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TEAEBT DEREIT A APPLICATION FOR 'P UM81NG PrRMIT 1
COUNTY OF LOS ANGELES ■
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVLSION 7LOCAL�3j7
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPT OF BUILDING FOA APPLICANT TO FELL IN NUMBER FIXTURE OR ITEM EACH FEEWATERCLOSET SI25BATH TUB 125
SHOWER 125 C TEL
LAVATORY 125 CO /O
Smc 1 MTILD
DISHWASHER 125TEL N
LAUNDRY TUB 125 LIC
CLASS
CLOTHES WASHER 125N GROUP ZONE P 86 BY
WATER HEATER 150GAS SYSTEM OUTLETS 150VAL
OUTLETS OVER 5 PER SYSTEM >DINSPECTION RECORD d
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H
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W
1
N
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APPROVALS DATE INSPECTOR a SIGNATURE
PERMIT E 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE
GAS PIPING I
1 NEPEBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IE CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
1 HEREBY CENTIPY THAT 1 AM PROPERLY REGISTERED ANOIOR PLUMBING FIXTURES
ucErvaEO As PEOVIREO 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 PROPERTY UTILITY CO NOTIFIED
SIGNATURE J c
OF PERMITTEE FINAL Z�'Z L,JI f�MQ
ALIDATION JACK R ALLEN
M o CASH SUPERVISING MECHANICAL ENG'R
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESSD
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN CNEKBE St ROSS
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NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET 1115 A y A OWNER
L� MAA.
RATH TUR las a ADDRESS
SHOWER 175 CITY TEL NO
LAVATORY 115 50 CONTRACTOR (�11;14ef_l
SINE 125 ADDRESS /y33/ �!/�
DISHWASHER 125 CITY t s7��j TEL NO /Q
LAUNDRY TUB 11TE
5 CONTRACTOR
NO 'Y / STATE
COONTY
17
CLOTHES WASHER 1 25 OI=RI��CrTr NO GR I ZONE P gas O BY _
WATER HEATER 150 `'� • (� /1
CAS SYSTEM OUTLETS 150 [) INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 70 INSPECTION RECORD i O
o
W
a
H
Z
APPROVALS I DATIE INSPECTOR E SIGr3*Tp RE
PERMIT ]I�ENO
00 UNDER SLAB WKIMIA(,AS 1 fJ'
��II ROUGH PLUMBING
TOTAL FEEL� C� GAS PIPING �W �/ F
1 Xl RESY ACNNOWLCDG! THAT I HAVE READ ICATION
AND STATE THAT THE ABOVE le CORRECT AND AOMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LUTIHG HOT WATER HEATER
PLUMBING
1 XIREBY CERTIFY THAT I AM PROPERLY REAno/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNS ENO TO GAS TESTRESIDE IN THE ABOVE DE EDR.....TIAUTILITY CO NOTIFIED (T r
SIGNATURE
OF PERMITTEE FINAL
VALIDATTQN—__,ROBERTA WOOD
cH M xo ( cnSX SUPERVISING MECHANICAL ENG R
LAC,0920 7G JAN 7 5 D /1100- IN
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