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76ASS7 17 9-49 ® APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY a a 1
COUNTY OF LOS ANGELES P LU
WILLIAM J. FOX. CHIEF ENGINEER i
FOR j�AQ*jPP/LIIICpyA���N�TgJyry/Tq�O}��p�FILyLq�� LIN ERN
GROUP ZONE PERMIT O.
PLUMBECo* "®�' ""•"""�+�+a1�Y ®O READY FOR_ D T 1 �
{!� J*y' FIRSJT_144SPECTION
FOR-
ADDRESS /1g1�123 S'o. Cloverly Ave. '.
CITY +�.djl►aPILE CITY,,Y,,"Lj � -BUILDING
ADDRESS v�+
COUNTY LOCALITY
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES 'cRoss sr. Qhs
NUMBER TYPE OF FIXTURE OR ITEM FEE 'OWNER
MAIL t�3�tf ibC
WATER CLOSET (TOILET) Q O Sol$l$ ADDRESS
BATH TUB Q 0.501 I CITY TEL. NO.
SHOWER Q 0.501 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) Q 0.501 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK Q O 501 STATE LAWS REGULATING PLUMBING.
LAUNDRY TUB OR TRAY Q 0.50 I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
ANGELES COUNTY LICENSE. OR I AM THE I-EGAL OWNER
GAS SYSTEM OUTLETS Q 0.50 I S I
OF THE PESIDENTIA P OPE T.Y D@SC IBQD� g V�
Cj.�IAM�I"Ip'R
WATER HEATER Q O.50 I ;�/ P
TT
SLOP SINK Q 0.501 INSPECTION RECORD
FLOOR SINK Q 0.501
FLOOR DRAIN Q 0.50
DISHWASHER Q O.SO
DRINKING FOUNTAIN Q 0.50I
URINAL Q O.SO I I J
IHOUSESEWER Q 0.50I I Z
MISCELLANEOUS I I a
I
0
I�
I
APPROVALS
DATE INSPECTOR'S NAME l
ROUGH PLUMBING
GAS PIPING
I. I GAS VENT
CESSPOOL Q 1.001 I CESSPOOL �I
SEPTIC TANK: I `SEPTIC TANK
DRAIN ( ) PIT ( ), Q 1.001 C SEWER
PERMIT . I 1.00 GAS TEST
$ A UTILITY CO. NOTIFIED
I TOTAL FEE
7
FINAL G'
O