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76A667 (C E-817)-4/72
`t' APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER 4-
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO 7ADD
NGSSHARVEY T. BRANDT, COUNTY ENGINEER ITYFOR APPLICANT TO FILL IN (PRINT OR TYPE) ST STS
NUMBER FIXTURE OR ITEM @ FEE
' OWNER 1
WATER CLOSET 1 75
MAIL
BATH TUB 1 75 ADDRESS
SHOWER 1 75 ` CITY TEL NO
LAVATORY 1 75 ) CONTRACTOR -Z
SINK 1 75 ADDRESS
DISHWASHER 1 75 CITY C,,V,2 TEL NOS
CLOTHES WASHER 1 75 STATE LIC
—
SWIMMING POOL RECEPTOR 1 75 LICENSE NO CLASS
DISLELLCT NO GROUPgZNE FRLAWN SPRINKLER SYSTEM 1 75 00r �
WATER HEATER 1 75 17INDUSTRIAL Q
WASTE APPROVAL
GAS SYSTEM OUTLETS 1 75 SPEC TI Q N 7RCORD CRD
OUTLETS OVER
5 PER SYSTEM 30 s� O
W
a
h
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INS CTOR 5 5 GNATURE
Plan check applicant UNDER SLAB WORK T
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I 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
PLUMBING GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGIS ERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY L S ANGEL TY AND STATE OF
CALIFORNIA OR THAT I A T LEGA /OF AND INTEN TO
RESIDE IN THE ABOV C B D RESIDENTIAL R PERTY FINAL
SIGNATU RE
OF PERMITTEE
PERMIT VA LI[}A;T / cK M O CASH
PLAN CHECK VALIDATION CK M CASH
► �' 2 3 5:3 MAY 3 0 5 D 17004
APPLICATION
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75A667 A 0 LICA G ION FOR PLUMBING PERMIT
DBS 17 10 55
DIVISION OF BUILDING AND SAFETY
Department of County Engmeer 1
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
11,U131 dAa4�-
CASSATT D GRIFFIN,SUP T OF BUILDING
LOCALITY !'�
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
OWNER DISTRICT O GROUP 171
E/ I READY FOR INSPECTION
MAIL
ADDRESS
INDUSTRIAL
CITY TEL NO WASTE APPROVAL G—
PLUMBER `� INSPECTION RECORD
Valley alle Rumbing Co. of C7r1pnCTnr2
d
CITY 442 W FygL% 4 Place a
Glendora, a 1 ornla
LICENSE NO EDgewood 5-1293
NUMBER TYPE OF FIXTURE OR ITEM FEE
v WATER CLOSET (TOILET) @ $1 00 $
I BATH TUB @ $1 00
i
SHOWER @ $100
LAVATORY (WASH BASIN) @ $100
KITCHEN SINK @ $1 00
DISHWASHER @ $100
LAUNDRY TUB OR TRAY @ $1 00
CLOTHES WASHER @ $1 00 I
WATER HEATER @ $1 00
GAS SYSTEM @ $100
APPROVALS
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
ROUGH PLUMBING 3 Z' '440 A
PERMIT $ 1 00
• GAS PIPING
TOTAL FEE IQ
GAS VENTEREBY `�
ANDH (J STATE THAT THEDGE ST CORRECT AI HAVE END AGREEAD THIS COMPLY HOT WATER HEATER 7
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING �7',��g ,r'•�
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 PROPERTY
SIGNATURE
OF PERMITTEE FINAL
JOHN A LAMBIE COUNTY ENGINEER ALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK ma
CASH
�_ ��0 7 6 1. —kr APR 2 9 3 1 0.0 0 In