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APPLICATION FOR PLUMBING PERMIT {�
COUNTY OF LOS ANGELES w L1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION FNEAREST
CLOVERLY AVE. 3884
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUP T OF BUILDING
LE CITY
FOR APPLICANT TO FILL IN PR NT OR TYPE)
ps
NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET 1 50 OWNER GEORGE DEAN
BATHTUB 1 So ADDRESS 50CLOVERLY AVE.
SHOWER PAN 1'Tg 1 CITY TEMPLE CITY TEL NO
LAVATORY 1 So CONTRACTOR LSM. HAMM2 INC.
SINK 1 50 ADDRESS 425W. MAIN ST.
DISHWASHER 150 CITY ALHAMBRA TEL NO 282-2151
CLOTHES WASHER 1 50 STATEp LIC
LICENSE NO 8 CLASS C16
SWIMMING POOL RECEPTOR 1 50
DISTRICT NO GAUP ZONE le86ED BY
LAWN SPRINKLER SYSTEM 2 00 Iva
CD
WATER HEATER 1 50 INDUSTRIAL V
WASTE APPROVAL
GAS SYSTEM OUTLETS 1 So INSPECTION RECORD
OUTLETS OVER v
5 PER SYSTEM 30 a
N
Z_
Plan check fee 25% of above See reverse
PI UMBING PERMIT ISSUING FEE 8 00
1 OTAL FFE 75 APPROVALS DATE INSPECTOR S SIGNATURE
Plan Check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel No HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND�OR UTILITY CO NOTIFIED _
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL WNER OF AND INTEND TO
RESIDE IN THE ABOVE DE RISE E NTIAL PROPERTY FINAL
SIGNATURE JACK R ALLEN, SU ERVISI MEC ANICAL ENG R
OF PERMITTEE
PERMIT VALIDATION CK M o CASH
PLAN CHECK V&A IDATION CK M O CASH
L►i1�o 9 2 3 6 N OCT 1 3 5 4.7 5, 01
D B t 17 25M SETS 7-47 APPLICATION FOR PERlVIIT
]?EPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
r WM J FOX. CHIEF ENGINEER PLUMBING
NATURE OF INSTALLATION DISTR1 NO G� o f PERMIT
lERMI(/�N/O
ROUGH FIXTURES COMPLETE f / J 2_J AGf
R IVSD BY READY FOR/ DATE ISSUED
HEATER CEBHPOOL 1-1
SEPTIC TAHK FIRST INSPECTION wallIXIIIIIIy
AS MISCELLANEOUS
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
� NAME �L.� , fy � ADORES �-3 �
W �
m ADDRESS �� LOCALITY
f
� NEAREST �t
OJ CITY ,TEL No. CROSS ST Q
COUNTY
CERT NO / EXPIRES 6' NAME !,,y
LOCATION OF SEPTIC TANK, OR CESSPOOL = MAIL
3 ADDRESS
NORTH
CITY V TEL NO
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIR CATE OF QUALIFICATION..
PLUMBER
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
OWNER
CORRECTIONS
SOUTH
J
/
DESCRIPTION OF WORK a z
BATH TUB (/ FURNACE
ROWER DISHWABHER 0
/ -LAVATORY REFRIGERATOR
/ KITCHEN SINK L/ WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
/ WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAINDATE�yp INSPECTOR B NAME
/ WATER HEATER DENTAL LAVATORY ROUGH PLUMBING JA
lQ-10 I �1'u
' METER GAS +=ODA FOUNTAIN
OUTL GAS PIPING I ��
« GAS VENT I I
CESSPOOL
TOTAL NUMBER OF FIXTURESeUo SEPTIC TANK I I
CESSPOOL_-SEPTIC TANK SEWER
S C/ UTILITY CO NOTIFIED
TOTAL FEE 1 �"
IL FINAL
Q,S S 17 25M SETS 113-47 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING
� � 7
COUNTY OF LOS ANGELES
IL Wm J FOX. CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT O G P PERMIT NO.
ROUGH FIXTURES COMPLETE
HEATER CESSPOOL SEPTIC TANK REC I BY READY FOR ��Tq ISSUED
FIRST INSPECTION =—�_t o�
A9 MIS ELLANEO S �T
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
K NAME � �,.f1" � ADDRESS
m n` `
ADDRE 80'�-� �knti� LOCALITY �d'.
NEARESTe
'1 CITY
6 6t.�Cs�D> TEL No CROSS ST 1✓1/ /
COUNTY '�'� /) ,(� (/ _ U
CERT No [S EXPIRES Cc NAME
LOCATION OF SEPTIC TANS, OR CESSPOOL z MAIL
3 ADDRESS
NORTH O l
CITY TEL No
IAM THI LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION
/ PLUM66R
I AM THE LEGAL OWN.B.�t OF THE PROPERTY DESCRIBED
ABOVE. `(//
3 OWNER
CORRECTIONS
SOUTH J
DESCRIPTION OF WORK ?
ATH TUB —FURNACE
SHOWER DISHWASHER C3
AVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
LOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN
DATE INSPECTOR 8 NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I I
METER—GAS pODA FOUNTAIN
OUTL GAS PIPING
GAS VENT I I
CESSPOOL i� ���-yY
TOTAL NUMBER OF FIXTURES SEPTIC TANK I I
-CESSPOOL--------SEPTIC TANK ® � SEWER I
S UTILITY CO NOTIFIED I
TOTAL FEE
FINAL
DEPARTMENT OF COUNTY ENGINEER PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING` �}y
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS �® /� c Z_ '�A? � ,101,
iallipmwin ITY
FOR APPLICANT TO FI IN NEAREST
�^
BUILDING ® � CROSS ST �{"®CaA-
ADDRESS
DISTRICT NO GROUP ZONE PERMIT NO
LOCALITY • C� I �r, 9/ 4^�
NEAREST V
CROSS ST RECEIVED BY Ready for Inepeoton DATE ISSUED
OWNER deej
MAIL INDUSTRIAL
ADDRESS WASTE APPROVAL
CITY TEL NO 1 INSPECTION RECORD
PLUMBER ff
ADDRESS01
�J
CITY TEL NO
Q TATE
LICENSE NO 77 OUNTY j
PERMIT'FEESQ -
'z
JUMSER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET(TOILET) @ 080 S O
BATHTUB @ 080
SHOWER @ 080
LAVATORY (WASH BASIN) @ 080 CJ
KITCHEN SINK @ 0 80
LAUNDRY TUB OR TRAY @ 0 80
SLOPSINK @ 080
FLOOR SINK @ 080
FLOOR DRAIN @ 1080
DISHWASHER @ 080
DRINKING FOUNTAIN @ 080
URINAL @ 080
GAS SYSTEM OUTLETS @ 1 00
WATER HEATER @ 100
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL-FEE d GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE XIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE ; _
OF PERMITTEE
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