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,DBS-17 - APPLICATION � O ° L,l�... 1 gN .� 9 T
I' '
• DIVISION OF BUILDING AND. SAFETY
Department of.County Engineer '
Countypf Los-Angeles
BUILDING'
WM.J. FOX. COUNTY ENGINEERADDRESS
CASSATT.D.GRIFFIN, SUPT OF BUILDING
•-.. ,- '-.. '.- ._• LOCALITY '`�t
FOR APPLICANT. TO FILL IN NEAREST s,� J
-. ��. CROSSST. !' .C''�� �l
OWNER` •s� i � _DIST T NO._ GROUP �� NE READY FOR INSPECTION
- _ .
MAIL "
�- , :
.ADDRESS'
ppb' ,, f - INDUSTRIAL
CITY .,6�' �tt1 .�+a: TSE Lu.:.N OE' WASTE APPROVAL •�'
.PLUMBER .•s'/:7.m'Yi°i A' 3 f"T ..w'�'a�'t + "a INSPECTION RECiO'RD
f # t y
.,ADDRESS. g."'i ,f-"-a PIF-F. e'`k%':.:�-'3v-.�t"'1►. .,
LICENSENO:
'NUMBER TYPE OF.FIXTURE OR.ITEM FEE
F;,L WATER CLOSET-(TOILET)- $/ I-t-) -
-. - -
BATH TUB
• SHOWER
t
—LAVATORY-(WASH BASIN)
J KITCHEN SINK Rlu
DISHWASHER
LAUNDRY TUB OR TRAY
1 CLOTHES WASHER
TOTAL NO. @ 0.80' APPROVALS
#y _.` - PATE INSPECTORS'SIGNATURE
GAS'SYSTEM" OUTLETS .� I.o6,. / 16" -
WATER HEATER. - • @ .7.00 ,�s L- UNDER SLAB WORK. - i I-:," 1,t�n �r•----- _
'ROUGH,PLUMBING �I
PERMIT S .I ' ' .1 00
f GAS PIPING
TOTAL FEE I / GAS VENT
Af HEREBY ACKNOWLEDGE THAT'I HAVE 'READ TH-IS APPLICATION HOT WATER HEATER
"AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH'ALL COUNTY, ORDINANCES AND STATE LAWS.REGULATING PLUMBING FIXTURES.. I I IA4 -sr'.
PLUMBING. I y
-I HEREBY CERTIFY THAT..I AM PROPERLY REGISTERED AND/OR T;GAS TEST'
LICENSED AS REQUIRED-..BY"LGS ANGELES COUNTY:AND'STATE OF -
CALIFORNIA OR ,THAT 1 AM, THE,-LEGAL OWNER-OF' .THE ABOVE UTILITY CO,NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE'
'OF PERMITTEE ...•-t.-4� A i:.o- Fled' .. .,.'FINAL ,. _ .. - Lx
:WILLIAM'J. FOX, COUNTY ENGINEER VALIDATION R.A. WOOD', CHIEF PLBG.'INSPECTOR
54 9 `JULI 1: 3 12.0 0