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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING Q _
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY ' Cb
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST. n
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 1.50
MAIL ;
BATH TUB 1.50 ADDRESS4!7,z9 "Cj
W.
SHOWER 1.50 CITY / C V TEL. NO.
LAVATORY 1.50 -CONTRACTOR ' 7-3200. 0-0
SINK 1.50 ADDRESS. Z.�V �.
DISHWASHER 1.50 CITY�j; G TEL. NO.�'.
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. 2 2,-S743 CLASS
SW{MA1ING POOL RECEPTOR 1.50 DISTRICT NO GRgPP ZONE PR CES ED BY
LAWN SPRINKLER SYSTEM 2.00 'J' D � �
O
WATER HEATER 1.50 INDUSTRIAL U
WASTE APPROVAL o
GAS SYSTEM. OUTLETS 1.50 ,i INSPECTION RECORD
OUTLETS OVER
U
5 PER SYSTEM .30 d
C/J
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Plan check fee 257' of above. See reverse.
PLUMBINC PERMIT ISSUING FEE 5 2 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan Check applicant UNDER SLAB WORK
Name ROUGH PLUMBING,
Address GAS PIPING
GAS VENT
City Tel. No.
HOT WATER HEATER
I E HEREBY ACKNOWLEDGTHAT I HAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED.AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN. TM ABOVE DEB IBED RESIOEN PROPERTY. FINAL
SIGNATURE .TACK R. ALLEN, SUPERVISIN NAE CHANICAL ENG'R.
OF PERMIT E
PERMIT VALIDATION CK.� M.O. CASH
PLAN CHEC' K VALIDATI cK. M.O. CASH
SEP 5 5 D 3.5. 0