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YeAesr �y s-as APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. ,
PLUMBER �7 - 1�� ,• - RECEIVED BY ~,READY FOR PATE ISSUED
FIRST INSPECTION
ADDRESS �f-
BUILDING M1i r r
s'��� f �. Il-
L i BUILDING _
CITY " d E r'TEL, NO.' .� ADDRESS
1 �.F�L SIF= .
—LICENSE COUNTY NO. J \ EXPIRES r �C--� ;J _ LOCALITY • �' Y
NEAREST nL
PERMIT FEES CROSS ST. (� �_•r�' 'a
NUMBER I TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET (TOILET) Q 0.50 I$ ADDRESS
BATH TUB a 0.501 I CITY TEL. N •
ISHOWER Q 0.501 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
LAVATORY (WASH BASIN) Q 0.50 I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK Q 0.50 STATE LAWS REGULATING PLUMBING.
t CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY Q 0.50 I ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM OUTLETS Q 0.501 %
SIGNATURE OF
WATER HEATER Q 0.501 PERMITTEE -' 7 <
SLOP SINK « 0.501 INSPECTION RECORD ^
FLOOR SINK Q 0.50
_ I FLOOR DRAIN Q 0.501
DISHWASHER Q 0.501
DRINKING FOUNTAIN Q 0.50 1
URINAL Q 0.501 I - ,J
IHOUSESEWER Q 0.501 I Q
_Z
MISCELLANEOUS
0
I 1
1 I
1 I
APPROVALS
1 DATE INSPECTOR'S NAME
1 I ROUGH PLUMBING
GAS PIPING
�— GAS VENT
CESSPOOL Q 1.00 CESSPOOL
SEPTIC TANK: 1 I SEPTIC TANK
DRAIN ( ) PIT ( ) Q 1.00 � SEWER
PERMIT . I 1.00 _ GAS TEST
I UTILITY CO. NOTIFIED I
TOTAL FEE I $
FINAL
75A657 17 5-49 ® -- _ APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY '
COUNTY OF LOS ANGELES
WILLIAM J. FOX. CHIEF ENGINEER '
FOR APPLICANT TO FILL IN DIST� `i°NO. GR UP ON EF2MIT NIK
�qT �T
PLUMBER `
,��'�,. NOTTyNGIRA (CO. RE EWEn ElY READY FOR DAT SSUEO—
FIRST INSPECTION
4
.ADDRESS
123 No. Cloverly (Ave, ADDR
�EMPL`jJ CH T SOA II ESS T
CITY
COUNTY - LOCALITY
LICENSE NO. EXPIRES
NEAREST.
O
CRSS ST
PERMIT FEES /
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET (TOILET) Q O.50 $ ADDRESS M
BATH TUB @ O.50 CITY TEL. NO.
SHOWER Q 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
LAVATORY (WASH BASIN) Q 0.50
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALI.p LOS
LAUNDRY TUB OR TRAY @ 0.50 [ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL/OWN$R
I OF THE RESIDENTIAL PROPERTY QESCRIBED,ABOVE./ i
J GAS SYSTEM OUTLETS Q 0.50
SIGNATURE OF
WATER HEATER @ 0.50 PERMITTE
SLOP SINK @ O.So INSPECTION RECORD
FLOOR SINK Q 0.50
FLOOR DRAIN Q 0.50
DISHWASHER Q 0.501
DRINKING-FOUNTAIN Q 0.50
URINAL @ 0.50 J
HOUSE SEWER Q O.50
Z
MISCELLANEOUS
O
I
I
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
I, GAS VENT �7
CESSPOOL Q 1,00 I .//. (v/-N, CESSPOOL
SEPTIC TANK: SEPTIC TANK /.
DRAIN ( ) PIT ( ) Q 1.00 I SEWER •' Q C%iM o
PERMIT 1.00 GAS TEST
d UTILITY CO. NOTIFIED
$ _
TOTAL FEE _H FINAL I7�� �?;,�,
DEPAR'T'MENT OF BUILDING APPLICATION FOR :PERMVIIT .
COUNTY ®F LOS ANGELES PLUMBING
NATURE OF INSTALLATION DISTRICT No. JOB No. PERMIT No.
PLOUMBING UGH FIXTURES COMPLETE' "` I
READY FOR _
HEATER CESSPOOL SEPTIC TANK RECEIVED BY DATE ISSUED
�J�
TION >
GAS MISCELLANEOUS
PLICANT FILL IN 'HEAVILY OUTLINED PORTION ONLY,
I- - JOB I
NAME �� � „�„oh An
ADDRESS t
m ADDRESS
LOCALITY h
f
;k-. NEAREST � �
IL CITY EL. N,o,9 CROSS ST.
STATE COUNTY
LICENSE NO. REG. NO. _ K NAME wM-
DESCRIPTION OF WORK z MAIL `
3 ADDRESS
r 0
BATH TUB FURNACE •CITY EL. NO. _9
SHOWER ? DISHWASHER CORRECTI®NS
LAVATORY Y L4 9 REFRIGERATOR - - i
KITCHEN SINK _X_ WATER SOFTENER
FLOOR SINK SAND TRAP �— 11 _J-�S' ``�� 4.,. J1 „'Z!
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL �"9 .•
WATER CLOSET DRINKING FOUNTAIN -�� �, •-` /' ` �''� '_`` `�� �
WATER HEATER DENTAL LAVATORY
GAS J
OU'TL. METER SODA FOUNTAIN Q
SEPTIC TANK _.— Z
CESSPOOL Q'
O
TOTAL NUMEER OF FIXTURES
LOCATION OF SEPTIC TANK. OR CESSPOOL
NORTH
Q
F \\ m
w a
3 APPROVED
N
_ SPECTOR•S NAME DATE
ROUGH PLUMBING
L4 - -a �a
GAS PIPING w ~� 1 -•�
GAS VENT
CESSPOOL
SOUTH I SEPTIC TANK
INSPECTION FEE ��, SEWER
PERMIT FEE ' (*p UTILITY CO. NOTIFIED
TOTAL FEE (-'FINAL `���� ����� �' 1 1 sS