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7GA;AP7 DSS 17 11 50 APPLICATION FOR PERMIT
'OEPARTMENT OF BIIILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J FOX, CHIEF ENGINEER
APPLICANT FILL IN I _J ` O• O P l � .
OR
PLUMBER `) READY FOR
RECEI Y DATE ISSUED
FIRST INSPECTION
ADDRESS
BUILDING
CITY TEL. No f ADDRESS
COUNTY LOCALITY
LICENSE NO EXPIRE
NEAREST \
PERMIT FEES CROSS ST
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) @ O 50 !li ADDRESS
BATH TUB @ O 50 CITY TEL. No
SHOWER @ O 50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ O 50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 050 AND STATE LAWS REGULATING PLUMBING
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB O TRAY @ O 50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
GAS SYSTEM OUTLETS @ 050 OF THE RESIDENTIA6..PROPERTY DEBCRIABOVE
SIGNATURE OFIf
WATER HEATER @ 050 1 PERMITTE
SLOP SINK @ 0513 �, INSPECTION RECORD
FLOOR SINK @ O 5O
FLOOR DRAIN Q O 50
DISHWASHER @ 050
DRINKING FOUNTAIN @ 1350
URINAL @ O 50 Q
HOUSE SEWER @ O 50
MISCELLANEOUS CJ
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APPROVALS
-LAPPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAB PIPING
GAS VENT
CESSPOOL @ 1 00 CESSPOOL
SEPTIC TANK SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1 00 SEWER �y
PERMIT I IOU GAS TEST
yjZ) ,.- UTILITY CO NOTIFIED Q` _
TOTAL FEE (//� �
_ FINAL /�
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APPLICATION FOR"PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER 19
BUILDING ob
BUILDING AND SAFETY DIVISIONADDRESS C d/��.�iC-
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING ' LOCALITY 7-
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FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER G t G GSL
WATER CLOSET $1 25 MAIL
BATH TUB 125 ADDRESS
SHOWER 125 CITY TEL NO
LAVATORY 125 CONTRACTOR
SINK 125 ADDRESS 9l Z .�fG>��
DISHWASHER 125 CITY
LAUNDRY TUB 1 25 BEGINS AAT ON NOla COUNTY ❑
`p STATE ❑
CLOTHES WASHER 125 DISTRICT NO GROUP ZONE. PRO S D BY
WATER HE 1 50
GAS SYSTEM OUTLETS 150 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD EL
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APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE J( GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND S OF GAS TEST
CALIFORNIA OR THAT I AM THE L��IOPERT
OWNOF AND END TO
RESIDE IN THE ABOVE DESCRIIBBEAD UTILITY CO NOTIFIED
SIGNATURE rIa `�
OF PERMITT C.
FINAL 1
ALMATION ROBERT A WOOD
CK M J CASH SUPERVISING MECHANICAL ENG R
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