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76A667-CE817 12/59 t TEMPLE COTY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTNUiT OF COUNTY ENGINEER BUILDING
AND SAFETY RMSION ADDRESS !J
JOHN A LAMBI COUNTY NGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CRT
NUMBER FIXTURE OR ITEM OWNER A
WATER CLOSET MAIL 000,
ADDRESS
BATH TDB
CITY TEL NO
SHOWER
LAVATORY CONTRA R
ADDRESS k
SINS /
DISHWASHER CITY TEL NO4-t72 �r
CON C S ELAUNDRY TUB REGISTRA NNO CY ❑
CLOTHES WASHER DISTRICT NO GROUP ZONE PROCESSEDB�Y/
WATER HEATER --5'. I (
GAS SYSTEM 1 INDUSTRIAL
S WASTE APPROVAL
INSPECTION RECORD / w
0
y
h
1
® $1 00 PER ITEM r
OR FIXTURE APPROVALS DATE INSPECTOR S SIGNATURE
-H PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST f ��
CALIFORNIA OR THAT I AM THE EG AL OWNER OF THE ABOV
DESCRIBED RESIDENTIAL P ER UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE FINAL !
OF, VALIDATION ROBERT d'WOIOD
CK m 0 CASH SUPERVISING MECHANICAL ENG R
LACO0 6 2.lk% JW22 5 D 3.50-
D S S 17 2SM SETS 7-47 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING
Wm J FOX. CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT
°� PI GROUP ZONE �fPER�MI O.
ROUGH FIXTURES COMPLETE d' � 1,I / ! !
HEATER CESSPOOL —I SEPTIC TANK RECEIVEDrBY READY FOR DATE ISSUED
) _// FIRST INSPECTION o�
A8 M18CELLA EOU "
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
d. NAME /7 ADDRESS
M ADDRESS ® 24\ LOCALITY
D NEAREST
G CITY TEL o CROSS ST.
COUNTY
CERT No EXPIRES 0: NAME �
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
_ NORTH O ADDRESS 714
CITY ! TEL No
1 AM THE LEGAL POSOKAOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
PLUMBER
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
0
3 I OWNER
CORRECTIONS
SOUTH
J
DESCRIPTION OF WORK z
/ BATH TUB FURNACE E3
ii
SHOWER DISHWASHER p
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP ,%
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
_WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR S NAME
1 WATER HEATER DENTAL LAVATORY ROUGH PLUMBING
METER_._GAS SODA FOUNTAIN GAS PIPING
oun
GAS VENT I I
CESSPOOL
TOTAL NUMBER OF FIXTURES SEPTIC TANK I I A
/ CESSPOOI EPTIC TANK SEWER ISEWER I IR
$ � UTILITY CO NOTIFIED I —To
TOTAL FEE
FINAL
DB 17 7-38 25M '
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES PLUMBING
NATURE OF INSTALLAT ON DISTRIX NO-_ GROUP i VIM
� IT No
CO
ROUGH r/ I � YYi
PLUMBING FIXTURES COMPLETE '
SEPTICTANK READY FOR RECEIVE/q YL DATE SSUE�
I_ FIRST INSPECTION
HEATER G6S8P001 I—
dlAS MISCELLANEOUS
//
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY '
G JOB
NAME w AAi /�a_4,0' _ADDRESS -
°° c � I` 4 �t1J_2�.I rte,
® ADDRff69 A LOCALITY 7NEAREf
CITY �d� �TEL NO CROSS SSTSTATE
TY
LICENSE NO REGNNO 777 y�� It NAME
LOBATION OF SEPTIC TANK, OR ` P{PVL z MAIL
3 ADDRESS
NORTH � CITY /1��A6A✓�/Ji'A� U TEL NO '
CORRECTIONS
' I
z
SOUTH \
DESCRIPTION OF WORE I V&Jy
—BATH TUB Y T-FURNACE
APPROVALS c
SHOWER DISHWASHER DATE INBPUCTOR n NAME
LAVATORY REFRIGBRATOR
ROUGH PLUMBING
KITCHEN SINK WATER SOFTENER
GAS PIPING _
-OOR SINK —_SAND TRAP `
- GAS VENT
GLOP SINK _FLOOR DRAIN _
CESSPOOL
WASH TRAY URINAL
' 6EPrIC TANK
WATER CLOSET __ DRINKING FOUNTAIN
'�%f�/��'�'' SEWER
UTILITY CO NOTIFIED WATER HEATER _DENTAL LAVATORY /
ap
�+ETER F V OUTL SODA FOUNTAIN c
INAL V
1 AM THE LEGAL OWNER OF THE ABOVE LOS ANGELES
��qq COUNTY REGISTR++ATII��OOpN NUMBER
TOTAL NUMBER OF FIXTUR� t— L
. —
SEPTIC TANK dd PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
CESSPOOL ABOVE _
TOTAL FEE I� OWNER I
D�`,i PAITjyyEi NT OF BUILIjiNG APPLICATION FOR PERMT
COUNTY OF LOS ANGELES � I PLUMBING
NATURE OF INSTALLATION DISTRICT No GROUP No PERMIT No
ROUGH V D J
PLUMBING FIXTURES COMPLETE 2,- 7-+�
HEATER CESSPOOL SEPTIC TANK READY FOR R6 EI/7 DA IJE�
FIRST INSPECTION 7
GAS MISCELLANEOUS
JOB
K ' NAME ADDRESS
A(gp�
ADDRESS _ -01 LOCALITY
IL
CITY MAY TEL NO CROSSSST STATE //'�
LICENSE NO REG
COUNTY
to NAME �D X /�
i3OCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
3 ADDRESS !yG J
NORTH O
CITY TEL NO L�
CORRBCTIONS
J
I a
SOUTH I Z
DESCRIPTION OF WORK I o
I BATH TUB FURNACE
SHOWER DISHWASHER
/ LAVATORY REFRIGERATOR
/ KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN/ D.,ATE INSPECTOR B/NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING r� /'0�L7 Q'�
/ METER GA OUTL AODA FOUNTAIN GAG PIPING
V
GAS VENT
CES4POOL
TOTAL NUMBER OF FIXTURES
_�—SSEPTIC TANK
SEPTIC TANK i
TCEQSPOOL SEWER
PERMIT FEE 100 UTILITY CO NOTIFIED
TOTAL FEE FINAL v,