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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGjNm MDU
BUIIAING AND SAFETY IMION D
JOHN A LAMBIE COUNTY ENGINEER 55)-A N, SiAtana
WILLIAM A JENSEN SUP T OF BUILDING LOCALILY
Tenmle C
FOR APPLICANT TO FELL IN NEARESOSST
NUMBER FIXTURE OR ITEM EACH FEE
ST
OWNER
BOATER closer 3125 MAD.
BATH TOB 125 ADDS same
RHOVFER lis CITY TEL No
LAVATORY 125 coNT"cTOR pacific Installers
BDR 125 ADDRESS
DOHWARHEI 125 CrrY TEL NO _
LAUNDRY TUB 125 CONTRA R B STATE
REGISTRATION NO COUNTY
CLOTHES WARE® 115 DIBTRIR NO O UP ZONE ► [[BED BY
WATER HEATER 150 ( }
GAS SYSTEM OUTLETS I50 INDUSTRIAL Q
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM m INSPECTION RECORD
C
0
H
a
z
Z
APPROVALS DATE INSPCLTOR S SIGNATURE
PERMIT s ]ANDIOR
UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACSNOWUROG[ THAT 1 MAV[ RI AD THIS GAS VENT
AND STATE THAT THE ABOVE a CORRECT AND wOR[E
WI
ALL COUNTY ORDINANCES AND RAT[ LIBOR HOT WATER HEATER
PLUMEINO
I N[MpY CCIRIIY THAT 1 AM PROPERLY RCpIR[RPLUMBING FIXTURES
LIC NRRD AS RKQU1RED BY LOS ANO[LMA COUNry AND F GAS TESTCALIFORNIA OR THAT 1 AM THE LEGAL OWNER OP ANDREBID[ IN THc ABOVE W&CR[RID[Ni1wL FENTUTILITY CO NOTIFIED
SIGNATURE f_
OF PERMITTEE FINAL Ay
�AIMA71ON ROBERT A WOOD
cK M O CASH SUPERVISING MECHANICAL ENG R
, UC4397.0 JAI414 5 A 325-
017
D" Io ee APPLICATION FOR PLUMBING PERMIT 1
D"
DIVISION OF BUILDING ANI) SAFETY f.
Depozhn5d of ConnffY Engiiipw
County of LoE AngdeSv '0 . ; BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN,SUP T OF BUILDING
LOCALITY
FOR APPLICANT T FIU IN NEAREST
CROSS ST
OWNER DISTRICT NO GROUP Z NQ erADY loP INtPeRION
MAIL j
ADDRESS
CITY TEL N Q INDUSTRIAL
WASTRAPPROVAL
PLUMBQ INSPECTION RECORD
ADDRESS
CI TEL NOq/
LICENfjV
NUMBER TYPE XF FIXTURE OR REM Fee
WATER CLOSET (TOILET) 51 GO
BATHTUB 51 00
SHOWER @ $100
LAVATORY (WASH BASIN) •100
KITCHEN SINK 5! 00
DISHWASHER @ 51 00
LAUNDRY TUDOR TRAY $100
CLOTHES WASHER 51 00
WATER HEATER 4100
GAS SYSTEM @ 0100
APPROVALS
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
PERMIT 5 1 00 ROUGH PLUMBING
TOTAL FEE
2 0 a
GAS PIPING
GAS VENT
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
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
i HEREBY CERTIFY THAT 1 M PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY S A S COUNTY AND STATE OF
CALIFORNIA OR THAT I TH LEGAL OWNER 2y THE ABOVE UTILITYCO NOTIFIED
DESCRIBED REBID IA OF
SIGNATURE
OF PBRMITT 8 FINAL �-
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBo INSPECTOR
eE LG3 6 6 5 A MAR 2 3 2.0 0 0
76 7 DEE 17 7-E1 APPLICATION FOR-PERM T
'..'DEPARTMENT COUN OFF LOS NG AND SAFETY a
COUNTY J. F LOS ANGELES PLUMBING 1
WILLIAM J. FOX, CNI[r ENGINEER
FOR APPLICANT TO FILL IN Y SNO
PLUNB[R RIC By R[AOY IOR DATE ISSUED
S / ►IRST INSPECTION
owl
BUILDINGw�
CITY TEL ®
No ADDRY //'
LIOEmRr DOIINTY O 1 R ��� /Q LCOALTY
�p(J� 4e�n L/
PERBU FEES CROBBBT.
