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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUiLDING
ADDRESS 10250 Freer $t.
JOHN A. LAMSIE. COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY T� le Cit
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE OWNER _ J B Weber Develo meat
2 WATER CLOSET $1.25 21 50 MAIL
]- BATH TUB 1.25 l 25
ADDRESS 5926 T le City Blvd
1. SHOWER 1.25 1 25 CITYTem le City TEL. NO.
2 LAVATORY 1.25 2 50
CONTRACTOR Valley Plumbing Co.
1 SINE 1.25 1JADDRESS 442- W. Fleetwood Pl.
1 DISHWASHER 1.25 1 Glendora TEL` NO-Ed 5-1293
CONTLAUNDRY TUB 1.25 SHAT ON NO. 209431 COUNTY CTOR'S STATE 0❑
1 CLOTHES WASHER 1.25 ZISTRICT NO. GROUP NE O ESSED BY
WATER HEATER 1.50 1GAS SYSTEMOUTLETS 1.50 1AL CL
IUS IPPROVAL 0
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK --r ow
ROUGH PLUMBING
TOTAL FEE 16 55 GAS PIPING
IH
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.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES (!
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST �r-`y��r' '-
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO 1
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED I D—I `G' V IA@'�'�-�C�
SIGNATURE .I A
OF PERMITTEE
FINAL 64.-
n ,VALIDATION ROBERT A. WOOD U
C M O CASH SUPERVISING MECHANICAL ET1G'R
L&o 2 0 7 6 Z APR 2 4 5 D 1 6.5 -5-