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APPLICATION FOR PLU BINE PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALRY
FOR APPLICANT TO FILL IN NEAREST -
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 Cl TEL. N . D
LAVATORY 1.Y5 ^
CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 CI nn TEL. NO. n
LIC
LAUNDRY TUB 1.25 LICESATNSE Nq�C�'Q �� CLASS
CLOTHES WASHER 1.25 `STRICT,N OFy GRZO E
WATER HEATER 1.50 S C/X O P
GAS SYSTEM OUTLETS 1'50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 / INSPECTION RECORD U
( O
H
U
W
O_
y
Z
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT 5 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ TMIB APPLICATION GAS VENT
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW. REGULATING HOT WATER NEATER
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANDIOR PLUMBING FIXTURES
LICENSED AS REOUIREO BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE L GAL OWNER OF.AND INTEND TO
RESIDE IN. THE AB BRAE ESIO ENTIAL PROPERTY. UTILITY CO. NOTIFIED
S IGN ATU R {1y ✓
OF PERMI
FINAL
OvIAUDATION JACK R. ALLE
CN. M.D. CASH SUPERVISING MECHANICAL ENG-R.
VuLOO 8 0 2� SEP22 5 D 3.50- Q
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APPLICATION FOR . PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING n '
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS /Q �h7�1•�yp/.d9� 011t
WILLIAM A JENSEN. SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAAFST _
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 51.25 MAIL
BATH TUB 1,25 ADDRESS O
CITY T TEL. NO.
SHOWER 1.25
LAVATORY 1,p5 COMRACYOI I l
SINE 1.25 ADDRESS oZ.
DISHWASHER 1.25 CITY gj ol TEL. NO.'�,..�U�
LAUNDRY TUB 1.25 COMPACTOR'S STATE ❑
REGISTRATION NO. Q COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT[l�/O'' GROUP ZONE P SSED BV
WATER HEATER 1.50 Q (I J
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n.
GAS SYSTEM OUTLETS 1.50 INDUSTRIALWASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 V
INSPECTION RECORD
C
O
u
U
W
d
VI
Z
APPROVALS DATE INSPECTORS SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
1 ROUGH PLUMBING
TOTAL FEE U
GAS PIPING
HERESY ACKNOWLEDGE THAT 1 HAVE READ APPLICATION GAS VENT
ANO STATE THAT THE ABOVE ICORRECT AND AGREE
E COMPLY
WITH ALL COUNTY ORDINANCES
S ANO STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANOIOR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN, THE ABOVE DESCR14FD RESIDENTIAL PR TY. UTILITY CO. NOTIFIED
SIGNATURE
OFPERMITTEE
FINAL �I / - /
6LIDATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENG'R
6542 H?� R12 5 0 3.50.'
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