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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ����✓� + /
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CHAS SST
NUMBER FIXTURE OR ITEM
OWNER l��- ••�„6/
WATER CLOSET 1 ,s b MAIL
BATH TUB
ADDRESS
3 ,
CITY TEL. NO.
SHOWER CONTRACTOR Valley Plumbing Co.
Y� LAVATORY L S a
SINS
ADDRESS 442 W. Fleetwood Pi.
/ . 1 ��
DISHWASHER S CITY Glendora TEL. NO. Ed 5—'129”
CONTRACTOR'S �t�p,� STATE
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LAUNDRY TUB REGISTRATION NOX60847 COUNTY ❑
CLOTHES WASHER Y f DISTRICT NO. GROUP ZONE RQCESSED BY
WATER HEATER ) (( C d
GAS SYSTEM L INDUSTRIAL 0
WASTE APPROVAL
INSPECTION RECORD
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--" F amu $ - APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE ' r ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE GAS TEST
DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
VALIDATION ROBERT A. WOOD
CK
M.0. CASH SUPERVISING MECHANICAL ENG'R
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