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76A667-CE817-11-57TO Lel4l
APPLICATION ,_ FOR PLUMBING •PERMIT
COUNTY OF-�iQS-.ANrdELELES
DEPARTMENT OF d6UNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING n
JOHN A. LAMBIE, Count Engineer ADDRESS Y 7,
CASSATT D. GRIFFIN, Sup t of Building 1 r —�
LOCALITY
a
FOR APPLICANT TO FILL IN NEAREST r
CROSS ST.
NUMBER FIXTURE OR ITEM -
OWNER
WATER CLOSET � �� .
BATH TUB
ADDRESS
SHOWER � -•'-
CITY
.eft-i. r- TEL. NO. p
r
LAVATORY CONTRACTOR �r 1•�J. h
SINK ADDRESS I r f „,
DISHWASHER CITY .rte TEL. NO:
LAUNDRY TUB CONTRACTOR'S STATE ❑
REGISTRATION NO. -COUNTY ❑
CLOTHES WASHER DISTRI T NO• GROUP ZONE I READY FOWINSPECTION
WATER HEATER ✓
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
$1.00 PEA ITEM .. DATE INSPECTOR'S SIGNATURE
OR FIXTURE $ 'G� UNDER SLAB WORK
PERMIT \\ S p4_0O ROUGH PLUMBING
TOTAL FEE \ GAS PIPING
7 U
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS,APPLICATL4V GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE-TO COMPLY, HOT WATER HEATER
WITH ALL, COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. _ PLUMBING FIXTURES
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1,AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED `
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE -
OFPERMITTE icy'.+•-. % .<<'l.sl(e•'S t, FINAL
ROBERTA.WOOD.
®F ' I
VALIDATION _ SUPERVISING MECHANICAL ENG'R
CK.� 0 i
76A667C ICE 617-A)- 11/76 app A p N
APPLOCA
FOR
G PERMIT
COUNTY OF LO ELES
EPARTMENT OF C U TY ENGINEER
BUILDING ANDS TY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 6234 ,N. LOMA
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY „•.MPU CITY
BATH TUB NEAREST
CROSS ST
SHOWER OWNER PP" 111UHAT F
LAVATORYMAIL S+� -
' ADDRESS
SINK CITY TEM CITY TEL NO 286-2 11
DISHWASHER CONTRACTOR TRANE HCG
CLOTHES WASHER ADDRESS 2034 N. PECK RD.
SWIMMING POOL RECEPTOR
LAWN SPRINKLER SYSTEM CITY S EL MD= TEL NO9-7982
WATER HEATER LICENSE NO 265094 c STATE AS 20
1 GAS SYSTEM 1 OUTLETS 3 00 DISTRICT NO ZON P SSED Bl^
OUTLETS OVER
IG.06
5 PER SYSTEM INDUSTRIAL 9L
WASTE APPROVAL Q
INSPECTION RECORD
O
1�
w
N
Plan check fee
PLUMBING PERMIT ISSUING FEE$ 50
TOTAL FEE 1 7150
Plan check applicant
APPROVALS DATE INSPECTOR S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel No GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES �l
REQUIRED BY LOS ANGELES COUNTY AND STATE OF LIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF AND INTEND TO RESIDE IN TH B VE D SCRIBED RESIDENTIAL r
PROPERTYUTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
wam
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PLAT F RI Irl PF3I\ SAT ION PERMIT VALIDATOI�ON 5 CK M o CASH
0 1 9J � —,
POLICYHOLDER: C717-: tJl AOSookLL es
POLICY NUMBER: v ( 19 00 ry"0-116�-