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76A667 -CE#817 5/63
�2 "'3 APPLICAGO FOR LUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
FADDRESS /Oo / �C�Y Lt/�5 TJOHN A LAMBIE. COUNTY ENGINEERWILLIAM A JENSEN SUP T OF BUILDINGFOR APPLICANT TO FILL IN t1
NUMBER FIXTURE OR ITEM EACH FEE p
OWNER �ItT�AM
WATER CLOSET $l MAIL
BATH TUB 1 25 air ADDRESS
SHOWER 125 i CITY TEL NO
LAVATORY 125 CONTRACTOR Alert P1umbinJ & H C d t i .
SINK 1,25 ADDRESS 13933 So., C r e n-3 h a vi Blvd .
DISHWASHER 125 CITY Hawthorne TEL. NO. 6S 93691
STATE 0
LAUNDRY TUB 125 J a REGISTRATIONN NO. 19,3617 C-�6 COUNTY
CLOTHES WASHER 1 25 27 DISTRICT NO GROUP Z NE PROCESSED BY
f WATER HEATER 1 50 L
GAS SYSTEM OUTLETS 150 SD INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD, u
/ -Aw
,tel za• tp-l. CL
Z
yAPPROVALS DATE I INSPECTOR S SIGNATURE
--------------
PERMIT $ 2 00 • UNDER SLAB WORK
ROUGH PLUMBING C.
_
TOTAL FEE �id " GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT 8
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE
PLUMBING LAWS REGULATING HOT WATER HEATER
ID
CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS N LES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM TH E AL OWNER OF,AND INTEND TO
4-7-6k Qm_tft
RESIDE IN, THE ABOVE DESCRIB SIDENTIAL ROPERTY UTILITY CO NOTIFIED .6
SIGNATURE
OF PERMITTEE FINAL 4-7,6 4-
�AIJDATION ROBERTA WOOD
M O CASH SUPERVISING MECHANICAL ENG R
r LA�o3702Z-03 DEC 19 5 D 20.00