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76AS67 08917 11-90 APPLICATION FOR PERMIT
DEPAR$MENT OF BUILDING AND SAFETY �,� n D
COUNTY OF LOS ANGELES U
WILLIAM J. FOX, CHIEF ENGINEER
015THIU] O. RO P .
FOR APPLICANT
/ /TQC FILL IN fes. � / / �.y��o
PLUMBER /L AIA Ab REC y D BY READYFORD7ATE ISSUED
( /-I ♦ C
ADDRESS FIRST INSPECTION sl 12-1�Vw W /f p �w�I ( ,{ •J
CITY .4 , 41 TEL. No. //J ADDRESSCOUNTY �J
LICENSE No. J / / / EXPIRES{i -�Owry LOCALITY i� '- /
NEARE6TA Q w
A
PERMIT FEES CR096fiT. R N
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER s O S -
'
WATER CLOSET(TOILET) 0 0.50 6 MAIL
BATH TUB @ 0.50 CITY TEL No.
40 SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ O.So ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPE DESCRIBED ABOVE.
GAS SYBTEM OUTLETS @ 0.50 V/_ESp
SIGNATURE OF
WATER HEATER @ 0.50 PERMITTE �
SLGP BINK @ 0.50 INSPECTION RECORD
FLOOR BINK @ 0.50 '
FLOOR DRAIN @ 0.50 Z / 4-5-1 G.✓ '•C. Bev
DISHWASHER @ 0.50 ,
DRINKING FOUNTAIN @ 0.50 >" R ' Cw
URINAL @ 0.50 J
Q
HOUSE SEWER @ 0.50 Z
MISCELLANEOUS Cl
R'
O
APPROVALS
DA yt1NBPELTOR-9 NAME
ROUGH PLUMBING fL�^^"A"✓ Z' /a()�'
GAS PIPING
GAS- VENT
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT i.OD GAB TEST / /✓
UTILITY CO. NOTIFIED A
TOTAL FEE 6
FINAL
l
J4R661' APPLICATION FOR PLUMBING- PERMIT -
DB5.IT 1294
DMSION OF BUILDING AND SAFETY
Dep. But of County Engineer
County of Los Angeles
NG
WM. J. FOX, COUNTY ENGINEER _ ADD EISS
•' CASSATT D. GRIFFIN, SUP'T.OF BUDDING
FOR APPLICANT TO FILL IN NE-RReSTY Tf=/� /� �Li
��aa / / CROSS ST.
OWNER ww If 4-2/E/= DIS7T NO. GROUP I ONE READY FOR INsr[cn6N
MAILADDRESS r_ -f /t/ Al p� .%` /
/ �a INDUSTRIAL
CITY /� /% /'��� TEL-:NO. WASTE APPROVAL
PLUMBER A f c Al A- L � . INSPECTION RECORD
ADDRESS L bS—G✓ A,(1 AE />///!JL' -
CITY 4'/j//1I, l ,5 TEL NO.0
{� C,
LICENSENO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET)' S
BATH TUB
SHOWER _
I LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER _
LAUNDRY TUB OR TRAY _
CLOTHES WASHER
TOTAL.NO. @ 0.50 _2—A10 APPROVALS
GAS SYSTEM--/—OUTLETS @ 1.00 d•O DATE INSPEQTOR•S SIGNATURE
UNDER SLAB WORK
WATER HEATER @ 1.00
ROUGH PLUMBING
PERMIT $ 1 00 GAS PIPING
TOTAL FEE -IV_ n GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER _I1
AND STATE THAT THE ABOVE 15 CORRECT.AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE t0.WS REGULATING _ PLUMBING FIXTl1RE5•
PLUMBING..
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE'OF . UTILITY CO: NOTIFIED
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE .ABOVE
DESCRIBED RESIDENTIAL PROPERTY:" ( II tt11II��
SIGN
OF PERM ETTEE FINAL r,F, RLXnlw
WILLIAM J. FO , COUNTY ENGINEER VALIDATION
Ap 7 '8:5.x. MR 21 3 4:A:.p��(t/o
. - — BY
I /[l' � �• 4 DEPUTY