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APPLICATION FOR LUMBIN4ERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION /
UILI
MAKE CHECKS PAYABLE TO: ADDRESS -1
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
Czj,2 j
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST / /
CROSS ST. ! f /V
NUMBER FIXTURE OR ITEM @ FEE
. WATER CLOSET
2.00 OWNER AV Sok—
MAIL /
BATH TUB 2.00 ADDRESS 6cS- Cl
SHOWER 2.00 CITU �n ` TEL. NO. �q-00J 3-,
LAVATORY 2.00 CONTRAC OR
SINK 2.00 ADDRESS
° DISHWASHER 2.00 CITY TEL. NO.
CLOTHES,WASHER 2.00 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 2.00
DISTRICT NO.GROUP ZONE 0,110ESLS
[-1 BY
LAWN SPRINKLER SYSTEM 2.00 ,
Pao
WATER HEATER 2.00 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLET 1 INSPECTION RECORD p
OUTLETS OVER V
5 PER SYSTEM .30
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O
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LLJ
W
G.
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Z
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. NO. GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ••THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES'
;- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST o e �y1
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED B LOS ANGELES COUNTY AND STATE OF
CALIF ORMA OR THAT 1 M THE LEGAL OWNE�Z, AND INTEND TO �rIRNIA H'E ABOVE- SCR BEDRESIDENT ARTY• FINAL - �.l u. f � f
SIGNA*TU RE _ 0: •ie '
OF PERMITTEE 4
PERMIT VALIDATION /M,O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH'
COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer ,._,LDr, � �M 13 �
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
DISTRICO. GROUP ZONE PERFAIT
FOR APPLICANT TO FILL IN / ����
PLUMBER �f(�/fJREADY FOR
RECEIVED BY DATE ISSUED
�� .� K.0FIRST INSPECTION
ADDRESS , /
BUILDING
CITY L17?�� TEL No. eC- �� fy�S ADDRESS 67 /� �Y��i ®l��
COUNTY Ie P . F
LICENSE NO. ���� EXPIRES (S-- LOCALITY / 1
CROSS ST.
NEAREST
PERMIT FEES
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL '
WATER CLOSET(TOILET) @ 0.50 C7 _ADDRESS _
BATH TUB 0.50 a CITY TEL. No.
SHOWER @6 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) 0.50U APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY Q 0.50 Q ANGELES COUNTY LICENSE, OR I AM THE LEGAL OW ER
OAS SYSTEM_ OUTLETS ® 0.50 / 000
d SI THE RESIDENTIAL PROPERTY D C BOV '
�`— SIGNATURE OF �
WATER HEATER IS 0.500 4 PERMITTEE
SLOP SINK 0.50 INSPECTION RECORD
FLOOR SINK 0.50 "dO/��lp
FLOOR DRAIN ❑.50 W
DISHWASHER 0.50
DRINKING FOUNTAIN ( 0.50
URINAL @ 0.50 -J
Q
HOUSE SEWER @ 0.50 _Z
MISCELLANEOUS E3
O
APPROVALS
DATP INSPECTOR'S NAME
ROUGH PLUMBING _ y+
GAS PIPING
GAS VENT
CESSPOOL (f+)! 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) CEI! 1.00 SEWER
PERMIT ' 1.00 GAS TEST
V r e
UTILITY CO.NOTIFIED
TOTAL FEE � i ply'
FINAL Pte" a
76A667 DBS #17 6-52 �/
RqS-17II1.gS M0 .. - APPLICATION FOR PLUMG PERM 1
Dt35.
DIVISION OF BUILDING AND SAFETY
Department of County Engineer 77
County of Los Angeles BUILDING (//
JOHN A'LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN SUPT OF BUILDING
<;....., r a «. .� ��..4.... : ..�o...... ._ LOCALITY
FOR APPLICANT TO FILL INNEAREST
r.
CROSS ST. •a'a' llc.G2/ m
n OWNER ? DISTRICT GROUP Z NE R AD OR PECTI
MAIL
v ADDRESS d f� Ly i!/LJ' Cf/ 6 r l� r � .', S
Q✓l-N'"
a ro INDUSTRIAL .
CITY TEL. NO. WASTE APPROVAL
PLUMBER d INSPECTION RECORD
.'`•, ADDRESS
CITY TEL. NO.
l9
9
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1:00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
J WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE
GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS.APPLICATION
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
1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
? CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ` UTILITY CO.NOTIFIED
`+ DESCRIBED RESIDENTIAL ))PROPERTY. a
t, SIGNATURE
OF PERMITTEE FINAL '
JOHN'A. LAMBIE, COUNTY ENGINEER ALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CASH