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76AGe7 n 5-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY I
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT'NO. GROUP ZONE PERMIT NO.
VALLEY IMLEVARD PLUMBING CO. .01-1 �?o/ -!B
PLUMBER RECEIVED BY READY FOR DATE ISSUED
6300 EASTVALLEY BLVD. FIRSTINSPECTIONA
ADDRESS y 'JI '/
ROStMLAU AT. 2.2719 BUILDING ADDRESS /o O .� as{7 y�
CITY TEL NO. 7 �G
COUNTY 93M LOCALITY J�
LICENSE NO. EXPIRES f
NEAREST
PERMIT FEES CROSS sT
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET (TOILET) Q O 50 $ � �/ ADDRESS
BATH TUB Q O 50 I i7 CIT TEL. NO.
SHOWER @ O 50 .S t) 1 1.0 HEREBY CKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ O SO I-_ /f70 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
_T AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ O 50 �'Q STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
/T
LAUNDRY TUB OF RAY @ O 50 `, v ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL- PROPERTY DESCRIBED ABOVE.
GAS SYSTEM OUTLETS @ O 50
WATER HEATER @ O 50 S SIGNATURE PF
PERMITT
SLOP SINK Q 0.so INSPECTION RECORD
FLOOR SINK Q O 50
FLOOR DRAIN @ O 501 77`
DISHWASHER Q O 501
DRINKING FOUNTAIN @ O 50
URINAL @ 0 Sol-I J
HOUSE SEWER Q O 50 � z
MISCELLANEOUS
I� O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING J✓� '
GAS PIPING
SY f
GAS VENT
CESSPOOL Q 1 00 CESSPOOL
SEPTIC TANK I SEPTIC TANK
DRAIN ( ) PIT ( @ 1 00 SEWER
PERMIT . I 1 00 GAS TEST
UTILITY CO NOTIFIED P1
TOTAL FEE $ I ��
FINAL