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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE W YE
OWNER 1
WATER CLOSET $1.25 MAIL
BATH TUB 1,25 ADDRESS ® L
CIT 1: TEL. NO.
SHOWER 1.25
LAVATORY 1.25 CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY �// TEL. NO.'
LAUNDRYE'fUB 1.25 CONTRACTOR'S ` STATE [I
REGISTRATION NO. / COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GRfO_ UP ZONE PROSSED BY
WATER HEATER 1.50 � 1� �vr� /`
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD d
o
101,'y is/6,4� 7N;�_;° ; ;;, 2!
_ APPROV.4 LRS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER'SLA`R WORK a .
ROUGH PLUMBING11A w' 1,.-AV"v
TOTAL FEE ...r. GAS PIPING II
p'�ll!1, `
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I 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 THA119-
HE LEGAL OWNER OF,AND INTEND TORESIDE IN,THE ABORIBED RESID TIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE :< /
OF PERMITTEE '
FINAL .
VALIDATI�ROBERT A. WOOD
CK. M.0. CASH n/SUPERVISING MECHANICAL ENG'R
LAC6 2 3 O 91 NOV 6 5 a 1 1.0 0-
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7ZA667
DBS;17 12.54 APPLICATION FOR PLU.MB*ING PERMIT
., •
DIVISION OF BUILDING AND SAFETY �~
Department of County Engineer
County of Los Angeles
BUILDING 570 5
WM. J. FOX, COUNTY ENGINEER ADDRESS +7 ,Y
CASSATT_D. GRIFFIN, SUPT OF BUILDING -
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
OWNER Q �;..�/ W�/..� �'�v
DISTRICT ICT NO. OUP READY FOR INSPECTION_
MAIL
ADDRESS O •/ JJ(�.Ny
b
INDUSTRIAL
CITY TEL:NO. WASTE APPROVAL '
P ' - INSPECTION RECORD
t
ADDRESS3W;- Gaevey �Z••, d$ +�t.4�`!" . d�,... _ .
CITYMonterey ' O.
` LICENSE NO
NUMBER TYPE OF FIXTURE OR ITEM FEE I -
WATER CLOSET (TOILET) -S 160. -
BATH TUB v' -
SHOWER / '
-Y LAVATORY (WASH BASIN) 1 ,6c
KITCHEN SINK - - .
DISHWASHER '
LAUNDRY TUB OR TRAY
CLOTHES WASHER Ira
TOTAL NO. @ 0.80 APPROVALS
DATE INSPECTOR'S SIGNATURE
l GAS SYSTEM OUTLETS @ 7.00 ��
` UNDER SLAB WORK
WATER HEATER @ 1.00 �L7
ROUGH PLUMBING
PERMIT S I 1 00 GAS PIPING
TOTAL FEE �zv GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER _
AND STATE THAT THE ABOVE IS'CORRECT AND AGREE TO COMPLY 11
• WITH ALL COUNTY- ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING. V y
HEREBY CERTIFY THAT -1 AM- PROPERLY REGISTERED AND/OR GAS TEST 4
LICENSED 'AS REQUIRED BY LOS'.ANGELES COUNTY AND STATE OF.T UTILITY OTIFIED
CALIFORNIA OR THATI AM E LEGAL OWNER OF THE ABOVE CO.. -r_
DESCRIBED RESIDENTIAL, PROP T .
SIGNATURE
OF PERMITTEE -FINAL
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
._.kCO 3 4 2 2'�-- my ' � -3 9.4 0 m
_ -.. _ BY i
DEPUTY '