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76A667 17"11-49 - APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT.TO FILL IN DI T _CTiNO. G-i- � �
PLUMBER a �lJ ` �E_EIVED BY READY FOR DATE ISSUED
R {
- ^ i%�, FIRST INSPECTION
BUILDING
CITY TEL. No. P7 1 a. ADDRESS
COUNTY �. LOCALITY' ' "11
LICENSE NO. A EXPIRES ���
NEAREST \'
PERMIT FEES CROSS ST. _ V
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) @ 0.50 I$ ADDRESS '
BATHTUB @ 0.50 CITY TEL. No.
SHOWER @ 0.501 1 .HEREBY 'ACKNOWLEDGE THAT 1 HAVE READ. THIS
LAVATORY (WASH BASIN) @ 0.50 I APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY DRDINANCES
KITCHEN SINK @ 0.501 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS-
LAUNDRY TUB OR TRAY @ 0.50 I ANGELES-COUNTY COUNTY LICENSE, OR 1 AM THE .LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DE CRIBED ABOVE.
IGAS SYSTEM�OUTLETS @ O.50I -
SIGNATURE OF
I WATER HEATER @ 0.50 I PERMITTEE _ d,�
SLOP SINK @ 0.501 SPECTION RECORD
FLOOR SINK @ C.50 I
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.501
(DRINKING FOUNTAIN @ O.SO I
URINAL @ 0.50 I '�
' Q
HOUSE SEWER @ 0.50 I Z
MISCELLANEOUS I E
O
I I
I
APPROVALS
DATE INSPECTOR;S NAME
- ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL- @ 1.00 CESSPOOL
SEPTIC TANK: I SEPTIC TANK
DRAIN (' ) PIT ( ) @ 1.00 I SEWER
PERMIT 1.00 GAS TEST
UTILITY CO.NOTIFIED /�-� "�71
TOTAL FEE717/1
S� ?
FINAL
•''�• '76A667 OSS 17 ,;-50 '' j APPLICATION.FOR'PERMIT, •-
DEPARTMENT OF BUILDING AND_ SAFETY
. COUNTY OF LOS ANGELES VAGP L mum M B I ON 1
WILLIAM J. FOX, CHIEF ENGINEER
'DISTRICT O. RO P. i ZONE PERMI,
FOR APPLICANT TO FILL IN
PLUMBERR• - REC[IVED'BY ` 'DAT ISSI,JED
EADY FOR /J
- _ FIRST INSPECTION
ADDRESS ;. -
�._...
113�
DING .(l
-CITY ,.., - TEL. Na. � d..AODRESS `J CCS f
.COUNTY .LOCALITY. J '. if,
.LICENSE NO. EXPIRESNEAREST
--'�r� -
PERMIT FEES cRo�s ST.
NUMB ERq TYPE OF FIXTURE CR ITEM FEE OWNERS
MAIL
WATER CLOSET(TOILET) ' @ 0.50 $ ,,-��~ADDRE5S, ,rx//l .• Al
• BATH TUB @ 0.50 CITY 6#,Ilk&Illki _TEL. No... -
`1f SHOWER ,@ 0.50. '&W'°°'. . r
-1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS_
.^�
LAVATORY (WASH BASIN) @ ,O.SO � ' APPLICATION AND STATE THAT THE .ABOVE IS CORRECT'
AND AGREE TO COMPLY WITH ALL'COUNTY ORDINANCES
> • AND STATE LAWS REGULATING PLUMBING.
KITCHEN SINK @ 0.50 _
1. CERTIFY THATI POSSESS THE ABOVE VALID LOSS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE. OR 1 AM THE.LEGAL,OWNER
N 'OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM OUTLETS @ 0.50
91GNATUi2E OF '
1`�..... WATER HEATER @ 0.50 PERMITTEE
SLOP BINK - @ 13.56INSPECTION RECORD
FLOOR SINK- - @ 0.50 -
_ FLOOR DRAIN
DISHWASHER @ O.SO _ /1.• �`��SI _ -
'DRINKING' FOU14TAIN @"0:50 i ../rxr• - If eI a�14'nr17 [A1 \
URINAL _ @ 0.50 '-... 4—
HOUSE. SEWER - @ O:BO !. Z�) iV.dr .•?l.C��G.- -- ./.�✓7_lT"" Z
1 MISCELLANEOUS - 13`
APPROVALS
- D,j7 E INSPECTOR'S NAME
•ROUGH PLUMBING
GAS PIPING - -
GAS VENT
CESSPOOL @ i.ab - 0_� CESSPOOL -
SEPTIC TANK: - ' SEPTIC TANK.
DRAIN ( ) PIT ( ) @ 1.00 SEWER
..PERMIT - .I. - 1/.00 GAS TEST
t
UTILITY CO:NOTIFIED
TOTAL FEE b
FINAL
1• _