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«r A—IVV lY 0-as APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING 1
WILLIAM J. FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTR15 O. GROUP ZONE PERMIT NO.
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PLUMBER REC V DBY READY FORFIRST NSPECTION �����
ADDRESS
ADDRESS
j� BUILDING
CITY vy TEL. NO.
COUNTY LOCALITY empLE ..�p IIT 1�/
LICENSE NO. EXPIRES
NEAREST Qy /
PERMIT FEES CROSS ST.___
NUMBER I TYPE OF FIXTURE OR ITEM FEE OWNER �-- �
MAIL
WATER CLOSET (TOILET) @ 0.50(S ADDRESS Vf If T- �'^ �.'L'P:'��r� r-'
BATH TUB @ 0.501 I CITY i, . TEL. NO.ft/y
SHOWER @ 0.501 1 1 HER BY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH EASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ 0.501 STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.501 ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
1 OF THE RESIDENTIAL PROPERTY DESCRIBED,
ABOVE.
GAS SYSTEM--OUTLETS @ 0.501 SIGNATURE OF - ///
WATER HEATER q 0.50 PERMITTEE
SLOP SINK @ 0.501 1 INSPECTION RECORIS
FLOOR SINK @ 0.50
FLOOR DRAIN (00-5011
DISHWASHER @ 0.50
1 1
DRINKING FOUNTAIN @ 0.50
1 1
I URINAL @ 0.501 1 �J
I HOUSESEWER n 0.501 Q
Z
MISCELLANEOUS I (7
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I
I
I
APPROVALS
1 DATE INSPECTOR'S NAME
ROUGH PLUMBING Z-y I ec.,
GAS PIPING
GAS VENT
CESSPOOL @ 1.001 CESSPOOL 1 J
SEPTIC TANK: I SEPTIC TANK 1
I DRAIN ( ) PIT ( ) @ 1.001 1 SEWER 1
PERMIT . I t.00 GAS TEST
I UTILITY CO. NOTIFIED 1
TOTAL FEE $ 2 � FINAL
I
7BS-17 APPLICATION FOR PLUMBING PERMIT 1
IDBS-17 10.55
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDING r �,/ �r
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 'Y* 'Y!% G 6• '
CASSATT D.GRIFFIN,SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN I NEAREST (_
CROSS ST.
OWNER /✓ �'1 ( DISTRICT NO. G�Q/y[e /ZONE I READY FOR INSPECTION
MAILADDRESS (/ 7 J V t�/79 `F�. L/� / - moi- /C
►� INDUSTRIAL
CITY 1-4 e" ;e TEL. NO. WASTE APPROVAL
PLUMBER r�I .: , � `rxt,,� INSPECTION RECORD
ADDRESS
CITY ?(, TEL. NO.
LICENSE NO.
NUMBER TYPE OF FIXT RE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00 GAUGE QST- B"x'
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
sn� GAS PIPING
TOTAL FEE C.' GAS VENT
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT M THE LEGAL OWNER OF HE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTI ROPERTY.
SIGNATURE
OFPERMITTE4 FINAL
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. Y.0. CASH
p 2 9 9 5`'& L1E 4 3 2.0 0
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