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D B s >1 2aAl SETS iz 4o `� APPLICATION FOR-PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES �`
Wm J FOX CHIEF ENGINEER
NATURE OF INSTALLATION DIST R CT NO GROUP /tZONE PERMIT NO
FIXTURES ROUGH COMPLETE I A ^
—1 6 t'J 3
HEATER CESSPOOL 1-1 SEPTIC TANK EIVED BY READY FOR DATE ISSUED
✓ FIRST INSPECTION ' 1_�
GAB MISCELLANEOUS (�
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APPLICANT FILL IN HEAVILY UTLINED PORTION ONLY
JOB
ADDRESS JZ 1 AP0 AV a'
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JNEAREST
4 CITY TELNo CROSSST
COUNTY I
CERT No EXPIRES It I NAME A00,8LCkT� L L�/l S
LOCATION OF SEPTIC TANS, OR CESSPOOL 3 AMAIL DDRESS ��/�. /—�/��(y I Ve
NORTH O C
CITY Q G" TEL No
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION
PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE `
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CORRECTIONS �.
SOUTH
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DESCRIPTION OF WORK
ATH TUB FURNACE
M
ROWER DISHWASHER �
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR BINK BAND TRAP
LOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS —
WATER CLOSET DRINKING FOUNTAIN DATE`/ lN9Cff T21t s NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING
METER I GAB SODA FOUNTAIN
OUn GAS PIPING
GAS VENT
��) CESSPOOL
TOTAL NUMBER OF FIXTURES f!"✓ SEPTIC TANK
CESSPOOL SEPTICTANK I ^ SEWER TOTAL FEE I $ �� 0-0 UTILITY CO NOTIFIED
FINAL // Y
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONADDRESSDf
JOHN A LAMBIE COUNTY ENGINEER nn
COLEMAN W JENKINS SUPT of BUILDING LOCALITY �jy.. [e CL
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
Y eek
NUMBER FIXTURE OR ITEM EACH FEE
OWNER `
WATER CLOSET 1 50 �Q
KAM
BATH TUB 1 50 ADDRE$'g In
SHOWER 1 50 SV CITYN TEL NO ��3��
LAVATORY 1 50 rj V CONTRACTOR
SINK 1 50 ADDRESS
DISHWASHER 1 50 CITY TEL NO
CLOTHES WASHER 1 50 STATE LIC
LICENSE NO CLASS
SWIMMING POOL RECEPTOR 1 50
DISTRICTN GRP ZONE PR EBBED BY
LAWN SPRINKLER SYSTEM 2 00 S09 ,� I'd-
O
WATER HFATER 1 50 INDUSTRIAL V
WASTE APPROVAL Z
GAS SYSTEM OUTLETS 1 50 0
INSPECTION RECORD F.
OUTLETSOVER v
5 PER SYSTEM 30 a-
Z
Plan cllec k fee 2-)% of abo,�e See reverse
PI UNIBIN( PERMIT ISSIIINC FI C S 2 00
IOTAL FFC
APPROVALS DA IN CTORIS SIGN RE
Plan check -ippllc int UNDER SLAB WORK !
Mame ROUGH PLUMBING
AddregS GAS PIPING
GAS VENT
Cit) I el No HOT WATER HEATER
IH
ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT AM THE LEGAL OWNER OF AND INTEND TO
BESIDE IN THE ABOVE iCRIBED REGI TIAL ROPER7Y FINAL /
SIGNATURE -/T
OF PERMITTEE { JACK R ALLEN SU E vISIN HANICAL ENG R
PERMIT VALH)A ION c K M o CASH
PLAN CHECK VALIDATION CK M 0 CASH
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