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APPLICATION FOR PLUMBING PERMIT
CO �y Og LpS ANGELES •
DEPARTNff dT OF COUNTY ENGIIIM
BAG ANDEAFETY EMN °N SS Qq I JOHN MBICCouuNw NEADR
WILLIAM A.JENSEN.SUPT OF BUILDING
LOCAL= 71E1MP;,V- C cvT
FOR APPLICANT TO FML IN NEAREST
CROSS ST. w
NUMBER FIXTURE OR ITEM oWNEg S Ns3
WATER CLOSET
BATS TUB �ESS
CITY TEL. NO.
SHOWER
LAVATORY {�
CONTRACTOR
sm ADDRESS -!o 9. GA.crAj (IR& ,
DISHWASHER CITY G. a I TEL NO. ,4 1 gge
CONTRACTOR'S UTATZ
LAUNDRY TUB REGISTRATION NO. COUNTY
CLOTHES WASHER DICT p10. UP ZONE PR SD BY
WATER HEATER Q(/
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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w
g8
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT E 2 00 UNDER SLAB WORK
TOTAL FEE -1 1— ROUGH PLUMBING
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL 70PRTY. d UTILITY CO.NOTIFIED
SIGNATURE d L CQ/
OF PERMITTE
FINAL-
TION
INALTION ROBERT A.WOOD.
CAIS SUPERVISING MECHANICAL ENG'R
LAo g o s AUG 1 5 D 3.a o
76A467-CE#8,I7 10-67 .
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITYor
FOR APPLICANT TO FILL IN PR NT OR TYPE NEAREST
CROSS ST. C 1
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 1.50
MAIL
BATH TUB 1.50 ADDRESS
SHOWER 1.50 CITY TEL. O.
LAVATORY1.50
CONTRACTOR
SINK 1.50 J, ADDRESS
DISHWASHER 1.50 CITY TEL. NO. �.
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2.00 Q t D_
O
WATER HEATER 1.50 ,• rCa INDUSTRIAL C7
WASTE APPROVAL
O
GAS SYSTEM OUTLETS 1.50 a INSPECTION RECORD V
OUTLETS OVER Lu
5 PER SYSTEM .30 O_
N
Z
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE 8 2 00
TOTAL FEE
APPROVALS DATE I ECTOR'S SI ATURE
Plan Check applicant UNDER SLAB WORK All
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City. Tel. No. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST -
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES UNITY AND STATE OF
CALIFORNIA OR THAT 1 AM 'LHE LfiGAL OW ROF D IN D TO
RESIDE IN.THE ABO [DE RI ID[NT P Y. FINAL
SIGNATURE JACK R. ALLEN, SUPERVI ING HANICAL ENG'R.
OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION M• s
4:7 6 9�S PAY 21 5 -D 9.5�~ �_. ..