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76A 67.4C E-817)-4/72 0160 ZLU' MBING
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APPLICATION FOR PERMIT COUNTY OF LOS ANGELES �J
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY { p��PL
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEARESTCROSS ST.
NUMBER FIXTURE OR ITEM @ FEE OWNER
WATER CLOSET 1.75 v
MAIL
BATH TUB 1.75 ADDRESS
SHOWER 1.75 CITYJ=pj e CA TEL. NO.
I• LAVATORY 1.75 CONTRACTOR
SINK 1,75 ADDRESS
DISHWASHER 1.75 CITY TEL. NO.-
CLOTHES WASHER 1.75 STATE LIC
SWIMMING POOL RECEPTOR 1.75 LICENSE NO. IIICLASS
DISTRIC�VO. GROUP ZONE OCESSED BY
LAWN SPRINKLER SYSTEM 1,75 �•�
WATER HEATER 1.75 INDUSTRIAL 9 r
WASTE APPROVAL 6r
GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD U
OUTLETS OVER
5 PER SYSTEM 30 f /8 173 1 O
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ .3 00
TOTAL FEE 160
APPROVALS DATE IaPErT.11 I S .NATURE
Plan check applicant O 1� 73
UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO. GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES 7, ' `
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST
iF
I HEREBY CERTIFY THAT AM PROPERLY REGIST D AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED B LO ANGELES COUNTY ADISTATE OF
CALIFORNIA OR THAT I TH LEGAL 0WNE OF, N I TEND TO
L
SIDE IN THE ABOVE DE CRIB D RES ENTIPRO ER FINALIGNATU RE
OF PERMITTEE
PERMIT VALIDATION OM.O. CASH
PLAN CHECK VALIDATION CK. M.0. CASH
4 �' 3652)73DST17 5D 10.000
�76A667-CE#817 4-67
APPLICATION FOR .s PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER fADDREUILDING ('
BUILDING AND SAFETY DIVISION SSJOHN A. LAMBIE, COUNTY ENGINEERCOLEMAN W. JENKINS. SUPT OF BUILDING OCALITYFOR APPLICANT TO FILL IN EAREST /+ rROSS ST. Ci
NUMBER FIXTURE OR ITEM EACHi FEE
"OWNER 6
WATER CLOSET $1.25
MAIL
BATH TUB 1.25 ADDRESS .7 AaAs4
SHOWER 1.25 CITY j 7�1 TEL. NO.
LAVATORY 1.25 'CONTRACTOR C
ADDRESS T a
SINK 1.25 �{ t
DISHWASHER 1.25 CITY TEL. NO.,?-,?Ig SS'2 Z
STATE LIC
LAUNDRY TUB 1.25 i LICENSE NO. CLASS
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCESSED BY
WATER HEATER 1.50 �' �'(f d` r
GAS SYSTEM 2 OUTLETS 1.50 A INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 >'
INSPECTION RECORD o
o
' U
00 W
O_
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ Z O0 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING I -10-41_1
I HEREBY ACKNOWLEDGE THAT i 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' D P
i v
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES �
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF /m ,/{,A y�
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST I-19 Of
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED v�
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SIGNATURE �p ,,y
�!o A wkly I
OF PERMITTE FINAL
VALIDATI JACK R. ALLEN
CK M o CASH SUPERVISING MECHANICAL ENG'R^ ,.
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