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APPLICATION F R PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
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NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY,--f;; /s- Ci
NEAREST
BATHTUB CROSS ST. K
SHOWER OWNER I d e A-Zte—
MAIL
LAVATORY ADDRESS SS'�
SINK CI Mje le 1. TEL.NO.t f,i
DISHWASHER CONTRACTOR /I�
CLOTHES WASHER ADDRESS
/S /(f I Ire, GcJ /f
SWIMMING POO(RECEPTOR M/ n
CITY /�Tm F-'�Jj TEL.NO l
LAWN SPRINKLER SYSTEM
STATE ,, GG LIC. /�
WATER HEATER LICENSE NO. `f"�7S CLASS ` - 3
GAS SYSTEM [ OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING
Y
GAS PIPING d
Q
GAS VENT U
HOT WATER HEATER 0
O
PLUMBING FIXTURE$
GAS TEST O Iift
6
Plan check fee UTILITY CO.NOTIFIED Z_
PLUMBING PERMIT ISSUING FEE E
TOTAL FEE -n FINAL
/ O c
Plan check applicom PLAN
.,C,H.,EC-KK VALIDAT N
Name
Address WN
City Tel.No.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE A 7 0 9. 2 A
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 5
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1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS M B R B B B
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF.AND INTE TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL 2 - . 1000
PROPERTY.
SIG NAT"RIEe n
OFPERMITTEE • B Q LJ 0 U
DISTRICT NO. OCED BV 10.09-79
.5: 0 Co
INDUSTRIAL
WASTE APPROVAL
76.687�CE#SIT 5-61
APPLICATION FOR PLUM ING PERMIT
DEPARTMENT UNTY OF COUNTYG GINEER
BUILDING AND SAFETY DrWSION BUQ.DDIG
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALRY 17
FOR APPLICANT TO FII.L IN NEST
CROSS ST.
NUYBlR FIXTURE OiY ITEM
wAree closer OWNER_ �C� MAIL 4
ADDRESS
RATH TUR
CRY TEL NO.
SHOWER _
LAVATORY Z�- 2 5--� CONTRACTOR
Som2 '
ADDRESS
DISHWASHER CITY TEL NO. 27 C-el
CO CTOR'S OSTATEe
LAUNDRY TUB BRommTION NO. CODNTY
CLOTHES WASHER DIYTRICr NO. GROUP ZONE PRq/ClaB ;Y
WATER HEATER S U .1� ` y
RIDUSTBM
GAS SYSTEM WASTE APPROVAL U
DISPECTION RECORD Y
0
u
W
a
Z
® jEA
IT
_
F7X'1'UAE $ 11 APP i ROV.ALS ATEI INSPECTOR'SSIONATURE
I
PERMIT $ 1 2100 UNDE B WORK --r'
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS'APPLICOLTION
AMC STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER I�
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AN OIDR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED PESIOENTIAL PROPERTY. UTILITY CO. NOTIFIED
O
SIGNATURE ` I
OF PERMITTE / FINAL
0i/ LIDATION ROBERT A. WOOD
/�t K/ M.G. CASH SUPERVISING MECHANICAL ENG'R
L,i;o O z 3 O'G JAN 2 5 5 D 1 3.7
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 'ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN. SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25
MAIL
BATH TUB 1.25 ADDRE L�
SHOWER 125 CITY TE . NO.
LAVATORY 1,25 CONTRACTO �,t
SINK 1.25 ADD"
DISHWASHER 1.25CITY TEL. NO. - n
LAUNDRY TUB 1.29 CONTRACTOR'S STATE
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT Np,/ G Z E PR C�/BE Y
WATER HEATER' 150 / � Oy
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS O A 5 PER YSTEM .00 INSPECTION RECORD D-
C
do O
� u
a
N
Z
APPROVALS DATE INSPECTORS SIGNATURE
PERMIT $ 2 GO UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE
GAS PIPING
1 HEREBY THAT
THE
THAT 1 HAVE READ THISGRE APPLICATION GAS VENT
AHD STATE TNAT TIIE ABOVE 18 CORRECT AND AGREE E COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURE$
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 DESCRIBED RESIDENTIAL ROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE FINAL`
VALIDATIROBERT A. WOOD f
CK. M. o. Us SUPERVISING MECHANICAL ENG'R
_j,Uo 2 9 6 2' WR 5 5 D 7. ; 5