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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
JOHN A. LAMBIE, COUNTY ENGINEER -7'x � 7 �)
COLEMAN W. JENKINS. SUPT. OF BUILDING
Y e� Al.
FOR APPLICANT TO FILL IN T. E/li G riy
NUMBER FIXTURE OR ITEM EACH FEE
OWNER iQ La w
WATER CLOSET ;1.25 MAIL
BATH TUB 1.25 ADDRESS A Nr
SHOWER 1.25 CITY 7- C , TEL No.
LAVATORY 1,15 CONTRACTOR C ,4/+t eS. v
SINS 1.25 ADDRESS
DISHWASHER 1.25 CTfYxA
TEL. NO.
STATE
LI.0 Cr
LAUNDRY TUB 1.25 LICENSE NO. �! o � OP � CLAS_S
CLOTHES WASHER 1.23PR
DISTRICT'NO. GROUP ZO E OCESSED BY
WATER HEATER 1.30 s 9 J � /
GI'M INDUSTRIAL
AS SYSTEM WASTE APPROVAL CD
OUTLETS OVER 5 PER SYSTEM .30 v
- IINSPECTION RECORD �
O
cl
W
CAId
- Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 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
I 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,AND INTEND TO
RESIDE IN,THE ABOVE DE6 RID RESIDENNTIIAZR/OPE:Irr, UTILITY CO.NOTIFIED
31GNATURE
OF PERMITTEE ��,777 FINAL
VALIDATION JACK R.ALLEN
CK. M.-0. CASH SUPERVISING MECHANICAL ENG'R.
LC 69607&Z J&14 5 D 3.50 IT
sll m fr K•io is
r Wwmn 6liT dF S mz=G An army
APP�.�IAIZON FOR P��'I
coum OF mm mom= PLUMBING 1
Vkq.L�AM J. FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT N0.
(r
PLUMEMR RECEIVED YY READY FOR DATE ISSUED
FIROTINOPKCTION
ADDRESS
344
aw"T mmism i
CITY y TE 3.10 ADDRESS y •
COUNTY LICKNOR N I IW IR LOCALITY •
NEAREST 1
PE Dur FM CROSS iT. 71L" Via
e
Numi TTFK OF n3rm t OR ITti PEE OWNER
MAIL
r WATER CLOSET TOILET 0.NO, ADDRESS
BATHTUB O. OI L. NO.
SHOWER 0.00 1 HERESY ACKNOWLEDGE THAT ) HAVE READ THIS
LAVATORY WASH EAKIN O.BO O APPLICATION AND STATE THAT THU ABOVE IB CORRECT AND
AGRER TO Q�QQ��11PLY WITH ALL COUNTY ORDINANCES AND
KITCHEN BINK a.00 STATE LAWO'REGULATING PLUMBING.
1 CERTIFY THAT I POSSE THE ABOVE VALID I=
LAUNDRY TUN OR TRAY 0.80 ANGELES COUNTY LICENSE K BOAC OWNER
GAS OYOT U•TLESS 0.00 OF THE RESIDENTIAL PRO D E.
SIGNATURE OF L f
WATER NEATER 0.00 rKIL
LOP OINK a 0.00
FLOOR SINK a 0.50
FLOOR DRAIN a 0.50 M T /O �L c
DISHWASHER 0.50 Mc V
DRINKING FOUNTAIN O.SO
URINAL Q 0.00 J
HOUSK SEWER 0.00 Z
MISCELLANEOUS IS
O
APPSOVjm
DATE IRSP[Cro11•e RAre
ROUGH PLUMBING •r
GAO PIPING
GAS VENT
CESSPOOL 1.00 CESSPOOL
SEPTIC TANKS SEPTIC TANK
I DRAIN 1 ) PIT 1 ) ® 1.00 SEW KR
PERMR . GAS TEST a�'
1.ao
LRILITY CO. NOTIFIED
;; I
TOTAL FEE i I_itDO
FINAL