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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / S
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NUMBER FIXTURE OR ITEM @ FEE ADDRESS
LOCALITY
WATER CLOSET
NEAREST / , t P
BATH TUB � � CROSS ST VL LIA /V �1
SHOWER OWNER
LAVATORY MAIL "/
ADDRESS
SINK CITY en, ale. i TEL NO
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS j
SWIMMING POOL RECEPTOR
CITY TEL NO
LAWN SPRINKLER SYSTEM STATELIC
WATER HEATER LICENSE NO S CLASSC36_C,5�b
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES ;;):r-,,
GAS TEST
VD
Plan check fee UTILITYCO NOTIFIED
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL
Plan check applicant PLAN CHECK VALIDATION
Name
Address
City Tel No '30481A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE #� O O 0 O 0 5
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 O 0 Q O O
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE /�
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL O O O •�'Q O O U
PROPERTY ���111 nnn
SIGNATURE 1 ,y, �� �J ����47�
OF PERMITTE /�� ,Z�` , b G(// /Wfl-✓'
DISTRICT NO PROCESSED BY
INDUSTRIAL
WASTE APPROVAL
D B 17 7-40 25M APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING
WM. J. FOX, CHIEF ENGINEER
F NAT E"OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT No
ROUGH
PLUMBING FIXTURES �Ir COMPLETE �RECEI ED BY READY FOR DATE ISSUED
HEATER CESSPOOL ASEPTIC TANK FIRST INSPECTION
GAS MISCELLANEOUS •���Sf �'�
n APPLICANT FILL INHEAAVI9Y OUTLINED PORTION ONLY
NAME ' "�� ..��%v��/ JOB
ADDRESS 0
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ADDRESS LOCALITY i�
NEAREST
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J CIT '-.���, TEI.�.6N� ,�//�l/c�� CROSS ST.
COUNTY Cs` v
CERT. NO. EXPIRES (!9G°eiEf�✓'- T,'� yaj NAME i i 1 �1� ✓�-vim✓ �
MAIL
LOCATION OF SZ EPTIC TANK, OR CESSPOOL O ADDRESS �
NORTH
CITY L-�; TEL No.
1 AM THE LEGAL-//POSSESSO OF THE ABOVE LOS
ANGELES COUNTY/CERTIFICATE OF QUALIFICATION�./J)�
v PLUMBER
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
N �
OWNER
CORRECTIONS
I
i
SOUTH
DESCRIPTION OF WORK
a
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BATH TUB FURNACE
SHOWER DISHWASHER Ir
0
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
LOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR', !NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING
METER GAS SODA FOUNTAIN GAS PIPING
OUTL
GAS VENT
CESSPOOL
TOTAL NUMBER OF FIXTURES Q SEPTIC TANK _
CESSPOOL SEPTIC TANK SEWER
I$ O UTILITY CO. NOTIFIED I _
TOTAL FEE I I FINAL ' L
D. B. 17 7-40 25M ~ APPLICATION FOR PERMIT
DEPARTMENT OF RUILIDING AND SAFETY
COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER
` y NATURE OF INSTALLATION DISTRICT NO. I GROUP I( ZONEO� PERMIT No
ROUGH ,J •�I ��1 -•° ..s
PLUMBING FIXTURESMPLETE RECEIVED BY READY FOR DATE ISSUED
HEATER CESSPOOL SEPTIC TANK FIRS INSP ION
GAS MISCELLANEOUS - 0
APPLICANT FILL IN HEAVILY OUTLINED PORTIO, ONLY
JOB
NAMF4j ADDRESS 1 :Z n
fv
m ADDRESS ,Iw LOCALITY A ��[ l>
nNEAREd NO
CITY J6,�1(i �(� .^.� TEL . v.`j� 9 CROSS. T.
COUNTY
CERT. NO. / EXPIRESW NAME 1,j
Z MAIL
LOCATION OF SEPTIC TANK, OR CESSPOOL O ADDRESS
NORTH ,y
CITY :�4.+aQFi.'�ay TEL No.
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFI TE OF QUALIFICATION.
PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
N >
3 In OWNER
CORRECTIONS
SOUTH
DESCRIPTION OF WORK
z
BATH TUB FURNACE 3
_SHOWER DISHWASHER
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME
WATER HEATER _ DENTAL LAVATORY ROUGH PLUMBING _
METER GAS SODA FOUNTAIN GAS PIPING
OUTL
GAS VENT
® CESSPOOL
TOTAL NUMBER OF FIXTURES SEPTIC TANK
_CESSPOOL SEPTIC TANK SEWER
$ UTILITYCO. NOTIFIED
TOTAL FEE FINALI
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