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7 APPLICATIO FOR PLUIV B G PERMIT
DBS-17 10-55
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los'Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS d
CASSATT D.GRIFFIN, SUPT OF•BUILDING
LOCALITY
FOR APPLICANT TO FILL IN I NEAREST
CROSS ST. 1 D
OWNER (- L DISTRICT NO. GROUP I ZONE I RE A Y FOR INSPECTION
MAIL
ADDRESS G' _ au
INDUSTRIAL
CITY A D 6 L/T J ' TEL. NO. WASTE APPROVAL
PLUMBER ' INSPECTION RECORD
LI S' I
ADDRESS J }49 1l E
I p �� ` ' I -
CITY IJ` } TEL. NO. p �(S 'L�e�. .sir
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE /
]/ WATER CLOSET (TOILET) @ $1.00 $ e;40
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00 e, V
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER "@ $1.00
j WATER HEATER @ $1.00 U U
! GAS SYSTEM @ $1.00 tJ
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 00 ROUGH PLUMBING _
GAS PIPING
TOTAL FEE I I. t-rj GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE•TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING, PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM T ZMA-�
OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL ROP
SIGNATURE
OF PERMITTEE FINAL �'3� �j
n
JOHN A. LAMBIE, COUNTY ENGINEER ALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK ( N.0. CASH
L^�0 �. 5 D
76A667 08917 11-50 APPLICATION FOR PERMIT
.
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER PLUMBING 1
DISTRICT 90 .
FOR APPLICANT TO FILL IN ROU� P ERMIT NO
PLUMBER el
I?6 � `� RECEIVED BY READY FOR DATE ISSUED
ADDRESS
�j�� SI ��� � � AOL,-
. 'FIRST INSPECTION BUIL
CITY C(- 8-mzl— TEL Na� I�y`f�� ADDRESS �f�
.COUNTYI s$ ADDRESS G
LICENSE NO. ! / ' EXPIRES /�p J'Y LOCALITY
NEAREBT
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL '
_ WATER CLOSET(TOILET) 0.50 IS ADDRESS 3(;
BATH TUB @ 0.50 CITY TEL. N0.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) (¢Z 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK Q 0.50 AND STATE LAWS REGULATING PLUMBING. -
I CERTIFY THAT I P09BESS THE ABOVE VALID LOB
LAUNDRY TUB OR TRAY 0.50 ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM-J--OU'rLETB 0.50
SIGNATURE DF,&4 0? .aua
WATER HEATER @ 0.50 PERMITTED
BLOP BINK @- 0.50 - INSPECTION RECORD
FLOOR BINK @ 0.50
FLOOR DRAIN 0.50
DISHWASHER Q 0.50
DRINKING FOUNTAIN 0.50
URINAL @ 0.50 J
Q
HOUSE SEWER _ @ 0.50 Z
MISCELLANEOUS E3
0
o
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
r� 1
GAS PIPING
Lam'
GAB VENT
CESSPOOL 49 1.00 CESSPOOL
SEPTIC TANK: SEPTIC.TANK,'
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT 1.00 OAS TEST
j
UTILITY CO.NOTIFIED 0n"
/
TOTAL FEE
FINAL