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APPLICATION FOR , PLUM ING PE IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNEP
WATER CLOSET lt-B& MAIL
BATH TUB .} ADDRESS
SHOWER ri.45, CITY TEL NO
LAVATORY t25 /` CONTRACTOR
SINE V ADDRESS 46 4r
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DISHWASHER t CITY ��/jJ) TEL NO 4/3_
-SATELIC
LAUNDRY•TUB 125 LICENSE NO �3 i '/�C CLASS
CLOTHES WASHER DISTRICCTT Np,J GR ZON P E SED B
I WATER HEATER 1 50 Q �J�✓
GAS SYSTEM OUTLETS 150 d INDUSTRIAL a
WASTE APPROVAL U
OUTLETS OVER 5 PERZSYSTEM 30 INSPECTION RECORD
W
CL
APPROVALS DATE INS ECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
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 CERTIFYfITHAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF I/
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO GAS TEST
RESIDE IN THE AD RIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
VALIDATION JACK R. ALLEN
M 0 CASH SUP RVISING MECHANICAL ENG'R
9C514
p a Jw 2 0 5 0 20.00- v
IrEPARTbIENT OF COUNTY EN(3INEM
PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGEL S BUILDING I
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WILLIAM J. FOX, COUNTY ENGINEER ADDRESS ✓ / Y
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS �/—� � C 44 1/���� q/ /7vF CROSSST CJ "�
DISTRICT NO GROUP ZONE PERMIT NO
LOCALITY Cb l'AAl �)%VNEAREST
�� D
CROSS ST /® V)-- EIVED BY Ready far Inspection DATE ISSUED
L
OWNER t ,NI 1 - t' ����✓
MAIL r'j INDUSTRIAL
V
ADDRESS �7 a/y��( q' 0,, r- WASTE APPROVAL
Z n V/
CITY i. CI TEL No / '/, INSPECTION RECORD
PLUMBER
J
ADDRESS
CITY TEL NO
State Contractor's
License No Class
J
L A County Contractor's
Registration No Q
Z
PERMIT FEES n
NUMBER TYPE OF FIXTURE OR ITEM FEE
0
WATER CLOSET(TOILET) a 080 $
BATH TUB @ 080
SHOWER @ 080
LAVATORY(WASH BASIN) @ 0 80
KITCHEN SINK @ 0 80
LAUNDRY TUB OR TRAY @ 0 80
SLOP SINK @ 080
FLOOR SINK @ 080
t
FLOOR DRAIN @ 080
DISHWASHER @ 0 80
DRINKING FOUNTAIN @ 080
URINAL @ 080 `
GAS SYSTEM / OUTLETS @ 1 00 A O
WATER HEATER @ 1 00
MISCELLANEOUS APPROVALS
DATE INSPECTOR'8SIGNATURE
UNDER SLAB WORK
PERMIT $ ( pp ROUGH PLUMBING
TOTAL FEE GARPIPING
1 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 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PER4W Aa�-
MITTEE r _
[FINAL
76A667 DBS 17 6/54