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'APPLICATION FOR PLUMBING P'ERMI'T"
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY .ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN, SUP T OF BUILDING LOCALITY
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FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
/ OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR
SINK _ 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
LAUNDRY TUB 1, CONTRACTOR'S STATE
REGISTRATION NO. %� 6 COUNTY 01
CLOTHES WASHER 1.25 DISTRICT NO GGROUP NE P ESSED BY
WATER HEATER 1.50 L-
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD x
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o
CL
APPROVALS DATE I INSFECTOR•SSIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK ^� II �l A �A
ROUGH PLUMBING
TOTAL FEE
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ-THIS APPLICATION )
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT A
WITH' ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING. _
va
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 1.
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE L OWNER OF,AND INTEND TO GAS TEST �.5
RESIDE IN,THE ABOVE DES IDENTIAL PR P TV UTILITY CO NOTIFIED
SIGNATURE
OF PERM ITTE -
FINAL P6�
LIDATION ROBERT A WOOD
CK M O CASH SUPERVISING MECHANICAL ENG'R
L�1La 4 7 1 41 RN 2 2 5 Q 1 1 .25-
DEPARTMENT OF COUNTY ENGINEER PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING /
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING C•� /: y� /tr NEAREST
BUILDIADDRENG
J 'L�iign L CROSS ST
�p y DISTRICT N0. 17GROUP ZONE PERMIT N0.///�//�����""""""
LOCALITY a4l. �i C.1/�.�,y `� ��� &/ 7�"`Qs�v
NEAREST /l / ) +G II
CROSS ST. RECEIVED BY Ready for Inspeotlon L�DATE ISSUED
LC
O W N E R A L' G r/✓Y+� IlesIADUSTRIXF
MAIL / WASTE APPROVAL
/
ADDRESS 4, A� ///mo�i/ , y�•Ci�✓rie��
CITY b-rrtiF� " TEL.NO. hx 7- INSPECTION RECORD
PLUMBER
ADDRESS
CITY TEL.NO. /
- ❑STATE �� � C� G-r•
LICENSE NO. ❑COUNTY ) J
PERMIT FEES ! a
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NUMBER TYPE OF FIXTURE OR ITEM FEE U,
WATER CLOSET(TOILET) @ 0.80 $
O
BATH TUB a 080
SHOWER @ 0.80
LAVATORY(WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY @ 0 80
SLOP SINK @ 0 80
FLOOR SINK @ 080
FLOOR DRAIN @ 0.80
DISHWASHER @ 0 80
DRINKING FOUNTAIN @ 080
URINAL @ 080
GAS SYSTEM..-------_-OUTLETS @ 1.00
WATER HEATER @ 1.00
MISCELLANEOUS
- 90 APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDERSLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE � GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE ")YI
OF PERMITTEE t.`.�:"_ dT.------
76A667 DBS 17 1/53