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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUII.DING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A..JENSEN, SUPT OF BUILDING ��-
LOCALITY •
FOR APPLICANT TO FILL IN NEST ��� ���
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET
ADDRESS zjt=-
BATH TUB
SHOWER CITY ���• TEL. NO.
AA1LAVATORY CONTRACTORAV
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ADDRESS Qom/ �'. /G rl�,c�/
SINK
DISHWASHER CITY TEL. NO.CONTRACT
STATE
LAUNDRY TUB BEGISiBATION NO.' COUNTY
CLOTHES WASIiEB DISTRICT NO. GROUP ZONE PROCESSED BY
WATER HEATER �r - O
GAS SYSTEM INDUSTRIAL V
WASTE APPROVAL
INSPECTION RECORD
O
U
' a
H
$3:00 PER ITEM J
I OR FIXTURE / APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE 00 ROUGH PLUMBING
t' G PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AHD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I M THE LEGAL O - OF THE AS E
R
DESCRIBED RESIDE NTIA OPERTY. /�C UTILITY CO NOTIFIED
SIGNATURE, l/•� '
OF PERMITTE
FINAL 4��(�14
ALIDATION ROBERT A. WOOD
CK.
M.0. CASH SUPERVISING MECHANICAL ENG'R
LALO,4 6 7 3 0 OCT 8 5 D 3 2 5 N