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APPLICATION FOR PLIJIVBING PERMIT 1
COUNTY OF LOS ANGELES Job 1 94
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /1
JOHN A. LAMBIE, County Engineer ADDRESS C LaJ
CASSATT D. GRIFFIN, Supt of Building LOCALITY
FOR APPLICANT TO FILL IN NEARESSCROSS T.
NUMBER FIXTURE OR ITEM
2WATER CLOSET OWNER Larkwood ConstructionMAIL
.
1 BATH TUB ADDRESS 10229 Lower Azusa R d e
SHOWER CITY 'El Monte TEL. NO.
2 LAVATORY CONTRACTOR Richard Cavanaugh P l b o
1 SINK ADDRESS 13354 So Central
DISHWASHER CITY Chino TEL. NO.
CONTRACTOR'S STATE ❑
REGISTRATION NO. 1 164 C 6 COUNTY ❑
LAUNDRY TUB
1 CLOTHES WASHER DISTRICT NO. GROUP ZONE READY FOR INSPECTION
1 WATER HEATER
1 GAS SYSTEM p� INDUSTRIAL
x WASTE APPROVAL
INSPECTION RECORD
y
a,
APPROVALS
9 @ $1.00 PER ITEM 9 DATE INSPECTOR'S SIGNATURE
FIXTURE OR FRE $ o
UNDER SLAB WORK
PERMIT $ 00 ROUGH PLUMBING 1 ,
TOTAL FEE 1 1 00 GAS PIPING
[ HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST 0 G�� 11-1
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED I b `. ``b.- --`�-"�j
DESCRIBED RESIDENTIAL PROPERTY.
'SIGNATURE r �r
OFPERMITTE -6- FINAL
ROBERT A.WOOD.
®F VALIDATION SUPERVISING MECHANICAL ENG'R
CK.
M.0. CASH
Z 8:'7-9% FEB 2 7 5 A 1 1..0-0