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APPLICATION FOUR PLUM -1 G PEF2'11AJT
-COUNTY CF LOS ANGELES: = � LDII WANDSAFETY \�
FOR APPLICANT TO FILL IN IPRINT OR TYPE) BUILDINGZ2 V
2
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
LOCALI I�
WATER CLOSET
NEAREST L
BATH TUB CROSS ST. r /!
SHOWER OWNER (Z ` S
LAVATORY MAIL' ,
ADDRESS
SINK CITY TEL.NO.M, 8`
DISHWASHER c~flFVC INSTALLERS
CLOTHES WASHER A
0 JE. GRAND AVE
SWIMMING POOL RECEPTOR L
;JTATEJ
EL. C�7LAWN SPRINKLER SYSTEM IC.
WATER HEATER CENSE IVO. CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER NDER SLAB WORK
5 PER SYSTEM. IROUGH PLUMBING
GAS PIPING
GAS VENT
I�
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST.
Plan check fee UTILITY CO.NOTIFIED �
PLUMBING.PERMIT ISSUING FEE$ o
TOTAL FEE FINAL
Plan check applicant PLAN CHECK VA o
(L-141
Name
.. # 0 0 0 0 O.5
Address '
City Tel.No. ,
2 0 0 1 Q O O
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE - O a 0 1 G002:
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES Z
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 3r/S
1, 1 !
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELE COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF.AN EN TO RESID THE ABOVE.DESCRIBED RESIDENTIAL
PROPERTY.
SIGNATUR
OFPER TTEE
DISTRICT NO. PROCESSED BY
O�
INDUSTRIAL
WASTE APPROVAL
7UBU7--CES17-11-57
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES Job ig-o
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. G�,C�ptv= ane ADDRESS
- 107,62 L y n r o s e
CASSA LOCALITY T 1 e C i
FOR APPLICANT TO FILL IN NEAREST.
CROSS ST:
NUMBER FIXTURE OR ITEM
2 WATERCLOSET oWNm Larkwodd Construction
1 RATE TUB DADnm 1 022 Lower Azusa Rd.
sEcwER CITY El Monte TEL.NO.
2 LAVATORY coiNTRAcToR Richard Cavanaugh P l b
1 snag nDDREss 13354 S. Central
DISSWASHER CITY Chino TSL.NO.
LAUNDRY TUB CONTRACTOR'S STATE ❑
REGISTRATION NO. 1 164 C 36 COUNTY ❑
1 CLOTS WASIM DISTRICT O: GROUPZ NE I RE o INSPECTION
1 WATER HEATES
1 GAS SYSTEM INDU37ZU
WASTE APPROVAL
INSPECTION RECORD
gAlEf
APPROVALS
0 $1.00 PER ITEM - 1 ATE INSPE R-3.S,IGN RE
OR Finam $ I J® 00 UNDER SkAE)-WORK 4-
PERMIT $ 21 1 00 ROUGH PLUMBING „h:Ior- w
TOTAL FEE GAS PIPING t�
I HEREBY ACKNOWLEDGE TIIAT 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
I HEREBY CERTIFY THAT I 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 O
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE
OF PERMUTE FINAL p '� �-✓7'�-���
ROBERTA.WOOD.
®� 0VALIDATION SUPERVISING MECHANICAL ENG,a
CE. H.O. CASH
LCo 5 0 6 s A APR 14 5 A 12.o o