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APPLICATION FOR PLUMBING PERMIT
COUNTY'OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE)• BUILDING
ADDRESS o /
NUMBER FIXTURE OR ITEM ® FEE
WATER CLOSET LOCALITY,
NEAREST
BATH TUB CROSS ST. �L ,✓/ �f�T
SHOWER OWNER GLS'j�J�
LAVATORY MAIL S'
ADDRESS
SINK CITY 1' 1 TEL NOa
DISHWASHER CONTRACTOR Ge p/ - oly
CLOTHES WASHER ADDRESS O L L/ ✓� o
SWIMMING POOL RECEPTOR
- - CITY Alt,III,� TEL NO /. 166
LAWN SPRINKLER SYSTEM STATEHn/ n 52
WATER HEATER LICENSE NOq'5QQ CLASS
GAS SYSTEM OUTLETS / APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING '
_ GAS PIPING 0
GAS VENT V
Q9
.. HOT WATER HEATER E.OIu...
PLUMBINGFIXTURES T [[,��T W
GAS TEST /f� pY /2 , h [M'/ytr - IIIIL
L
Plan check fee - UTILITY CO.NOTIFIED '' Z
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL
Plan check,opplicant - PLAN CHECK VALIDATION
Name
Address N•R IL�26�7$ ' �D216J24
City Tel.No.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE "
THATTHE ABOVE IS CORRECTAND AGREE TO COMPLY WITH ALL COU NTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION
( HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REOUIgED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE '
LEGAL OWNER OF.AND INTEND TO RE IDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. - -Ao j1•
EO 0N
SIGNATURE PO o?
OF PERM=
O �J
- DISTRICT NO. P CESSED BYr
IM Y
err ® cn D>
INDUSTRIAL CH
WASTE APPROVAL
DEPARTMENT OF COUNTY ENGINEER P L U M 6 9fel G IV
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS �O�O f{ ` �GL+V✓`�O
FOR APPLICANT TO FILL IN LOCALITY
'LDNGG p �/ NEAREST
ADDRESS 1 �90 E. I I/V �S - GROSS ST.. Y�r
•-T� ,Q I DISTRICT N0. GROUP (ZONE PERMIT N0.
J
LOCALITY �/LJ �G I �9,S-" 4171
NEAREST
CROSS
CROSS ST.'I'M� `�Q UG/f RECEIVED BY Raedy for lnaVectlan DATE ISSUED
OWNER OC�)] gZ w k� [3RKEP T��9-•ry
yr/
MAIL 1 INDUSTRIAL
ADDRESST o
{;'Oy E'N�IIU ES ^�U�P .fa WASTE APPROVAL
CITY TeM4p4,e e-IT./ TEL.NO. FCJ'O-95-2L INSPECTION RECORD
PLUMBER Jr ��! -_e `l
ADDRESS
CITY TEL.NO. --
STATE
LICENSE N0. Cl COUNTY /(
U f �/ J .
J
PERMIT FEES a
i..EER TYPE OF FIXTURE OR ITEM FEE 0
WATER CLOSET(TOILET) @ 0.80 $
BATHTUB @ 0.80 i.lw/ O ��[Gl lid G/J0 1
SHOWER @ 0.80 4<e
LAVATORY (WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80 s ���wN{elQ1—
C�i
LAUNDRY TUB OR TRAY @ 0.80
SLOPSINK @ 0.80
FLOORSINK @ 0.80 !/
FLOOR DRAIN @ 0.80
DISHWASHER @ '0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM_j......OUTLETS @ 1.00
WATERHEATER i @ 1.00
MISCELLANEOUS
_ APPROVALS
_ AT INSPECTO jSSIGNATURE
_ UNDER SLAB WORK
PERMIT $ I 00 7, ROUGH PLUMBING lv .rNW"
GAS PIPING - B
TOTAL FEE _ -5 �d -
1 HEREBY ACKNOWLEDGE THAT I HAVE READ-THIS APPLI. - GASVENT
CATION AND STATE THAT THE ABOVE IS CORRECT:AND AGREE q HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND'STATE LAWS I
REGULATING PLUMBING. a PLUMBING FIXTURES
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST O
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE
yy,�II""DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITT!55y..�
FINAL
76A667 DRS 17 Cdb 12-53 ..
76A667 DBB 17 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEr ENGINEER
tiDISTRICT NLJ. URLV�KMII NU.
FOR APPLICANT TO FILL IN
READY FOR
PLUMBER _J RECE VED BY FIRST INS P ECTION DATE IHSUED
S
ADDRESS /BUILDING/
CITY
CITY TEL No. ADDRESS
COUNTY LOCALITY iGi/I
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES 1=5s"ISTT. 1 lI
llull-
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER Dr / / l
MAIL
WATER CLOSET(TOILET) 0.50 S ADDRESS /
BATH TUB O.sD CITY U/ .0 / TEL No. (1k2,2 37 ;p
SHOWER 0.50 1 HEREV(ACKNOWLED E THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ O.SO AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDEN PROPERTY DESCRIBED ABOVE.
GAS SYSTEM OUTLETS @ 0.50
SIGNATURE E /
WATER HEATER @ 0.50 PERMITTEE
SLOP SINK @ D.So INSPECTION RECORD
FLOOR BINK 0.50
FLOOR DRAIN ® 0.50
DISHWASHER ® 0.50
DRINKING FOUNTAIN ® 0.50
URINAL Q 0.50 J
Q
HOUSE SEWER @ 0.30 Z
MISCELLANEOUS ED
O
APPROVALS
DATE INSPECTOR'. NAME
F ROUGH PLUMBING
OAS PIPING
GAS VENT
CESSPOOL @ I.Dp CESSPOOL
SEPTIC TANK! SEPTIC TANK
DRAIN ( ) PIT ( ) @ I. SEWER
PERMIT 1.00 GAS TEST
UTILITY CO.NOTIFIED
TOTAL FEE S �. 'v (p
.FINAL