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D.B.S.-17 ?5M SETS 12-45 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUPLUMBING
COUNTY OF LOS ANGELES
Wm. J. FOX. CHIEF ENGINEER
' NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO.
ROUGH FIXTURES COMPLETE _
HEATER CESSPOOL I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
GAS MISCELLANEOUS
AP ICANT FI IN HEAVILY OUTLINED PORTION O LY
�/ JOB
K NAME !--'iL^�- (/ ADDRESS 1.
W
ADDR@SS LOCALITY r.
D '� NEAREST
J CITY TEL.No. CROSS ST.
IL
COUNTY
CERT.No. /J" EXPIRES w NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
3 ADDRESS
NORTH 0
CITY TEL.NOj 1 AM THE LEGAL POSSESSOR OF THE
ANGELES COUNTY CERTIFICATE OF QUALIFI
PLUMB
I AM THE LEGAL OWNER OF THE PROPERABOVE.
OWN
CORRECTIONS
SOUTH
DESCRIPTION OF WORK — z
c�
BATH TUB FURNACE
-SHOWER DISHWASHER O
LAVATORY REFRIGERATOR
KITCHEN SINK __WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN
DATE INSPECTOR'S NAMC
WATER HEATER _DENTAL LAVATORY ROUGH PLUMBING I,4-
METER-GAS
4rMETERGAS aODA FOUNTAIN
OUTL GAS PIPING
GAS VENT
CESSPOOL
_TOTAL NUMBER OF FIXTURES SEPTIC TANK
CESSPOOI SEPTIC TANK SEWER
TOTAL FEE - UTILITY CO.NOTIFIED
�
FINAL
dis COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
epartment of County Engineer
DIVISION OF BUILDING & SAFETY u G
WILLIAM J. FOX, County Engineer PLI
LE�EIVED
NO. GRJ;Lup ZONE PER .
FOR APPLICANT//T❑ FILL IN PLUMBER C... / f "� I ,S BY READY FOR DATE ISSUED
FIRSTINBPECTION
ADDRESSy -\ BUILDING - —� y
CITY P`S p �Q /Va .TEL.. No. v ADDRESS of
COUNTY
LICENSE NO. C7� / EXPIRES /v e S ,� LOCALITY
NEAREST
PERMIT FEES CROSS ST. j6rQ -
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER G_
MAIL
WATER CLOSET(TOILET) @ E3040 $ ADDRESS
BATH TUB @ D-)O CITY - /_ TEL. No.
SHOWER @ 040 I HEREBY A NOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ O. O APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.110 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
13.40 LAUNDRY TUB OR TRAY a 0 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIA PROPERTY UadRIBED VE.
GAS SYSTEM OUTLETS @ 13.AD SIGNATUREF-- /
WATER HEATER @ OPERMITTEE y
SLOP SINK @ D. D INSPECTI ECORD
FLOOR SINK @ D.5 F .f
l J4r 7 20�
FLOOR DRAIN @ O.
DISHWASHER @ ❑ 0
DRINKING FOUNTAIN Q O. O
URINAL CgT O. O Q
HOUSE SEWER @ O.io Z
MISCELLANEOUS
D
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING �-���sw ,��.{• ,.-
GAS PIPING
GAS VENT I
CESSPOOL @ 1.00 CESSPOOL '
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT 1.00 GAS TEST
UTILITY CO.NOTIFIED
TOTAL FEE $ f
(/ FINAL
76A667 DBS $17 6-52
D.B.S.-17 25M SETS 12-45 APPLICATION FOR PERMIT
DEPAgTT OF BUILDING AND SAFETY
COU ��������
° COUNTY OF LOS ANGELES
Wm. J. FOX. CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO.
ROUGH FIXTURES COMPLETE J`
HEATER CESSPOOL I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
GAS MISCELLANEOUS
APPLICANT FILL'IN HEAVILY OUTLINED PORTION ONLY
` JOBADDRESS
.�
C NAME �.I+. r'
W
� ADDRESS7zZa _21 -L"ILL ;-{�' LOCALITY
OJ
NEAREST.. CITY y�J� .,.-�ri _� TEL.No. CROSS ST
COUNTY r
CERT.No. EXPIRES W NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
3 ADDRESS
NORTH 0 r
CITY -� TEL.No.
IAM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
PLUMBER
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
OWNER
CORRECTIONS
SOUTH
DESCRIPTION OF WORK
BATH TUB FURNACE
SHOWER DISHWASHER
0
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN
DATE INSPECTOR'S NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING
METER GAS SODA FOUNTAIN
OUTL RAS PIPING
GAS VENT
�'
TAL NUMBER OF FIXTURES CESSPOOL SEPTIC TANK
CESSPOOL SEPTIC TANK SEWER
Is
TOTAL FEE UTILITY CO.NOTIFIED
FINAL