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COUNTY OF LOS ANGELES r,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DrWSION BUII DING `
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ,YYI S/Z ,C,fUe GL
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN CROSS TT. �a Q
NUMBER FIXTURE OR ITEM OWNER
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WATER CLOSET buuL
ADDRM S� S' re D t
BATH TUB
CITY aiEL. NO. _ L
SHOWER a
CONTRACTOR
LAVATORY
ADDRESS
SINK �y
DISHWASHER CITY TEL NO.CONTRA
LAUNDRY TUB REGISTRATIONS NO. 7 y2 �' 7 COUNATY
CLOTHES WASHES DISTRICT NO. GROUP ZONE PR CESSED 13Y
WATER HEATER — J d
INDUSTRLAI. O
GAS SYSTEM WASTE APPROVAL u
INSPECTION RECORD 1%
f O
tl'!
® $1.00 PER ITEM
OR FIXTURE $ I i APPROVALS PATE INSPECTOR'S SIGNy_ATURB
PERMIT $ / 2100 UNDER SLAB WORK �/(ta
TOTAL FEE ROUGH'PLUMBING p, 1(q_ V
GAS PIPING
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -
D AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER ttlJ _��, ��
PLUMBING.
i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
C
ALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE GAS TEST
DESCRIBED RESIDENTIAL fllt OPERTY. UTILITY CO NOTIFIED ) r �'•
SIGNATURE -7� f ' T w A
OF PERMITTE FINAL
ALIDATION ROBERT A WOOD
EK.
M.0. CASH SUPERVISING MECHANICAL ENG'R