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APPLICATION FOR PL BING IT,
COMITY ow Los ANdEMS
DUARTNM OF COUNTY MGA
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NUMBER FUCrURE Ort ITEM
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5 ; 5.00 APPROVALS DATE 1""X DR•S WGRATURs
PERMrr 2 00 WMER Sue WORK
TOTAL FEE
ROUGH PLUMBIN
GAB PIPING
1 HIERTRY ACK11 I '(flAi I HAYI READ T I AFFLICATIOX GA9 VHNC
AID DTATI THAT Tlri ADOY7< Il CORRICT All A TO COYFLT
LITH ALL COUNTY ORDIWCIB L� 8TAT1 I_U RIQULATINa HOT WATER HFJ4TE7t
FLUIMS
I HIRIIT CMdLPV THAT I Al FRDFKRLT RIHSTEM AND/OR PLUMBING FIXTURES
UCI■S<D AS RIQUIRID NY LOS ANSILIR COUNTY AND ITATI OF rMal�W=- ,/,if/
CALIFORNIA QR THAT I AN THI LI SAL O�iN OF THi ADM G"T�� `
DISCRIDtD RWDLffUA1,g,PRO UTILITY CO.NOTIFIEDBIGNATURIT
OF PERMITTER
m• VAMATION ROBERT A. WOOD,
Q. CAM/ y ■ SUPERVISING MJ19HAMICAL EN(rH
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76A667-CE817-8-57
COUNTY of LOS APPLICATION FOR PLUMBING PERMITANGELES
1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OL ,
WATER CLOSET WNER � z
IL
BATH TUB
ADDRESS
SHOWER CITY 2- TEL.NO.
LAVATORY CONTRACTO 1
SINK ADDRESS
DISHWASHER CITY TEL.NOC,A ,
LAUNDRY TUB CONTRACTORS STATE
REGISTRATION NO. O 0 COUNTY
CLOTHES WASHER
DISTRIC NO. GROUPZONE READY FOR INSPECTION
WATER HEATER _L:77 0
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
z ?E- !
h 17'-
APPROVALS 7'-APPROVALS
Qa $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE
OR FIXTURE $ " UNDER SLAB WORK
PERMIT t 1100
ROUGH PLUMBING
GAS PIPING
TOTALFEE GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 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 FIXTURES
PLUMBING.
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED
DESCRIBLD RESIDENTIAL PROPERTY.
SIGNATURE
OF PERM I T T E E FINAL
op I /
ROBERT A. WOOD,
VALIDATICASH�SUPERVISING MECHANICAL ENG'R
CK. M.0.
(, 1628 V 9 3 A 4.00
YSAe" w g'b§ M APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER PLUMBING 1
i
FOR APPLICANT TO FILL IN DISTRICT NO. GRP ZONE pER%T�,
,,J"" )q / 6 7
PLUMBER / V\ - REfoLVED BY READY FOR DATE ISSUED
FIRST INSPECTION
f f.
ADDRESS -
BUILDING
CITY TEL. NO. ADDRESS
COUNTY LOCALITY • t
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES CROSS ST.
NUMBER I TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET (TOILET) @ O.50 $I I ADDRESS
BATH TUB @ O.50 I CITY TEL. NO.
SHOWER @ 0.501 I 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (MASH BASIN) @ 0.50 I APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ 0.501 STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ O.50 I ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM-OUTLETS @ 0.50SIGNATURE OF
WATER HEATER @ 0.50 PERMITTEE
SLOP SINK @ 0.501 INSPECTION RECORD
FLOOR SINK @ 0.50
_ I L+-
FLOOR DRAIN @ 0.501
DISHWASHER @ 0.50
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.501 ( ..1
TI HOUSE SEWER a 0.501 I Q
MISCELLANEOUS I (�
O
� I
I
I
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.00 I_ CESSPOOL I
ISEPTIC TANK: I V ( SEPTIC TANK (
DRAIN ( ) PIT ( Y ) @ 1.00 I SEWER
PERMIT . I 1.00 GAS TEST
TOTAL FEE $
UTILITY CO. NOTIFIED
I - I /
_2 FINAL
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES PLUMBING
WM.J. FOX. CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUPI ZONE PERMIT NO.
ROUGH FIXTURES COMPLETE _
READY FOR DATE ISSUED
RECEIVED BY
HEATER CESSPOOL SEPTIC TANK FIRST INSPECTION
GAS- MISCELLANEOUS
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
NAME ADDREAS
Im AD-D--R�E�SS \� LOCALITY
J
CITY I NEAREST
IL __ 1'Q.w .} TEL.N� 6 _ CROSS ST.
COUNTY
CERT.NO. j EXPIRES Fz
NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL MAIL
3 ADDRESS
NORTH O
CITY TEL.NO.
IAM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
PLUMBS
I AM THE LEGAL OWNER OF THE PROPERTY OMCRIBED
p� ABOVE.
W D
3 i OWNED
CORRECTIONS
SOUTH
J
DESCRIPTION OF WORK a
z_
BATH TUB FURNACE
SHOWER DISHWASHER O
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
—..I.WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'R NAME
WATER HEATER DENTAL LAVATORY -
ROUGH pLUT,lB]N6
i METER GAS SODA FOUNTAIN
OUTL GAS PIPING
I
GAS VENT
CESSPOOL
_ TOTAL NUMBER OF FIXTURES SEPTIC TANK
a CESSPOOL SEPTIC TANK SEWER
$ UTILITY CO.NOTIFIED
TOTAL. FEE L/ Q
FINAL