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APPLICATION FOR PLUMBI PERMIT
7
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 NAM A
BATH TUB 125
DRESS —5
SHOWER 125 CI TEL. NO _ S'
LAVATORY 125 CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 125 C TEL. NO
LAUNDRY TUB 1.25 STATE LIC /
LICENSE NO � ��` � CLASS
CLOTHES WASHER 1.25 DISTRICT NOGR ZONE P S BY
WATER HEATER 150 Q � o
GAS SYSTEM OUTLETS 1'so INDUSTRIAL O
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V
O
_ H
w
a
z
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITHALL 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
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDC IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
/VALIDATION
K� M O CASH
Lhuo 0 9 4 5 SEP 2 9 5 Dcv
D B S-17 25M SETS 12-45 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WM. J. FOX. CHIEF ENGINEER PLU
NATURE OF INSTALLATION DISTRICT NO. GR71AI
ZOE PERMIT NO.
r�
ROUGH FIXTURES COMPLETE
HEATER CESSPOOL 1-1
SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
GAS MISCELLANEOUS
APP ICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
C NAME ADDRESS
W
m ADDRESS LOCALITY
NEAREST
A CITY" /�� TEL N./V, CROSS ST.
COU TY
CERT.NO _,2-M EXPIRES � NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
3 ADDRES GCd
NORTH O �g
CITY (1 TEL.Nw . Y
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUAL CA ON.
r AA
PLUMBER
I AM THE LEGAL OW ER OF THDESCR ED
ABOVE. JPOPERTY
OWNER
CORRECTIONS
SOUTH
d
DESCRIPTION OF WORK
BATH TUB FURNACE a.
1 SHOWER DISHWASHER
1�LAVATORY REFRIGERATOR
� -KITCHEN SINK WATER SOFTENER
FLOOR SINK BAND TRAP
+@LOP SINK FLOOR DRAIN
e WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING
_METER=!�GAS SODA FOUNTAIN
OUTL GAS PIPING
GAS VENT
CESSPOOL
TOTAL NUMBER OF FIXTURES, SEPTIC TANK
CESSPOOI SEPTIC TANK SEWER II
TOTAL FEE UTILITY CO NOTIFIED
1 '�S�/J y
FINAL �f
°IT a6M s>yTs s-4s APPLICATION FOR PERMIT
DOAMMENT OF BUILDING
SAFETY
CO NTY OF LOS ANGELE PLUM M I G
WM.J. FOX.CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT GROUP O E / PERMIT .
ROUGH FIXTURES COMPLETE
HEATER CESSPOOL h SEPTIC TANK RZCEIVaD.BY._r READY FOR. DATR ISSUED
' FIRST INSPECTION f�
AS MISCELLANEOUS
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
NAM • • HAM COS ADDRM"
W
CITY
m ADDRESSLOCALITY
3.23 N. 61=9VERLY AVe;
p`I, CITY TEMPLE CIT'ftLOAL IF-
COUNTY na-
w
a- 1
CERT NO EXPIRES WK NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
3 ADDRESS
NORTH O
CITY TEL.No.
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
&HE
PwMe LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
N
a -
3 (d OWNER
i CORRECTIONS
SOUTH J
DESCRIPTION OF WORK z
BATHTUB FURNACE
SHOWER DISHWASHER O
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INBPECTOR'B NAME
WATER HEATER .-DENTAL LAVATORY ROUGH PLUMBING
METER-GAS _SODA FOUNTAIN GAS PIPING
oun
GAS VENT
CESSPOOL
l TOTAL NUMBER OF FIXTURES SEPTIC TANK I V
�,L _CESSPOOI Z aEPTIC TANK SEWER Y
S UTILITY CO.NOTIFIED I I 41
TOTAL FEE
FINAL '