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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION M ADDRESS
JOHN A. LAMM CountF Engineer --��
CASSATT D. GRIFFIN. Supt of 8uildmg LOCALITY J M
FOR APPLICANT TO FILL IN NEAREST
caoss sT.
NUMBER FIXTURE OR ITEM
OWNER (f�t
WATER CLOSET MAIL
BATH TDB ADDRESS,
SHOWER CITY TEL. NO.
LAVATORY CONTRACTOR
SINS ADDRESS
DISHWASHER CITY TEL NO.
CONTRACTOR'S STATE ❑ '
LAUNDRY TUB REGISTRATION NO. COUNTY
CLOTHES WASHER DISTNO GROUP ZONE
WATER HEATER A- 1
O`7'�
GAS SYSTEM ,G,qs - L /Ghc r INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
i @ PER ITEM
OR FIRTURE / (J DATE INSPECTOR'S SIGNATURE
1/
OR $
UNDER SLAB WORK
PERMIT $ 2100 ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTI PR R
.SIGNATURE FINAL
OF PERMITTE
®F VALIDATION $OBRV�IS NG MOOD ETA NICAL ENG'R
CK. M 0, CA
' ACn 6 1 1 5 144 y 4 5 A 3 .00
'® APPLICATION FOR PERMIT
P'�` EPAWR`TINENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUPI ZONE PERMIT NO.
PLUMBER Revere Service Corp. RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
ADDRESS 11811 Teale St• NOW --s—LI5
BLhLD �.
CITY Culver City TEL NO 72151
ADDRESS 2932 ines Dr.�` /D S-41 �
COUNTY / LOCALITY Temple City
LICENSE NO 6750 r.2 EXPIRES 6-30-Ki
NEAREST
PERMIT FEES
CROSS ST El Monte Ave.
NUMBER TYPE OF FIXTURE OR ITEM FEE
OWNER C. J. Knieper '
MAIL
WATER CLOSET (TOILET) @ O 50 S I ADDRESS Same a9 -bo-%r,-
BATH
bnyeBATH TUB @ O 501 CITY TEL NO
SHOWER @ O Sol I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ O 50 I APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ O Sol STATE LAWS REGULATING PLUMBING
t CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ O 501 ANGELES COUNTY LICE 1 AM THE LEG OWNER
OF THE REST ENT ROPERTY DESCRIBE4BE-
D
GAS SYSTEM OUTLETS @ O 50
SIGNATURE O
WATER HEATER @ O Sol PERMITTE
SLOP SINK @ o SolI INSPECTION RECORD
FLOOR SINK @ O 50
FLOOR DRAIN @ O $0
DISHWASHER @ O 50I
DRINKING FOUNTAIN @ O 501
URINAL @ O 50I
HOUSESEWER @ O SOI I Q
Z
MISCELLANEOUS U'
1 Water Softener
I o
I
I
I
APPROVALS
DATE -INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1 00 I CESSPOOL
SEPTIC TANK I SEPTIC TANK
I DRAIN ( ) PIT ( ) @ 1 00I SEWER
PERMIT I 1 00 GAS TEST
UTILITY CO NOTIFIED
TOTAL FEE 1 50
FINAL