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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 1N
JOHN A. LAMBIE, COUNTY ENGINEER ADDDRESSDREss
214 Degas Ave,
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
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FOR APPLICANT TO FILL IN NEAREST RandwiCk
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE OWNER Dnal Cor
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2 WATER CLOSET $1.25 2.50 MAIL
1 BATH TUB 1.25 1.25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
2
2 LAVATORY 1.25 2.50 CONTRACTOR Owen Bros. Plumbing, Inc
1 SINK 1,25 1.25 ADDRESS 4265 No. Baldwin Ave.
1 DISHWASHER1.25 1.2 CITY El Monte TEL. No. 443-0078
LAUNDRY TUB 1CONTRACTOR'S STATE
.25 EG 5 RAS ON NO. 231741 COUNTY Q
1 CLOTHES WASHER 1.25 1.25_ DISTRICT NO. GROUPNE /PROC EBBED BY
/
1 WATER HEATER 1.50 1.50 R:
1 GAS SYSTEM 5 OUTLETS 1.50 1.50 INDUSTRIAL y
WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
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APPROVALS DATE INSPECTORS SIGNATURE
PERMIT S 2 00 UNDER-BtAB WORK -ZoZ-
ROUGH PLUMBING
TOTAL FEE 2.
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AN 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 1 AM PROPERLY REGISTERED ANDIOR PLUMBING FIXTURES -2,T Lti
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
Y RESIDE IN,THE ABOVE SCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE
_ FINAL
�\ VALIDATION ROBERT A. WOOD /'
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cIL\ M.D. CASH SUPERVISING MECHANICAL ENG'R
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