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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
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JO N A MBIE Cou NTY Na1NEER
WILLIAM A JENSEN SUP T OF BUILDIwa- FOR APPLICANT TO FELL IN a. / J ,
NUMBER RIXTURE OR ITEM EACH FfiE WATER CLOSET W75blAn BATH TOR 175 2D ✓ /�'
SHOWER 125 CITY , f vTEL NoWr 6/to CT
LAVATORY 125
CONTRACTOR
SING 175 ADDRESS L /�'I e✓' Pd {�I�
DIMMASHER 175 CITY TTEL NW-oqITDO
LAUNDRY TDB 125 REGISTRATION 'Z �((OJ COUP
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CLOTHES WARNER 175 DISTRICT NO GROUP ZONE PROCESSED BY
WATER NEATER E W1 50 A-1 60L4DV 1YL0
-GASINDUSRIAL
RrRTEIS 2 OUTLETS 1 50 WASTE APP
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM' 70 INSPECTION RECORD >
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APPROVALS `- INSPECTO *S'SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE
GAS PIPING
1 X[R[SV ACKXOWL[DO[ THAT I HAVE READ THI[ APILIG IOM GA$VENT
ANR STATE THAT THE ABOVE 1[ CORRECT AND AOR[[ TO COMPLY I
WITH
ALL COUNTY ORDINANCES AMD STAIR LAWS R[OULATINO
PLUMEINO HOT WATER HEATER
1 H[ARMY CSNYIPY THAT I AM PROPERLY wealRlER[p AND/OR PLUMBING FIXTURES
LICENSED AS R[ODIR[D SY LO[ ANOEL" COUNTY ANO STAT[ OP GAS TEST
CALIFORNIA OR THAT 1 AM THE "GAL OWNER OP ANO IMTdD TO
11[DI O[ IN THE ABOVE OCEC IEER RES, NTIAL PIIOP[RTY
UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL �
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APPLICATION FOR -PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER aonDDtc
BUIIaDINGLFM SAFETY DIVISION wn S7 O$ ]STATE JO N A MR,E COUNTY ENGINEERWILLIAMA JENSEN SUITofBumo1NG
LOcmm TEFOH APPLICANT TO FELL IN CRS TNUMBER FIXTURE OR ITEM EACH F!! LWNER
WATER CLOSET S133 ° L,Y BATH Toa 125 �D�SS S20 e SERCtJo DSHOWER 125 CIT C TEL NOLAVATORY 1u CONTRACTOR CRI-IF-sm 105 ADDRESSDISHWASHER 133 CITY SPTtl SftGWELTZL NO PMLAUNDRY TUB 115 CONTRACTORS REGISTRATION NO
CLOTHES WASHER 1 33 DISTRICT NO GROUP ZONi P OC! Q Y
WATER HEATER 130
GAS SYSTEMOOTLET9 130 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 3 PER SYSTEM 30 TSPECTION RECORD N
1 ooh-S.It�ITEtZ 6 0
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APPROVALS DATE INSPECTOR R SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE
GAS PIPING
1 XKRMY2TATZ THAT
TH OOKA'"' THAT I XAV[ RGO THIS AIOLICATION
COMPLY GAS VENT
AND [TAT[ TXAT TX[ OINA 1[ CANI Z ANO AGR[[ TO GAMILY
WITH ALL COUNTY MOINAHC[D ANI [TAT[ uwE REOuuiINO HOT WATER HEATER
PLUMBING
I H[R®T M14711 THAT 1 AM PVK)P LY R[GIe l ANO/OR PLUMBING FIXTURES
LIC[NRID AE R[OU [Y LW AMO[ CO HTT ANO AT-
AT OI GAS TEST
CAuFORNIA OR T AM TH[ L[OAL O OF
ANO O TO
Rule[ IN TH[A [ SCRIBED R"10 L rt UTILITY CO NOTIFIED T
YIGNATDRE 1
OF PERMITTEE // 11
FINAL
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ICAL ENG R
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TMftl oeS17 ll- APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY q
(� COUNTY OF LOS ANGELES PLUMBING li
WILLIAM J. FOX, CHIEF ENGINEER
FE3fiK3PPLICWT TO FILL�I �( >
PLUMBER/ RECLINED BY READY F DAT[ IBSUtD
FIRST INEPEOTION
ADDRESS
INO
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DDUMTYS 'LOCALITY G ��
LICENSE D PI
NEAREST
OWNER ST.
PERMIT FEES
NO MYLI, TY![ OWNER
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WF FI TIER[OR IT M FEE MAAILIL �• S
WATER OLOB[T(TOILET) @ D 60 • ADOR Me
BATH TUB @ O BO 01TY TCL NR
ROWER @ 660 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ TMIB
IS CORRZCT
LAVATORY (WASH BASIN) @ O m ANDA REE TO COMPLY WITH ALL COUNTY ABOVEPPLICATIION AND STATE THAT THE ORDINANCES
KITQHEN BINK @ Can AND CTAT[ LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 PO®EES THE ABDV[ VALID LAB
LAUNDRY TUB O TRAY @ O 60 ANDELED
COUNTY I PNB OR D M THE.[AAL ER
GAB SYSTEM UTLETS i MID SIGNATURE NF—
WATER HEATER ® 050 P[RMI
SLOP BINK @ o eD INSPECTION RECORD-
MID
ECORD
FLOOR BINK @ 0.60
FLOOR DRAIN Q O.BO
DISHWASHER @ D eD
DRINKING FOUNTAIN @ 060
4 2 t�2
uRINwL @ coo i
I Nouse SEWER @ O BO
a
MIBCELLAH[DUS ¢
0
APPROVALS
DATE INEFLO wm NAM[
ROUGH PLUMBING
A'
SAB PIPING
GAB VENT Q
CESSPOOL @ Ica 6EBBPOOL
SEPTIC TANK SEPTIC TANK
DRAIN ( I PIT ( ) @ 100 SEWER
PERMIT I no GAS TEST -�� S V—
UTILITT CO NOTIFIED
TOTAL FEE B ` SQ
GJ FINAL