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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �.
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUP'T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN QST
caoSS Sr.
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSES 7MAIL /Y
BATH TUB ADDRESS
CITY TEL. NO.
SHOWER
F(c
ONTRACTOR
LAVATORY .)
SINK DDRESS
DISHWASHER / ITY r �/�9�.TEL NO. � ?-
CONTRACTOR'S ' / S A
f LAUNDRY TUB � ) REGISTRATION NO. YQS COIINTY
CLOTHES WASHER DISTRICT O. GRN R E
7
WATER HEATER T. _ �' y c, O
GAS SYSTEM 1NDUSTRIALV
WASTEWASTEAPPROVAL
INSPECTION RECORD w
- O
I-
V
W
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@IT
EM
FIXTURE $ � 7� APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 100 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANDJOR PLUMBING FIXTURES
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 ROP RTY. / UTILITY CO. NOTIFIE
SIGNATURE L
OF PERMITTEE
FINAL
VALIDATION, ROBERT A. WOOD
CK. M.O. ASH SUPERVISING MECHANICAL ENG'R
10-67 -
APPLICATION FOR PLUMBING PER
COUNTY OF LOS ANGELES
DEPARMIENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING
FOR APPLICANT TO FILL IN PR NT'OR TYPE)
NUMBER FIXTURE OR ITEM EACH FEE
J G OWNER _
WATER CLOSET 1.50 MAIL
BATH TUB 1.50 3V ADDRESS
SHOWER 1.50 CITY TEL. NO.
LAVATORY 1.50 CONTRALTO 'L6
-�L ,
SINK 1.50 ADDRESS . r
DISHWASHER 1.50 CITYTEL. N0.1y(
CLOTHES WASHER 1.50 STATE LI'C
LICENSE NO. y— CLASS C'
AV
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GRO E PROCASS BY
LAWN SPRINKLER SYSTEM 2.00
WATER HEATER 1.50 INDUSTRIAL
DUSWASTppPROVAL �
O
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD V
OUTLETS OVER '
W
5 PER SYSTEM .30 y
Plan check fee 25%of above. See reverse.
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan CheCk_Emplicant. UWDER•SLAB WORK =-
Name ROUGH PLUMBING
Address GAS PIPING
GAS.VENT
City Tel. No. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT I 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 GAS TEST
PLUMBING. _
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED 117
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
LOFPER'
OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
THE ABOV DESCRIBED RESIDENTIAL PROPERTY. FINAL
E JACK R. ALLEN, SUPERV.IS:ING MECHANICAL ENG'R.
ITTEE �/+
PERMIT VALIDATION M.O. CASH
PLAN CHECK VALI ATION CK. M.0. CASH
f Ar±,,9 4 5 b>~ mAR 3 0 5D 6,50- V