NUMBER TY/[OI FI%TIIR[DR ITEM FC[
OWNER
IL
WATER CLOSET(TOILET) @ coo • AGMAGRESS
BATH TUB @ 660 CITY TEL NO
SHOWER @ G.BC 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH CABIN) @ Goo AP
jDLICATION AND AGREE ATZ THAT H CORRECTE ABOVE 10
TO COMPLY WITH ALLCOUNTY CRDINANO[B
KITCHEN BINK @ 050 AND STAT[ LAWS REGULATING PLUMBING.
1 OERTIFY THAT I POSS[BB THE ABOVE VALID LOU
LAUNDRY TUB OR TRAY @ OBC ANGELES COUNTY LICENSL OR I AM THE LEGAL OWNER
GAB SYBT[M OUTLETS @ DISC OF THE REBID[ PR P[ CRIRED ASOVL
SIGNATURE OF
WATER HEATER @ 050 PIMMITTZIL
SLOP BINK @ DSO IMSPECTWN RECORD
FLOOR SINK @ G.BO
FLOOR DRAIN @ G.BO
DISHWASHER @ CSC
DRINKING FOUNTAIN @ G.SC
URINAL @ 0,50 Q
HOUR[ BEWER @ G SC _Z
MISCELLANEOUS O
R
0
APPROVALS
00re IN ..IYR NAME
ROUGH PLUMBING �Zle Z
BAD PIPING
GAB VENT
OEBBPDOL @ I.CC CESSPOOL
SEPTIC TANK- SEPTIC TANK
DRAIN ( ) PIT ( @ 100 SEWER
PERMIT 100 GA91 TEBT
UTILITY CO.NOTIFIED
TOTAL FEE • D ��, J-2
FINAL
p:°,,,, APPLICATION FOR PLUMBING PERMIT 1
DIVISION OF SUn DING AND SAFE"
D.Forimm.Dfof comtt Engin
C.mtp Of Los AB1fSf// BUILDING
WM J FOX COUNTY ENGINEER ADDRE88
CASSATT D GRIFFIN SUP T OF BUILDIND
LOCALITY
FOR APPLI O FILL NEAREST
CR SSr.
OWNER &AatDISTRICT NO GROUP . wO—NH'� ARAor PDA INSPECTION
MAIL iEa�,
ADDRESS
( a INDUSTRIAL
CITY TEL N WASTE q PROV
PLUM INSPECTION RECORD
ADDRESS ♦ I ) _
CITY TEL N
LICENS
HUM0"rTYP66VFIXTURF OR IT&A FEE
WATER CLOSET (TOILET) s
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
rK
TOTAL NO a OHO APPROVALS
DATE INSPECTOR 5SIGNATURE
OAS SYSTEM__OUTLETH 100
WATER HEATER tool UNDER SLAB WORK
ROUGH PLUMBING
PERMIT f 1 00 GASPIPING
TOTAL FEE v GAS VENT
1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED Y LOS ANGELES COUNTY AND STATE OF UTILITY CO NOTIFIED
CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESMENTIV P OPERTY
SIGNATURE
OF PERMITTEE FINAL 1 1
WILLIAM J FOX COUNTY ENGINEER VALIDATION R A WOOD CHIRP PLSG INSPECTOR
C9654HOV 3 3 260 in
D 8 H-IT 26M SETS 12-I61APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFSYIS �������� 'I
COUNTY OF LOS ANGELES
WM J FOX,CHIEF ENGINEER
NATURE OF INTI DIST GROUP -ZONE
� P R�M7IT N I
ROUGH FIXTURED �1I COMPLETE 57
HEATER CESSPOOL I SOTIC TANK R VED BY READY FOR DAT[ ISGUm
FIRST INSPECTION
SCELLA 7,(�!
,A�PPLI ANT HEAVILY OUTLINED PORTION ONLY
E NAM[ f// tet/ ADDRESS V
■
JY ADDRESS D � � LOCALITY
L /
CITY T�1,// (/1 �� CROSS NKARINI T 1
COU
CERT No 77 EXPIRES _ U ` NAM[
LOCATION OF SE C TANS, OR CESSPOOL Z MAIL
3 ADDRESS
NORTH O
CITY TEL NO
1 AM TH[ LE FOBS[SSOR OF THE ABOVE LOS
ANGR[S COUNTY (FICA 'O OUALI CATION
PLUYBR
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
I ABOVE
OWN=
CORRECTIONS
SOUTH
DESCRIPTION OF WORK
ATH JF7LXTURM
FURNACE
HOWDISHWASHER C
VATREFRIGERATOR
ITCHWATER SOFTENER
RANDTRAP
FLOOR DRAIN
WASHURINAL APPROVALS
WATET DRINKING FOUNTAIN DATE 1M�F 2'B MAN[
WATEM DENTAL LAVATOpY
ROUGH PLUMBING
1
RERGAB FOUNTAIN GAB PIPING
1 un
GAS VENT
CESSPOOL
TOTALR O FFDTTURM �Q SEPTIC TANK
ESSPRRPTICTANK S[YVER
STOTAL PEEB d � UTILITY CO NOTIFIED
FINAL ' -/ _YF 6 ✓ 4 nl
f Do t IT mN ttn Ii N APPLICATION FOR PERPUT
DEPARTMENT OF BUILDING AND SAFETY ' s,A
COUNTY OF LOS ANGELES �`o ,��B'��
WM J FOX.CHIEF W40INMR
ir
T .
