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76A667-CE817 12/59
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 0 ¢
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPIT OF BUILDING LOCALITY -
L
FOR APPLICANT TO FILL IN NEAREST
n CROSS.ST.
NUMBER FIXTURE OR ITEM
O'
WNER
WATER CLOSETMAIL
ADDRESS
BATH TUB CITY:' d CDJ rE
L. NO.
3 SHOWER
CONTRACTOR 1
LAVATORY
/
SINS ADDRESS 'f uos
-
DISHWASHER TEL.:NO..
CONTRACTOR'SL STATE
LAUNDRY TUB REGISTRATION NO. �`(/6 d� 9 COUNTY
CLOTHES WASHER DISTRICT NO. GR UP ZONE PRO ESSED BY
WATER HEATER L "
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL w
INSPECTION RECORD O
U
w
D
_ a
@ $1.00 PERITEM
OR FIXTURE $ I/ v APPROVALS DATE INSPECTOR'S SIGNATURE'
PERMIT $ 2 00 UNDER SLAB'WORK
TOTAL FEE G) .^ ROUGH PLUMBING
/ •GAS PIPING
1 HEREBY ACKNOWLEDGE THAT' 1 HAVE READ THIS APPLICATION -
' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY >. GAS VENT -WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 'p HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS AN ELES COUNTY AND STATE OF :. .GAS TEST
CALIFORNIA OR THAT 1 AM THE $GAL OWNER OF T ABOVE
DESCRIBED RESIDENTI�PROPERTY, i '. UTILITY CO.NOTIFIED -
SIGNATURE � ,�
OF PERMITTE FINAL '
®r VALIDATION-• ROBERT A. WOOD,
CK
.0. CASH SUPERVISING MECHANICAL ENGR
8 ; b.