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TBA 667-•C ERBIT 4-64
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES {
DEPARTMENT OF COUNTY ENGINEER ADDRESS ���� A( •
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE. COUNTY ENGINEER _
WILLIAM A. JENSEN, SUPT OF BUILDING M
LOCALITY ( F
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE ^ p'eM� p L t�j.1 ps�Y�
OWNER KJ IJ /�
WATER CLOSET $1.25
MAIL
BATHTUB 1.25. ADDRESS q&do /V. �/{Leel3i-C P,
SHOWER 1.25 CITY7_F/1IPtF
p C( Y - TEL. NO. '79738
LAVATORY 1,2s CONTRACTOR (� ( pi�uL!c
SINK 1.25 —A
ADDRESS b& ( -S YU• /A-S
DISHWASHER l.zs cITYSA/,/ M. NO.
LAUNDRY TUB 1.25 CONTRACTOR'S !S IS � D < STATE 11COUNTY
REGISTRATION NO. v Lam• Ll
CLOTHES WASHER 1.25 DISTRICT NO. OUP I ZONE OCESSED BY
WATER HEATER 1.50 10 05
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GAS SYSTEM OUTLETS 1'50 INDUSTRIAL , d
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD V
1 P- 7X'A P
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APPROVALS RATE ,
� INSPECTOR 5 SIGNATU_BE
PERMIT $ 2 00
UNDER SLAB WORK
,
ROUGH PLUMBING ,I
TOTAL FEE GAS PIPING �py M.,�9.r5.{-,
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT F
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANOIOR PLUMBING FIXTURES f ti
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER ANO INTEND TO 'b
RESIDE IN. THE ASO EBCRIBEO E51 E TIAL R ERTr. UTILITY CO. NOTIFIED
SIGNATURE 'Sy
OF PERMITTE T FINAL /6 / F
ALIDATION ROBERT A. WOOD
CKll M.D. CASH SUPERVISING MECHANICAL ENG'R
LAC,u 1 4 4 0 Q KAY 11 5 D 4.7 5
16Ab6T CE#BIT 2-fi2 ' I
APPLICATION FOR/ PL BING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ABU
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ,�/•• Y
WILLIAM A. JENSEN. SUPT of BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE �A ^ ✓' /+
L• C1fJ/:. /_`�
WATER CLOSET E7.25 OWNER
MAIL
BATH TUB 1,15 ADDRESS
SHOWER 1.25 CITY S Fg/ '/171 EL. NO.
LAVATORY 1.25 CONTRACTOR
SINK 1.25aEpBY DISHWASHER 1.15 CITYNO� gi-
LAUNDRY TUH 1.25 CO RACTOA'S REGISTRATION'NO. CCLOTHES WASHER 1.25 DISTRI OTONO. G�UP Z P OC
WATER HEATER 1.50 5
GAS SYSTEM OUTLETS- 1'50 �Q INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD y
CL
O
u
O
`v
W
d
h
Z
I
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
_ ROUGH PLUMBING /
TOTAL FEE GAS PIPING/-
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES ^
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO
RESIDE IN, THE ABOVE DESC D SID TIAL PROP Tv. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTE FINAL
VALIDATION--) ROBERT A. WOOD U
CK. M.O. ('=H/
CASH SUPERVISING MECHANICAL ENG'R
LAL;o6479NOV 5 5 D 3.50- Q