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76A957-CE#917 5-61
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUELDING SAND SAFETY DIVISION svlLDnvG
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ® � '
WILLIAM A. JENSEN; SUPT OF BUILDING
LOCALITY 6
FOR APPLICANT TO FR.L 1NNEAREST
NUMBER FIXTURE OR ITEM CROSS ST.
S
WATER CLOSE! WN
MAIL
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BATF/TUB BATADDRESS
F/
SHOWER
CITY TEL No:
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LAvaToaT CONTRACTOR Va.I By pl UMbi TIC,
Snm ADDRESS' 442. Fps F. z
DISHWASHER3 PQ
cirY, Glendora TSL.No. L,
CONTRACTOR'S H
LAUNDRY TOB REGISTRATION NO. COUNT ' ,❑.
CLOTIM WASHER DISTRICT NO. GROUP ZONE P ED BY
WATER BEATER V
GAS SYSTEM INDUSTRIAL
® WASTE APPROVAL V
IIiSPECTION RECORD
�Ah �1_ A V
PD�tT11E $ I 310, APPROVALS D4TE4 INSPECTOAR's 0961ATURIt
PERMIT $ 2 .0 UNDER SLAB WORK ��I II+'�• C.Nw�L�'`Fie'�J 19
k7l P ROUGH PLUMBING
TOTAL FEE. aP 113� e ®/a. v
rv' r r q
GAS PIPING 4 Yi
1 HEREBY ACKNOWLEDGE THAT tHAV6 READ THIS APPLICATION, - -
AND STATE THAT THE.ABOV6 18 CORRECT AND AGREE TO COMPLY 'GAS VENT _ i
:WITH ALL COUNTY 'ORDINANCES AND STATE LAWS REGULATING HOT WATER'HEATER
/
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES' Sir OAVT ,/
LICENSED AS REQUIRED BY LOS,ANGELES 'COUNTY AND.STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATUREL
OF PERMITTE FINAL ;,
v
y/�/� ALIDATION ROBERT A.W oD.
M.o, CASH SUPERVISING MECHANICAL ENG'R
t}`►t;a 7 8 2 9% DEC 4 5.D