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7SA687 17 9-49 ® APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
1
COUNTY OF LOS ANGELES mhul
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
PLUMBER FO.NTANA p( LIMBINr- CONTRACTOR RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION G e
ADDRESS 344 W. Garvey - Mon77t77erey Park, Cali
njberl=d,3.j BUILDING
CITY A� 2_4654 TEL NO ADDRESS Ci
COUNTY /pl LOCALITY
LICENSE NO JS EXPIRES bs'
NEAREST
PERMIT FEES CROSS ST
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET (TOILET) Q O Sol$ 0 ADDRESS
�/BATH TUB Q O 50 I I � CITY TEL NO.
4"S-HOWER Q O Sol I%3 4)_ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
�• -LAVATORY (WASH BASIN) Q O 50 O APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING PLUMBING.
KITCHEN SINK Q O 50 I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY Q O 50 I ® ANGELES COUNTY L E ORI AMaTHE LEGAL OWNER
OF THE RESIDENTIAL PERT DESCRIBED ABOVE.
GAS SYSTEM OUTLETS Q O 50 SIGNATURE OF
-l-WATER HEATER Q O 50111 S a PERM ITTE
SLOP SINK Q O 50 I INSPECTION RECORD
FLOOR SINK Q 0 SO I
_ FLOOR DRAIN Q O 501
DISHWASHER Q O 501
DRINKING FOUNTAIN Q O Sol
URINAL Q O 50I,_
HOUSE SEWER Q O 501 'Z
MISCELLANEOUS I� 2
I I O
I�
I I
I�
APPROVALS
DAY9 INSPECTOR'S NAME
ROUGH PLUMBINGyy
GAS PIPING
( GAS VENT
CESSPOOL Q 1 00 I L_ CESSPOOL
SEPTIC TANIC. I I SEPTIC TANK
I DRAIN ( ) PIT ( ) Q 1 00l SEWER
PERMIT I 1 00 GAS TEST
• $ ®® UTILITY CO NOTIFIED
I TOTAL FEE p
FINAL �ly.t� � a�j
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