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COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUILDING & SAFETY
WILLIAM J FOX, County Engineer
DISTRICT O. GROUP I ZONE
FOR APPLICANT TO FILL IN f
PLUMBER VALLEY BOULEVARD PHIMBING cc) rVED BY READY FOR DATE ISSUED
FIRST INSPECTION
ADDRESS 8300 EAST VALLEY BIND
BUILDXG
CITY ROSEMEAD TEL- N-. ADDRESSCOUNTY (O
LICENSE NO. --"' EXPIRE-3 6-3 - LOCALITY
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER `
MAIL
WATER CLOSET(TOILET) a O.sp 0 ADDRESS
BATH TUB 0.5 CITY TEL. NO
SHOWER 0.40 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Cgs
0.40 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0. O U AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY a 0150 O ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE REBIDENTIA PROPERTY DESCRIBED A VE.
GAS SYSTEM OUTLETS 0 0150 v v O
�• SIGNATURE OF
WATER HEATER 6 O 50 PERMITTE
SLOP SINK 50 INSPECTION RECORD
FLOOR SINK 60
FLOOR DRAIN C.50
DISHWASHER c 50
DRINKING FOUNTAIN 13.50
URINAL 050 Q
HOUSE SEWER O 50 Z
MISCELLANEOUS P
O
APPROVALS
DATE //1 SPECTOR'S NAME
ROUGH PLUMBING
OAS PIPING
GAB VENT
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: EqlSEPTIC TANK
DRAIN ( ) PIT ( ) 0 1.00 SEWER ,���jj ,j�Sp�T
J
PERMIT 1.00 OAS TEST / 1\ t '
UTILITY CO.NOTIFIED
TOTAL FEE 0 I V yi
Lg FINAL 'F
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