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APPLICA••
*ON FOR PLUMB�I/N("RMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIggVISION ABUDB ss -�, O G O
CASSATT D. GRIOHN A. FFIN, Sup E. f of Building
LOCALITY
FOR APPLICANT TO FILL IN xFaREST
CROSS ST tee.—�/ -
NUMBER FIXTURE OR ITEM u�O O Q G G/f/
^ OWNER _
'[ WATER CLOSET MAIL
BATH TUR E�fADDRESS
SHOWER CITY TEL. NO.
LAVATORY CONTRACTOR Valley Plumbin
SUIS ADDRESS 442 W. Fleetwoo
DISHWASHER CITY Glendora TEL. NO.
CONTRACTOR'S STATE
I LAUNDRY TUR REGISTRATION NO. 160847 COUNTY
CLOTHES WASHER DISTRICT NO. -G--R-OUP ��ZONE PRgltESSED BY
WATER HEATER --Z� . l-- I'1'`
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
n n
Uc
,..p� APPROVALS
0 ORER ITEM
BFDPC=RE S /� L/ �/ DATE/ INSP CTOR'S SIGNATURE
UNDER SLAB WORK -' /,i r
PERMIT $ 2 00 ROUGH PLUMBING
TOTALFEE GC-p GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING /-`
PLUMBING. PLUMBING FIXTURES
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST 'va�vwt
CALIFORNIA OR THAT I 4M THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED a1
DESCRIBED RESIDENTIAL ROPERT .
SIGNATURE �"dot(; /lLY/t✓+�
OF PERMITTE 4,& INAL V
ROBERT A.WOOD.
®P V ATION SUPERVISING MECHANICAL ENG'R
CK. M.0. CASH
i Ea6 0 6 0 FF9 4 5 A 12 .00
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