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cE en I-BW APPLICATION FOR PLUMBING PERMIT
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1
AND SAFETY DMSION 1
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE,COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING
LOCALITY
FOR-APPLIRMT TO FILL IN NEAREST
�r• CROSS ST. B!✓�ifPG
OWNER S MAI L ,,/aJ� DISTRICT NO. GROUP ZONE/ READY FOR INSPECTION
ADDRESS Orr/(/�{/�.��i I tool A 1
RIAL
CITY /� �' TEL. NO. �T/�+ !� WA TEINDUSTAPPROVAL -
PLUMBER QCt3N .� INSPECTION RECORD
ADDRESS
CITY TEL. NO.
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
p GAS PIPING
TOTAL FEE GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT VI(ATERHEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. pLUMBTNG FIXTURES
1 HEREBY CERTIFY TH I AM ROPERLY REGIST ED AND/OR GAS TEST '
LICENSED AS REQUIRED Y LOS GELES CO T!101 ND TATE OF
CALIFORNIA OR TZHAI AM T LEGAL N 0 HE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDEN AL R RT�
SIGNATURE /�
OF PERMITTE - FINAL _
ROBERT A.YV0016.
JOHN A. LAMBIE, COUNTY ENGINEER AIMATION SUPERVISING MECHANICALENG'R
CK. W-0.0 8 CXSR�; juL 1 :7 - . 3 2.0 r�
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DEPARTMENT OF COUNTY ENGINEER P L U M B I N 0 � .•• 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING �[
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
•. v
OR APPLI(`ANT TO FILL IN -LOCALITY
NEAREST
BUILDING �/w / CROSS ST.
ADDRESS
DISTRICT NO. GROUP ZONE PERMIT NO.
LOCALITY \, [l_ '
NEAREST 7D RECEIVED BY Ready for Inspection DATE ISSUED
CROSS ST. \ V
OWNER (O
MAI La INDUSTRIAL
ADDRESS d ? WASTE APPROVAL
CITY hA A) _.TEL.N0. Io �g d 7 INSPECTION RECORD
PLUMBER
ADDRESSr (� VA A VkL
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CITY TEL.NO. �jj ml h�i
[]STATE
LICENSE NO. p� ([�6OUNTY J
PERMIT FEES a
z
NUMBER TYPE OF FIXTURE OR ITEM FEE
,l
WATER CLOSET(TOILET) @ 0.80 $
` BATH TUB @ 0.800 V O
�^^ SHOWER @ 0.80 0
N 'LAVATORY(WASH BASIN) @ 0.80 �U.O
KITCHEN SINK @ 0.80 6 D
LAUNDRY TUB OR TRAY @ 0.80
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 v
WATER HEATER @ 1.00 Q
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT S 1 00 ROUGH PLUMBING A
TOTAL FEE GAS PIPING
1.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 /
REGULATING PLUMBING. PLUMBING FIXTURES ,
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED'
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THA AM THE LEGAL OWN- s
ER OF THE ABO E DESC BED RE E TIAL PROPERTY. UTILITY CO.NO 1�
SIGNATURE / 04
OF PERMITTE _ 1�._= ... . .....
FINAL �.li .r3✓ �`'��
76A667 DBS 17 1/63