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DSS-17,o-ss APPLICATION FOR PLUMBING PERMIT
SS-17
DIVISION OF BUILDING AND SAFETY :-
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN I NEAREST
CROSS ST.
OWNER DISTRICT NO. GROUP ZONE READY FOR INSPECTION
MAIL
ADDRESS
-INDUSTRIAL
CITY TEL. NO. WASTE APPROVAL
PLUMBER --1 INSPECTION RECORD
ADDRESS
CITY TEL. NO.
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $
BATH TUB @ '$1.00
'
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00 -
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00 -
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
PERMIT $ l OO" 1.1 ROUGH PLUMBING
GAS PIPING Vflr/
TOTAL FEE
GAS VENT
I HEREBY ACKNOWLEDGE THIAT 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. -PLUMBING FIXTURES
9
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 -=KLIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
CCK. M. O. CASH
' 1
76A667-CM17-I1-57
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES N
DEPARTMENT OF COUNTY ENGINEER 110
BUILDING AND SAFETY DIVISION ADDRESS BUILDIN / P i :L. C f
JOHN A. LAMBIE, County En weer
CASSATT D. GRIFFIN, Supt of Building
LOCALITYJ_
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
WATER CLOSET OWNER
MAIL
BATH TUB ADDRESS 91 / 4 if
SHOWER CITY f'r ;,L f' f 7—, TEL. NO.
LAVATORY CONTRACTOR >( 1, < /,% f A-7
I SINK ADDRESS
r..
DISHWASHER CITY. / /,/ r TEL. NO. )'
I LAUNDRY TUB
CONTRACTORS r ~STATE
REGISTRATION NO. J C. i COUNTY
CLOTHES WASHER DISTRIC.7•'-Pf6.— GROUP —ZONE READY FOR INSPECTION
/-t
WATER HEATER l J /
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
dol $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE
! OR FIXTURE $
UNDER SLAB WORK
PERMIT $ 00 ROUGH PLUMBING
TOTAL FEE f GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER 2_
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GASTEST �//1'�
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF J •
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE
FPERM TTEE rf� FINAL Z
...
ROSERTA.WOOD.
VALIDATION SUPERVISING MECHANI CAL ENG'R
i CK. M.0. CASH