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APPLICATION FOR PLUMBING PERMIT {�
COUNTY OF LOS ANGELES �J
DEPARTMENT OF COUNTY FNCIINEER
BUILDING AND SAFETY DIVISION FL
DING
1N 41�Ti CHECKS PAYABLE TO: RESSHARVEY T. BRANDT, COUNLTY EINa1NEER ALITYFOA APPLICANT TO FILL IN SPRINT OR TY PEI RESS ST.
NUMBER FIXTURE OR ITEM FEE
_YA
WATER CLOSET
1.76 OWNER C I7S
�1AIL.,
RATH TUB t,76 ADDRESS
SHOWER 1.75 C ITY TE-L. NO.
'LAVATORY 1.76 CONTRACTOR g-
SINK t.75 ADDRESS b ��
DISHWASHER 1.75 CITY TFL NO. -
C LOTH ES WASHER 1.75 STATE LIC
LICENSE N0. 0 CLA -C.'3
SWIMMING POOL RECEPTOR 1.75
DI O $OUP �ESSED
LAWN SPRINKLER SYSTEM 1.76 +LJ Y/
WATp HEATER 1.76 WASTE XPPROVAL
GAS SYSTEM OUTLETS 1.76 INSPECTION RECORD
UTLETS OVER1zSO
6 PER SYSTEM
Plan check fee S" Reverse
PLUMBING PERMIT ISSUING FEE $ OO
TOTAL FEE
APPROVALS DATE IH4P[CTOR'e SIGNATURE
Plan check applicant UNDER SLAB WORK
Name MAu!, b ROUGH PLUMBING
Address GAS PIPING
City DOLTel. No. GAS VENT
HOT WATER HEATER
1 H[R"Y ACKNOWLEDS THAT I HAY[ READ THIS PLICATION
AND STATE THAT THE AD VE 1S CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PL UM DI we.
I HERESY CERTIFY THAT I AM PROPERLY RF4ISTk R[D AND/OR UTILITY CO: NOTIFIED
LIt[NS[D AS REOUI RED BY LOS ANGLES COUNTY ANb &TAT[ OF
CALIFORNIA OR THAT I AM THE LEGA MER OF, AND INTEND 70
R[IIDE IN THE ASOV[ D[ C�16ED R [ I'.L PROPER FINAL
51 ONATU RE
OF PERMITT
PERMIT LIDATIONCK. M•O. CASH
PLAN CHECK VALIDATION C M.O. CASH
4.Z-n;;t 5 `B' 4-75A-%
OOUNTY OF L0E ANGELES
APPZ.ICI1ITION FOR PERhIIT
n�R,.+,tOF � PLUMBING 1
DIVISION OF BUIZ.DING 8z SAFETY
WILUAN J. FOX, Camrty EallneW
OR13UP ZONE PERMIT NO.
FOR APPLICANT TO FILL IN ��. .
PLUMSBOULEVARDPLUMBING GO. O READY FOR DATE IMUIED
ADDR® 8300 EAST VALLEY BLVD. hRST INSPECTION
cnl�
AT. ■UILDING
CITY EMEAD TIL.N9. AT. 2-271 ADDRESS D 41-1
DUUNTY No, 6-30- LOCALITY C.. .
t.
n NEARKwT
PEBbM FEES ORCUM ET.
MUM�CR TYrE or rTx-r JRI on rTKM FE[ OWNER
MAIL
WATER OLOSTT(TOILET) • 0.60 0 ADDREW
MATH TUM • 0.60 CITY TEL No.
SHOWER ! 0.60 I HEREMY AOKNOWLIDGE THAT 1 HAV[ READ THIM
LAVATORY (WAMH MANN) ! 13.50 APPLIDAT10H AND STATE THAT THE ABOVE 10 CORRECT
AND ACRE[ TO COMPLY WITH ALL COUNTY ORDINANCES
K TCHEN MINK • 0.80 AND RATE LAWS REGULATING PLUMMING.
1 OERTIFY THAT I POSSENG THE ABOVE VALID LOM
LAUNDRY TUB OR TRAY ! 0.60 ANGELES COUNTY LIDENU54 OR I AM THE -LEGAL OWNER
0.60
GAS oY1i"!'[ UTL£T7
Of THE RESIDENTIAL PROPERTY DMORI ADOVE.
!
■IGNATURE OF
WATER HEATER ! 0.60 PERM
■LDP MINK • C.EO INSPE=ON ETZW
FLOOR MINK • O.BO
FLOOR DRAIN ! 0.60
DINHWA19HER • 0.60
DRINKING FOUNTAIN • 0.sC
URINAL • 0.60 J
t
HOUSE SEWER • 0.M0 Z
MIMOICLLANEOUD
APPROVALS
DATE iNvwro NAM[
ROUGH PLUMBING
GAS PIPINv
a" VENT
OEHSPOOL • 1.00 DEMPOOL
SEPTIC TANKi SEPTIC TANK
DRAIN PIT ( ) • 1.00 BEWER
PERMIT 1.013 GAS TEST < 1�
TOTAL FEE UTILITY 130.NOTIFIED
F
7&&687 DRS#17 6-U