ROUGH FDm/R® eoNPLerE _ 9f
92-7
HEATER CESSPOOL- SVTIC TANK ry FI READY FOR N DATE ISSUED
APPLICANT FILL IN HEAVILY OUTLINED PORTION Y
,u
NAME �� ADDREIO Z J
G ADDRESS! Z LOCALITY /
j NEAREST
L CITY L No CROSS ST
COUNTY CERT No EXPIRES e' NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL Mwa
NORTH ADDRtDS /p
CITY `+ TO-No
I AN THE LEGAL 80a • THE ABOVE LOS
ANO16O COUNTY CERTI.1 O• UAL O TION
NLOMttt
1 AM THE LEGAL OWNER OF THE PROPERTY COCE ED
ABOVE
Ol
owlrn
CORRECTIONS
SOUTH
DESCRIPTION OF WORK
ATH TUE ^�RNACE Lry
HOWER DISHWASH®1
VATORY REFRIGERATOR
TTCH@I OINK WATER SOITO/OR
R SINK RAND TRAP
OINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOOET DRINKING FOUNTAIN DATE DltacTow•wwrt
WATER HKATO DENTALLAVATORY ROUGH PLUMBING
ETE GAS WDA FOUNTAIN OAS PIPING
OUTL
GAS VENT
CEI POOL
TOTAL NUMBER OF FIXTURES SEPTIC TANK
t--POC REPTIC TANK SEWER
S UTILITY CO NOTIFIED
TOTAL FEE
MA
worm thaCOMPENSATIONcate of cone APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of cement to sell ' 76A667A
insure, or a certificate of Workers Compensation Insurance CE 817(REV 10/81)
or a certified copy thereof (Sec 3800, Lob C) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Company
Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) 8UA IO�REu
donha Lr
Certified copy fled with the county building
hon Oportment NUMBER FIXTURE OR ITEM ® FEE
LOCALITY !MSftS_ Ciq If CA
Date Applirant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION F WORKERS' BATH TUB CROSS Sr
COMPENSATION INSU CE SHOWER OWNER
(This section need net be completed IF the work Involved by MAB L,�,�"s
the Permit Is for one hundred dollars($100)or less) LAVATORY ADDRESS r7sss�1/f�►r7
1 certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner SINK CITY TEL NO
so as to become subject to the Workers'Compensation Laws DISHWASHER
CONTRACTOR
Dote Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT If after making this Certificate of 5W W.
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forthCITY L
with comply with such provisions or the LAWN SPRINKLER SYSTEM permit shall be STATE UC
deemed revoked WATER HEATER LICENSE NO MSS
LICENSED CONTRACTORS DECLARATION DISTRICT NO 55®BY
1 hereby affum that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business CUTLETS OVER r
.and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL�J_�J�
Q{p a,� .,w� DATE Y'G.�ef _ VALIDATION u
License Number 3rL1 Lic ClassyJ_ WTMw T �—tC•s U
FINAL O
Contractor Date sg3 BY C
❑ I am exempt der Sec W
6
N
B BP C for this reason plan check fee Z
Date
PLUMBING PERMIT ISSUING FEE$ 100
Signature
TOTAL FEE
Plan check applicant
SINGLE FAMILY
HOME OWNER BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor s License Address 9 2 0 0 7 A
Law for the following reason (Section 7031 5, Buslmns and
Professions Code) City Tel No • 5
❑ 1, as owner of the property, s
p perry, will do the work and the Poo
,2 s • 2 250
structure a not intended or offered for sole (Section
7044 Business and Professions Code) . . . 2 2'5 Q 6
CONSTRUCTION LENDING AGENCY
I hereby affirm that there s o construction lending agencyfor 0 r1 1 6—8 3
the performance of the work for which this permit is issued
(Sec 3097, Cry C )
Lender's Name
Lender s Address
I certify that I have read this application and state that the polo
mformonn ois correct I ogres to comply with all County
ordinances and State laws regulating Plumbing, aid hereby
authorize representatives of this County to enter upon the
above-m4fWried pr party for inspection purposes
�,�� ������lQL'.�1� SEE REVERSE FOR EXPLANATORY LANGUAGE
Si nature o�errm t, !Dote