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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFET�
FOR APPLICANT TO FILL IN(PRINT OR TYPE( BUILDING
ADDRESS (' { //to j')'t 19
NUMBER FIXTURE OR ITEM @ FEE LOCALITY ,
WATER CLOSET
NEAREST
BATHTUB CROSS ST
d
SHOWER OWNER
LAVATORY MAIL -
ADDRESS
SINK CITY TEL NOa
DISHWASHER CONTRACTOR
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CLOTHES WASHER ADDRESS
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SWIMMING POOL RECEPTOR CITY 772W/� �' TEL NO, f/
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER LICENSE NO CLASS
GAS SYSTEM OUTLETS ig APPROVALS DATE INSPECTOR'S SIGNATURE
C UNDER SLAB WORK
OUTLETS OVER
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING .
GAS VENT
HOT WATER HEATER p®
PLUMBING FIXTURES QD
GAS TEST
Plan Check fee UTILITYCO NOTIFIED
PLUMBING PERMIT-ISSUING FEE$` 7 /� e
TOTAL FEE FINAL
Plan check applicant PLAN CHECK VALID ON
I
Name V � 0IIDvlT�
Address
City Tel No ' p j,2 A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTYORDINANCES O c U O �-
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION '
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 9 0,O �+
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIF
O NIA OR THAT I AM THE 0,00 t�
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE SCRIBED RESIDENTIAL O c C l' 0 V;}
PROPERTY
20G---�8
SIGNATURE
OF PERMITTEE
DISTRICT N P CESSED BY
INDUSTRIAL
WASTE APPROVAL
.76A667-CE817 12/59
APPLICATION FOR PLUMBING PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY RIVISION BUILD7777�a2 026 �JOHN A. LAMBI OUNTY NGINEER ADDR
WILLIAM A. JENSEN. SUPT OF BUILDING LOCALITY San Gabriel
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. ar Garibaldi 'Rurtnn
NUMBER FIXTURE OR ITEM
Ovam Monarc Esa s
WATER CLOSET
1 BATH TUB 'ADDRESS 11518 Lambert
crrr El Monte TEL. NO. Gi 1761
1 SHOWER
2 LAVATORY CONTRACTOR alley Plumbing (:o.
ADDRESS 442 W. Fleetwood Pl .
1 DISHSINK CITY Glendora TEL. NO. Ed 5-129'
DISHWASHER -
CONTRACTOR'S 16084I1 STATE ❑
LAUNDRY TUB REGISTRATION NO. COUNTY ❑
CLOTHES WASHER DISTRICTNO. GROUP I ZZOON]E PROCESSED BY
WATER HEATER s- �{ I
1 GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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a
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F
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W
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14 Q $1.00 PER ITEM l a
OR rDCTURE $, Ot APPROVALS DAT,EIINSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK Q�I wr7?-r
TOTAL FEE 00 ROUGH PLUMBING p�yl nn
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT r
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
L
MBING.
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
NSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST //r�
FORNIA OR THAT I AM HE LEG OWNER OF THE OVE
RIBED RESIDENT R RT UTILITY CO.NOTIFIED
NATURE PERMI1 I PEZ4 'N
®r VALIDATION ROBERT A. WOOD,
Cs. H.O. CASH SUPERVISING MECHANICAL ENG'R
2201 � F 12 .00
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