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76A667-CE#817 10-82 PEE
APPLICATION FOR PI imBING P RMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING77
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS GC{•µ
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WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
EARE STCROSS . A4C
NUMBER FIXTURE OR ITEM EACH FEE
_ OWNER
WATER CLOSET $1.25 MAIL
J BATH TUB 1.25 ` �5 ADDRESS
CITY TEL. NO.
SHOWER 1.25 r
LAVATORY 1.25 t z� CONTRACTOR u Jif G.
SINK 1.25 ADDRESS .4//
DISHWASHER 1.25 CITY L ) TEL. NO.
CONTRACTOR'S STATE COUNTY �
LAUNDRY TUB 1.25 REGISTRATION NO. 12 7,9
CLOTHES WASHER 1.25 DISTRICT IN GROUPJONE 1,R ESSED BY
WATER HEATER 1.50 Ic
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL d
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V
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APPROVALS DAfTE INSPECTOR'S SIGNATURE
PERMIT $ 2 OO UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE Z 00
GAS PIPING
I HEREBY 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 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES MC ,6! ,ted,.
re
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
V LIDATION ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENG'R
Lr' o4 9 6 41--o OCT 16 5 D 7.00-
76AG67 (CE-817( - 1/75
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES '�` � s
DEPARTMENT OF COUNTY ENGINEER r� a
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BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
HARVEY T. BRANDT, COUNTY ENGINEER ADDRESS
LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEAREST
NUMBER FIXTURE OR ITEM @ FEE CROSS ST.
WATER CLOSET 2.00 OWNER
MAIL
BATH TUB 2.00 ADDRESSq
SHOWER 2.00 CITY C~G �„�� TEL. NO.
LAVATORY 2.00 CONTRACTOR C
SINK 2.00 ADDRESS /7✓✓✓ (� �G�`
DISHWASHER 2.00 CITY TEL. NO.
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CLOTHES WASHER 2.00 STATE f� n LIC v
LICENSE NO. L. �1r CLASS
SWIMMING POOL RECEPTOR 2.00
DISTRICT NO.G OUP ZONE P CESSE BY
LAWN SPRINKLER SYSTEM 2.00 ;OT j
WATER HEATER 2.00 INDUSTRIAL ���CCC
WASTE APPROVAL
GAS SYSTEM OUTLETS 2.00 INSPECTION RECORD V
OUTLETS OVER
5 PER SYSTEM .30 O
F-
ry co LLJ
a-
f/7
Z
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEES 00
TOTAL FEE �j
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. No. GAS VENT
HOT WATER HEATER
1 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 TH AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED L S ANGELES COUNTY AND `TATE OF
CALIFORNIA OR THAT I M T E LEGAL OWN OF, AND NTEND TO
RESIDE IN THE ABOVE D C ED RE DE T L PROPERT FINAL - .!.
SIGNATURE Py
OF PERMITTEE L �L
PERMIT VALIDATIONCK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
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