MAIL
PLUMBER ADDRESS
f cW.•-C
PERMIT FEE IS $1.00 FOR THE FIRST FIXTURE OR CITY TEL. No.
ITEM LISTED BELOW, PLUS SOC FOR EACH ADDITIONAL 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROP-
ITEM. FOR EACH SEPTIC TANK AND PIT OR DRAINFIELD ERTY DESCRIBED ABOVE.
$1.00. MINIMUM FEE FOR ANY PERMIT $1.00. EACH
GAS SYSTEM 19 A SEPARATE ITEM.
OWNER
NUMBER TYPE OF FIXTURE OR ITEM
WATER CLOSET (TOILET) CORRECTIONS
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
LAUNDRY TUB OR TRAY
GAS SYSTEM-OUTLETS
WATER HEATER
SLOP SINK J
Q
FLOOR SINK j
FLOOR DRAIN U'
DISHWASHER
D
DRINKING FOUNTAIN
URINAL
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
. GAS VENT
CESSPOOL
SEPTIC TANK - DRAIN ( ) PIT -( 1 $ SEPTIC TANK
CE99POOL $ SEWER
HOUSE SEWER $ GAS TEST I
5 U
TOTAL FEE UTILITY CO. NOTIFIED
$ ,�
FINAL
T°A°°°
DBS IT APPLICATION FOR PLUMBING PERMIT
DIV1
( ISION OF BUILDING AND SAFETY
Department of County Engineer -
County of 1.05 Angeles BUILDING /
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ✓
CASSATT D.GRIFFIN, SUPT OF BUILDING
LOCALITY �71_10
_
FOR APPLICANT-TO FAL IN NEAREST
CROSS ST. _
OWNE ` DISTRICT NO. GROUP I ZONE I READY FOR INSPECTION
MAIL
ADDRESS - il!
CIT TEL. N ' WA TETAPPROVAL
PLUMB
.t INSPECTION RECORD
Rr�' / � YL/ A
ADDRESS
CITY TEL.
LICENS NO �.SIS�
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ SI.00 $ �D
BATH TUB @ S1.00
SHOWER @ SI.00
LAVATORY (WASH BASIN) @ S1.00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ S1.00
WATER HEATER @ S1.00
GAS SYSTEM @ 51.00
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
PERMIT. 5 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEES '
GAS VENT
' 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT-WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. pLUMBING'FI%TURES
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR GAS TEST
LICENSED AS REQUIRED BY OS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I A THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED
DESCRIBED RESIDENTIAL OPE TY. .
SIGNATL
OF PERM TTEE < F-�1 I1p
FINAL � `'.0 II pz,i A • Vl.
F
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
CK. Y.0. ASN
(AC 0 9 5 0 u AUG 5 3 2.0 0 to