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76A667-CE4817 DAPPLICATION FOR PLUG PERMI U
COUNTY OF LOS 'ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING Y/�j
JOHN A. LAMBIE, COUNTY ENGINEERADDRESS C / /
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN(PR NT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 1.50
MAIL
BATH TUB 1.50 ADDRESS
SHOWER 1.50 CITY TEL. NO.
LAVATORY 1.50 CONTRACTO ,/ C�
SINK 1.50 ADDRESS 7 :.r
DISHWASHER 1.50 CI49
�.
CLOTHES WASHER 1.50 LICENSE O. OC� �� LIC e
STAT ECIC
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP ZO E PRO SS BY
--
LAWN SPRINKLER YSTEM 2.00
NATE L50 INDUSTRIAL U
WASTE APPROVAL
CD
GAS SYS M11 OUTLETS 1.50 INSPECTION RECORD -_ 1—
OUTLETS
OUTLETS OVER W
5 PER SYSTEM .30
Z
Plan check fee 25- of above. See reverse.
PLUMBING PERMIT ISSUING FEE 3 k2 00
TOTAL FEE LSC, - -
APPROVALS DATE INSPECTOR SIGNATURE
Plan check applicant UNDER SLAB WORK
NameROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel. NO. -
HOT WATER HEATER
1 HEREBY THAT
THE
THAT 1 HAVE READ THIS APPLICATION
ANO STATE TXAT TXE ABOVE IB CORRECT AND AGREE TOE COMPLY PLUMBING FIXTURES -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST-
PLUMBING.
EREB
HEREBY CERTIFY THAT AM PROPERLY REGISTERED ANDI OR UTILITY CO. NOTIFIEDLICE NSED CALIFORNIA
AS REQUIRED I M LOS ANGELES ER NTYOF, AND STATE OF
TO
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN.THE ABOVE DESCRIBED R.SIDIE1y_!4K PROPERTY FINAL G
ti
SIGNATURE JACK R. ALLEN, $u PER VISIN HANICAL ENG-R.
OF P. '—
PERMIT VALIDATION cK. M.C. CASH
PLAN CHECK VALIDATION CK. M.O. CASH '
LEI�o a y o JUN 3 s o 3.50-
76A667-CES17 B-57
APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES _
DEPARTMENT OF COUNTY ENGINEER E
ING /
BUILDING AND SAFETY DIVISION ESS �7JOHN A. LAMBIE. COUNTY ENGINEERCASSATT D, GRIFFIN. SUPT OP BUILDING LITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. -d. �(/ ,v .; S
NUMBER FIXTURE OR ITEM
OWNER t. �2 �.. 5 G IK
]� WATER CLOSET MAIL
y BATH TUB ADDRESS
SHOWER CITY TEL.NO.
y LAVATORY CONTRACTOR Al
y SINK ADDRESS �I uJe r
DISHWASHER CITY TIM le Ci TEL.NO. �p 77Jfr
'y LAUNDRY TUB CONTRACTOR'S 1 STATE Llmt
REGISTRATION NO. D COUNTY ❑
CLOTHES WASHER -
DISTRICT NO. GRIPNE xeAxx FOR Ies P[<T mn
WATER HEATER j
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
J @q $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE
OR FIXTURE UNDER SLAB WORK
ROU
PERMIT 5 1100 GH PLUMBING
J GAS PIPING
TOTAL FEE d GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING.
I 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 RESIDENTIAL P PERT
SIGNATURE ee
OF PERMITTEE FINAL
o+ 0�IDATION ROBERT A. WOOD.
SUPERVISING MECHANICAL ENG'R
C6. M.0. CASH
M431 60R AUG28 5 A 15.00 110