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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION w
ILDING
JOHN A. LAMBIE. COUNTY ENGINEERWILLIAM A. JENSEN, SUPT OF BUILDING FOR APPLICANT TO FILL IN NUMBER FIXTURE OR ITEM EACH FEEWATER CLOSET 51.25 BATH TUB 1,25
CITY EL. NO.
SHOWER 1.25 _
LAVATORY 1.25 CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY j?lTEL. NO.
CONTRACTOWS STATE
LAUNDRY TUB 1.25 REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GR p E PRO SED BY
WATER HEATER 1.50 f
}
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL o_
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD 11
/ 0
1v I bf i OF
/ c c,
z
APPROVALS DATE INSPECTORS SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH15 APPLICATION GAS VENT `
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST rr
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERT� UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL Q
S(ALIDATION ROBERT A. WOOD
O. CASH SUPERVISING MECHANICAL ENG'R
LE1Lv 6 2 7 8 DEC.: 8 5 A 4.50-
IN
76 A 667—CE 817 8/68
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ZC ,!
1;2-
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST. _
NUMBER FIXTURE OR ITEM EACH FEE
OWNER`C'
WATER CLOSET 1.50
MAIL L
BATH TUB 1.50 ADD �, 15.1 /J
SHOWER 1.50 TEL. NO. •-fie
LAVATORY 1.50 CONTRACTOR
SINK 1.50 ADDRES ["
DISHWASHER 1.50 C .� TEL. NO
CLOTHES WASHER 1.50 STATE LIC
LICENSE N CLASS
SWIMMING POOL RECEPTOR 1.50
DIBTR�NO. GRO Z`ONE PR �F BY
LAWN SPRINKLER SYSTEM 2.00 / l] o
WATER HEATER 1.50 INDUSTRIAL �C V
WASTE APPROVAL Z
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD 0�
OUTLETS OVER U
5 PER SYSTEM .30
Plan check fee. 25- of above. See reverse.
PLUMBING PE11MIT ISSUING FEE S 2 00
TOTAL FETE D
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan Check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Addre55 GAS PIPING
GAS VENT
Cil)' Tel. No. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
1 HEREBY CERTIFY THAT 1 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. NO INTEND TO
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL
SIGNATURE JACK R. ALLEN, SUPERVISING CHANICAL ENG'R.
OF PERM ITTE `/
la PERMIT VALIDATION CK. M.O. cASH,
PLAN CHECK VALIDATION CK. M.O. CASH
i p('„ 8 4 0 5 JAH 2 0 5 A 3.5 0"