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APPLICATION FOR PWM`BING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER,
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY, ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY �Ep 1• Lt= C
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. 7B�
NUMBER FIXTURE OR ITEM EACH FEE- OWNER-
WATER CLOSET $1.25 MAIL l
BATH TUB 1.25 ADDRESS 3 R
SHOWER 1.25 CITY TEL.j�� .G TEL. NO.A'T 9#5�Z
LAVATORY 1.25 CONTRACTOR 40 ff"Z
SINE 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
LAUNDRY TUB 1.25 CONTRACTOR'S STATE ❑
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 " DISTRICT NO. GROUP` ZONE.: PROCESSED BY
WATER HEATER 1.50 S�® f' J A-1 60"v
r 1.50 �:U INDUSTRIAL
GAS SYSTEM OUTLETS WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD
9
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1 _
' APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT s 2 OO UNDER SLAB WORK
ROUGH PLUMBING ,/ �A ,���N
TOTAL FEE �" GAS PIPING Lj" 7W1 16 —
I 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 HOT WATER HEATER
PLUMBING.
I HEREBYC TI FY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
'LICENSED AS UIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST t
CALIFORNIA OR T I AM THE 'LEGAL OWNER OF.AND INTEND TO
RESIDE IN,THE ABO 'DESCRIBED RESIDENTIAL PROP TY. ,UTILITY CO. NOTIFIED -
SIGNATURE
OF PERMITTEE FINAL ��
�i.yv r
LIDATION ROBERT A_ .WOOD
. - cK. - M 0. cnsH SUPERVISING MECHANICAL.ENG'R
�.
L1'uo 5 1 1 3 ik9r°ii ? 5 D 3.50 `'
25.
76A667-CE817-11-57
APPLICATION FOR PLUMBIN.G,- PERM_IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER M7714 OFU1522
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS 5138 N. Rosemead
CASSATT D. GRIFFIN, Supt of Buildiag LOCALITY
Rosemead
. FOR APPLICANT TO FILL IN NEAREST
NUMBER FIXTURE OR ITEM CROSS ST.
2 WATER CLOSET OWNER Calvyn R. Campbell
'MAIL
1 BATH TUB ADDRESS
1 SHOWER CITY TEL. NO.
2 LAVATORY . CONTRACTOR Belvedere Plumbin Co.
1 SINX ADDRESS 11900 E. Garvey Ave.
DISHWASHER CITY E1 Monte TEL. NO.
STATE 0
LAUNDRY TUB REGISTRAT ON NO. 179568 COUNTY ❑
1
CLOTHES.WASHER DISTRIC O: =PjNE READY FOR INSPECTION
1 WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
3 .
b
$1.00 PER
✓ ._.
' APPROVALS
IX
lO OR FTURE $ DAT INSPEC'CAR-S NATURE
10+00 UNDER SLAB WORK S �
PERMIT $ 00 ROUGH PLUMBING ._
TOTAL FEE 12 oo GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS-APPLICATION GAS VENT A /.,
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -
PLUMBING. PLUMBING FIXTURES y
I HEREBY CERTIFY THAT I AM PROPERLYA�REGISTERED AND/OR GAS TEST y y�
LICENSED AS REQUIRED BY LOS ANGELES 0011'NTY AND ATE OF
CALIFORNIA OR THAT 1 AM THE LEGxz�c_
VE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTII/ ROPERTY.
SIGNATURE /�G +�(I�s / •v
OF
SIGNATURE
iEEEE__-!!! /y vv FINAL'
ROBERT A.WOOD.
®P VALIDATION SUPERVISING MECHANICAL ENG'R
'/ CK/ M.0. CASH
-
76 A 667 CE 617 7-69 ;
APPLICATION : FOR PL', BIN PER �j
COUNTY OF,LOS.
DEPARTMENT,
OF ANGELES
ENGINEER. siriNc
BUILDING AND SAFETY DIVISION ADDRESS " �Qr
'JOHN A. LAMBIE,-COUNTY ENGINEER,
COLEMAN , JENKINS. SUP of BUILDING". LOCALITY, •.•�� _
�..
F'OR•P:P.PLICANT T.O FILL IN(PR NT.OR TYPE) 'NEAREST - - -.
CROSS'Sr.
NUMBER FI-XTU,R E'O.R ITEM. EACH' -FEE -
OWNERPD
WATER CLOSET,; - '1.50 �- N -
.. �.. ..
BATFI TUB 1.50
MAIL
!� J �Z � t` M1F
,- _T
SHOWER 1.50 :� CITY " '. /� " TEL. NO. b
.LAVATORY' `, ,+ -. a..<; 1.50� - Afu_ Cf , � � 1.
CONTRACTOR; _ ,'' 1
SINK 1.50 - ADDRESS
-DISHWASHER 1.:50 � '.CITY- :;�, ����1't JTEL. NO.� �
CLOTHES WASHER - :-•4' 1.50- - STATE'. rr�� ` -` "LIC
r
Nwr
` LICENSE,NO.�` V "/ - CLASS.C-'- -
SWIMMING POOL.RECEPTOR 1.50 DIST�RRICT- O. - GROUP, ONE' SSED BY `
LAWN SPRINKLER SYSTEM 2.00 - V -
WATER HEATER+ 1.50 .INDUSTRIAL' - a.
WASTE APPROVAL O
G'AS SYSTEM' ,6UTL:ETS 1.50 - INSPECTION RECORD
OUTLETS OVER .-...30 - _ .
- 5.PER SYSTEM
UJI
N.
z
Plan!Aeck'fee,25% of above. See reverse.
PLUMBING PERMIT ISSUING'-.FEE S- 2 00
TOTAL FEE - S� ,
APPROVALS - DATE ' INSPECTOWS SIGNATURE
Plan check applicant. + '..- UNDER SLAB.WORK
.. • ROUGH PLUMBING
Name '' '
Address ' GAS PIPING
- GAS VENT - ..
City., Tel. No.
HOT WATER HEATER'-
..I HEREBY ACKNOWLEDGE THAT '1 HAVE .READ THIS;APPLICATION'AND STATE,-THAT THE ABOVE IS-CORRECT. AND AGREE-TO.COMPLY PLUMBING FIXTURES.
WITH ALL COUNTY-'ORDINANCES AND' STATE. LAWS REGULATING
GASTEST.
- -
I-HEREBY, CERTIFY THAT7'I AM PROPERLY, REGISTERED ANDIOR
.UTILITY CO.CO."NOTIFIED.
LICENSED AS+REQUIRED".BY-.LOS=AN GE LES'COUNTY AND. ST TE OF. -
CALIFORNIA'OR .THAT, I',AM.-THE'LEGAL OWNER ;AND i NO TO
LRESIDE IN,THE OV DEGCRIBE D RESIDENTIAL P o ERrY. FINAL.. 13 .e '
Al
V, ti
GNATURE - JACI( R,'ALLEN, SUPERV ISING _ FiANICAL ENG R.. '
OF PERMITTEE' . -
-PERMIT VALIDATION cK. M.O. CASH
PLAN CI3ECK_,VAL'IDATION CK.` m.o. CASH
HKY,