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COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUILDING & SAFETY L ;'
WILLIAM J. FOX, County Engineer
DISTRICT O. GROUP O
FOR APPLICANT TO FILL IN ✓� 7 ,
PLU14BER VALEY Y P rl'I' r '"'"� ►" "^' + READY FOR
L� RECEIVED BY DATE ISSUED
- - J FIRST INSPECTION � _ ����i.�
ADDRESS 83CG L:,^
BUILDIN13 /
CITY ROSz�,.. .,� TEL No. ADDRESS Q b
COUNTY �J,+' LOCALITY
LICENSE NO. EXPIRES F I
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE DIF FIXTURE OR ITEM FEE OWNER �-
MAIL
WATER CLOBET(TOILET) @ 0.50 111 ADDRESS
BATH TUB @ 0.50 CITY TEL. No.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 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.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
GAS SYSTEM OUTLETS 0.50
OF THE RESIDENTI L ROPERTY DESCRIBED ABOV
@
WATER HEATER @ 13.50 SIGNP TRMITTOF
SLOP SINK @ 0.513 INSPECTION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.50
DISHWASHER Q 0.50
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50 Q
HOUSE SEWER @ 0.50 Z
MISCELLANEOUS U'
O:
O
APPROVALS
DATE INSPECTORS NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL CESSPOOL
SEPTIC TANK, SEPTIC TANK
DRAIN ( ) PIT ( ) @ 7.00 SEWER /
PERMIT 1.1313 GAB TEST
UTILITY CO.NOTIFIED
TOTAL FEE —
FINAL f
76A667 DBS#17 6-58