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7OA667 17 5 SO APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING 1
WILLIAM J FOX CHIEF ENGINEER
FOR APPLICANT TO F L IN DISTRICT NO GROUP ZONE PERMIT NO
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PLUMBER RECEIVED BY READY FOR DATE ISSUED
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C-'+ / FIRST INSPECTION
ADDRESS / "/ „,
® BUILDING
017111
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CITY BDAa fd" TEL NO ADDRESS U
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COl1 TY LOCALITY
LICENSE NO EXPIRES
NEAREST
PERMIT FEES CROSSST !�
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET (TOILET) Q O 501$ ADDRESS
i BATH TUB @ O 50 1 CITY TEL NO
SHOWER @ O 50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Q O 50 I APPLICATION AND STATE THAT THE ABOVEIS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
1 KITCHEN SINK Q O 50 I STATE LAWS REGULATING PLUMBING
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ O 50 I ANGELES COUNTY LICENSE OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
1 GAS SYSTEM OUTLETS Q O 501 SIGNATURE OF
WATER HEATER @ O 50 1 PERMITTE
SLOP SINK @ O 50 I I INSPECTKbfi RECORD/
FLOOR SINK Q O Sol
FLOOR DRAIN @ O 501
DISHWASHER Q O 501
DRINKING FOUNTAIN Q O 50
URINAL Q O 501 J
HOUSE SEWER @ O 50 1 1 1�e-o- Q
MISCELLANEOUS 1 (�
i
1
APPROVALS
DATE INSPECTOR S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
f CESSPOOL Q 1 00 1 CESSPOOL
SEPTIC TANK SEPTIC TANK
I DRAIN ( ) PIT ( ) @ 1 00 I SEWER
PERMIT 1 00 GAS TEST
UTILITY CO NOTIFIED
TOTAL FEE $
6015'4 FINAL
76AG67 n 0 50 0 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J FOX CHIEF ENGINEER
FOR AP LICANT, TO FILL INn DISTRICT NO GROUP I ZONE PERMIT NO
PLUMBER 4,6 ;�. '�=�Sa RECEIVED BY READY FOR DA TE ISSUED
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ADDREFIRST INSPECTION
SS . b� 4'+lY i � ��Yii- F �
py+/ BUILDING
CITY TEL NO�� " ('J ADDRESSCOUNT
LICENSE
y+� �j c- ' LOCALITY C'
LICENSE NO EXPIRES
NEAREST
PERMIT FEES CROSS ST
NUMBER TYPE OF FIXTURE OR ITEMFEE
OWNERS
MAIL
WATER CLOSET (TOILET) Q O 50 $ I ADDRESS
BATH TUB Q O 50 IJ CITY TEL NO
SHOWER Q O 50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
LAVATORY (WASH BASIN) @ O 501
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ 0 1=0KITCHEN SINK @ O 50 STATE LAWS REGULATING PLUMBING
1 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ O 50 ANGELES COUNTY LICENSE OR 1 AM THE LEGAL OWNER
0 I
GAS SYSTEM OF THE RESIDENTIAL/PROPERTY DESCRIBED ABOVE
ip OUTLETS @ O Sol SIGNATURE
O
WATER HEATER @ O 501 Eb' ' d
SLOPSINK ERM
I� INSPECTION RECORD V
FLOOR SINK @ O Sol � ��
FLOOR DRAIN @ O Sol
DISHWASHER @ o 50I '
DRINKING FOUNTAIN @ O 50
URINAL @ O 50 J
HOUSE SEW ER @ O SOi� z
MISCELLANEOUS 0
1 � I
I� o
I-J
I
I
APPROVALS
DATE INSPECTOR S NAME
ROUGH PLUMBING '-
GAS PIPING
GAS VENT
CESSPOOL Q 1 00 I CESSPOOL
SEPTIC TANK I SEPTIC TANK
I DRAIN ( ) PIT ( ) Q 1 00 SEWER
PERMIT I 1 00 GAS TEST
UTILITY CO NOTIFIED
TOTAL FEE $
FINAL
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