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APPLICATION FOR LUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS p Q
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CAAOSSSS
NUMBER FIXTURE OR ITEM EACH FEEI' t
OWNER
-� WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDR
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR 1
SINK 1.25 ADDRESS772 (02,44197
DISHWASHER 1.25 CITY TEL. NO. y
CONTRACTOR'S STATE
LAUNDRY TUB 1.25 REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE ESSE,D 81
WATER HEATER 1.50
GAS SYSTEM OUTLETS 1'� INDUSTRIAL
P� WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD U
1 Qs= W
I
I
I
I
I
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ Z On UNDER SLAB WORK
F- ROUGH PLUMBING z+
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLIC TION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER D INTEND TO
RESIDE IN, THE ABOV LCRIB ED REST NTIA ROP Tr. UTILITY CO. NOTIFIED `
SIGNATURE '
OF PERMITTE �` �4� -
FINAL
VALIDATION ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
Uil,o 5 4 4 9 Na0V 2 5 D 2.7 j
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APPLICATION OR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN, SUP T OF BUILDING LOCALITY _ +
FOR APPLICANT TO FILL IN NEAREST
CROSS S
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $125
— IL
BATH TUB 1 25 ADDRESS
SHOWER 125 CITY TEL NO
LAVATORY 125 CONTRACTOR
SINK 125 ADDRESS
DISHWASHER 125 CITY'fj
TEL NO
LAUNDRY TUB 125 CONTRACTOR'S TA'L'E
REGISTRATION NO JCOUNTY ❑
CLOTHES WASHER 1 25 DISTRICT NO GROUP ONE 1 SSED BY
WATER HEATER 150
GAS SYSTEM OUTLETS 1 50 INDUSTRIAL a
WASTE APPROVAL L^ f0 .� 0
OUTLETS OVER 5 PER SYSTEM 30 INSPE ION RECORD
t LU 1. Tjd 'u /Fa- �i rL a
W
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING d
ele
ti
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
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
CALIFORNIA OR THAT I AM THE LEGAL OWNER O AND INTEND TO GAS TEST j 1
RESIDE IN THE ABOV SCRIBED RESID IAL O ERTY / UTILITY CO NOTIFIED ( s
SIGNATURE
OF PERMITTEE
V DATION ROBERT A�WOOD
cK M O CASH SUPERVISING MECHANICAL ENG R
Llj1o50311 OCT20 5 D 6.00-