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(DEPARTMENT OF COUNTY ENGINEER PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FIR
FOR APPLICANT TO FILL IN LOCALITY
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BUILDING AA �,I NEAREST
ADDRESS Dy��. JI/tMl1.. CROSS ST.
4 0, DISTRICT NO. GROUP ZONE PERMIT NO.
LOCALITY Q
NEAREST T iJ
CROSS ST. I // RECEIVED BY Ready for Inspection DATEISSUED
OWNER r,
MAIL _ J INDUSTRIAL
ADDRESS WASTE APPROVAL
CITY VAA . TEL.NO. _ -9INSPECTION RECORD
PLUMBER I b A , 1 H
a co I
ADDRESS
CITY JLAJ TEL.NO.
' II ❑ST�TE
LICENSE N0. �� 19 I @'COUNTY J
PERMIT FEES a
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NUMBER TYPE OF FIXTURE OR ITEM FEE
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T WATER CLOSET(TOILET) @ 0.80 $ r ((tl//V It
/ BATH TUB @ 0.80
SHOWER @ 0.80 a
LAVATORY(WASH BASIN) @ T80
KITCHEN SINK @ 0.80 7v
LAUNDRY TUB OR TRAY @ 0.80 V
SLOP SINK @ 0.80
FLOOR SINK @ 0.80
FLOOR DRAIN @ 0.80,
DISHWASHER @ 0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM..............OUTLETS @ 1.00 OlJ
WATER HEATER @ 1.00
,.MIS ELLANEOUS
d APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00ROUGH PLUMBING J 7 w
TOTAL FEE Q v GAS PIPING / Y// ,v l A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- GAS VENT /
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH-ALL COUNTY ORDINANCES AND STATE LAWS p /
REGULATING PLUMBING. PLUMBING FIXTURES d 7
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THA ,II AM THE-LEGAL OWN- -V —
ER OF THE ABOVE DESCRIBED RE ENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE ' t
0 OF PERMITTEE..._---.-_= � "- ---...._.._..__--•----.--....�.--..-.LZ FINAL Com/ 3�
76@667 DBS 17 1/53