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NIO EES APPLICATION FOR PLUMBING PERMIT 1
DIVISION OF BPMING AND SAFETY '
Dep Cro eW d Co Aa En�ew
�� �� ADDRESS SZ/ I
JOHN A LAMBIE COUNTY ENGINEER
CABSATT p GRIFFIN.SUP TOP BUILDINGING
P'
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
Y CROSS
OWNER DISTRICT NO O OU ZONE RKADY FDR IKlPECTION
MAIL
MAILADDRESS
INDUSTRIA]
91-
CI T!L NO WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS Z S
CITY TEL NO
LICENSE
NUMNIR TYPE OF FIXTURE OR ITEM PER
WATER CLOSET (TO ILIET) - $100 S
BATH TUB $1 00 /
SHOWER ® 1 00
LAVATORY (WASH BASIN) @ $1 00
KITCHEN SINK a $100
DISHWASHER @ $100
LAUNDRY TUBORTRAY @ $100
CLOTHES WASHER @ $100
WATER HEATER @ $100
OAS SYSTEM @ $100
APPROVALS
DATE INSPECTOR 5SIGNATURE
UNDER SLAB WORK
PERMIT f 1 00 ROUGH PLUMBING
OAS PIPING
TOTAL FEE GAB VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IE CORRECT AND AGREE TO COMPLY HOT WATER HEATlR
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR GAS TEST
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL PROPER.
SIGNATURE
OF PERM IT TE FINAL
JOHN A LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK ■ • usN
LG5 5 6 3V-, FE826 3 5.0 0 1D
2e .rrs ro..n APPLICATION FOR PERMIT
DEPAR7RNT O OFF LOS ANGELES
COUNTY �`���t�V
WM J FOX.CHIEF ENGINEER
O
ROUGH FIXTURES COYPLSTR READY FOR
�O
m
NXATER MINECESSPOOL SVTI6 TANK PIwST INSPECTION
APPLICAM FILL IN HEAVILY OUTLINED PORTIO NLY
Jos
y. NAME ADDRESS
10
6 M=1 ADDRESS miz�auwwwpma
CITY 0% - NT0. No.
COUNTY
CERT No EXPIRES
LOCATIO SEPTIC TANK, OR CESSPOOLNORTH TSLPOSSESSOR OF THS ABOVE LOS
RTIFICATE OP QUALIFICATION
' P1.YRNIES _
1 AM THE LEGAL OWNER OF TH PROPERTY DMPCWMW
ABOVE.
CORRECTIONS
SOUTH J
DESCRIPTION OF WORK i
l ATN TUB rURNACX a
NOWER DISHWASHER C
:JAVATORV REFRIGERATOR
ITCNQI SINK WATER SOFTENER
R SINK RANDTRAP
BINK DDR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSER DRINKING FOUNTAIN DATE 1MEP6TOR t MANS
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING Q� rCLQ
RODA FOUNTAIN OAS PIPING
OUTL
OAS VENT
CESSPOOL
TOT AL NUMBER OF FIXTURES
Sl(PTIC TANK 3
ESEPOOL_/_.JEPTICTANK Q SEWER (J
S UTILITY CO NOTIFIED 3•R C / I I
TOTAL FEE pu FINAL
TBABP) ORB n v-{I APPLICATION FOR PERMIT
DEPARTMENT OFNG AND SAFETY
1:OUNTY OFF LOS LOS ANGELES
WILLIAM J FOX. CHIEF ENGINEER PLUMBING 1
FOR APPLICANT TO FILL IN DISTRICT mss Q/�Z '
PLY B 1 R FIR EINBPEOTION Y FOR DATE IBOUED
ESB Cll
(I� BUILDING
CITY TEL NO Q ADDR[YB
LICENSE NO EXPIRES
ODUNYY LOCALITY
PERMIT FEES otum mT
NYMBEII TY'E OI FIKTLRE OR IT(Y FEE OWNER
WATER OLOEET(TOILET) @ OBC O ADDREB>_
BATH TUB @ 050
CITY4rfaiAn�.� TEL NO
SHOWER @ D.SO 1 HEREBY ACKNOWLED01i THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ O 60 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AORKE TO BOMPLY WITH ALL COUNTY ORDINANCES
KITCHEN BINK @ 050 AND STATE LAWI RESULATING PLUMBING
I CERTIFY THAT 1 POBBESS THE ABOVE VALID LOB
LAUNDRY TUB OR TRAY @ O SO ANGELES COUNTY LICENSE. OR 1 AN THE LEGAL OWNER
OAS SYSTEM OUTLETS @ 050 OF THE pEI1DENTIAL PROPERTY DESCRIBED ABOV[.
INGNATURE OF
WATER HEATER @ O BG PERMITTE
SLOP BINK @ 050 nwz&iog RECORD
FLOOR BINK @ O Be
FLOOR DRAIN @ 050
OISHWABNER @ 050
DRINKING FOUNTAIN @ O BO
URINAL @ O SO Q
HOUBE ILW" @ O BO Z
MISCELLANEOUS 0
R'
L U
APPROVALS
DATE INYEOTOR•R NAME
ROUGH PLUMBING
GAB PIPING ..r
OAS VENT
CESSPOOL @ 1.10 CESSPOOL
BEPTIO TANK. BEPTIO TANK
DRAIN ( ) PIT ( ) @ 100 BEWER
PERMITI DO GAB TEST
T13TAL•FEE s f o Yr1uTYDO NGnneD
FINAL