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APPLICATION FOR PLUMBI G PERM
COUNTY OF LOS ANGELES
DEPARTMENTp��OppF COUNTY ENGINEER saaDaHc jCOUZNm
C qua lipGLAM�IEs o�� PNlal�KER ADDRESS �WILLIAM A JENSEN SUP T OE BUILDING LOCALITYT�MP��FOR APPLICANT TO FILL IN CNEAREST
EOSS ST
NUMBER FIXTURE OR ITEM SACH FEE WATER CLOSET S'O OA®SIu efAIIBATH TOS 12S lir ADDRESS
SHOWER ITS CITY TEL NO
LAVATORY I$ CONTRACTORBINK 1TS ADDRESSDISHWASHER 125 CITY HacthD TEL xLxHnmax ron 1u ST
REGISTRATION NO 193617 C-36 8 STATE
CLOTHES WASHER 125 DISTRICT NO GROUP ZONE PROCESSED BY
WATER HEATER 150 O I R-3 GS &LDVKD
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-GAS SYSTEM OUTLII'S ISO DmaSTRIAtWASTE APPROVAL O
OUTLETS OVER S PER SYSTEM 00
INSPECTION RECORD �+
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APPROVALS AT INIPICT_0116elOHATURE
PERMIT E 2 OO UNDER SLAB WORK
ROUGH PLUMBING 0
TOTAL FEE GAS PIPING /
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ "IS APPLICATION GAS VENT
AND TATE THAT THE AEOVE lE CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND TAT! LAWS REGULATING
PLUMBING HOT WATER HEATER
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES
LICEMSCO AS REQUIRED SIT LOS ANGELES COUNTY AND TATE OF GAS TEST
CALIFORNIA OR THAT I AM THE "GAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE OESCRIDED RESIDENTIAL PROPITY UTILITY CO NOTIFIED
SIGNATURE
n
OF PERMITTEE
FINAL
ATION ROBERT A WOOD
(7 M O CASH SUPERVISING MECHANICAL ENG R
LAPo 3 0 9 2G2 APR 9 5 D 13.75-
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF 68S ANGEtEGS�
DEPARRpDUM OF
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B[0 OGLAFIBI CO ,1YOYIN'iII°RN 7LEE'lMaWILLIAM A JENSEN. SUPT OF BVILDINGFOR PaWCANT TO F= IIPclow
NUNBER FIXTURE OR ITEM WATER CLOSET
BATH TDB
c+rT TEL NO.
SHOWER
LAVATORY r�HraAcrca
/ eaa ADDRESS
DIRRWABffi CITY TEL NO ._
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CLOTHES WASHER DISTRICT NO GROUP 6 P BY
WATER DATER Cr O
DiDDSTBiAL
GAS
SMEM WASTE APPROVAL V
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OR ramm S APPROVA DATE-. INSPECTOR l'IUXAWRE
PERMIT S 2 OO UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 H'RE'Y ACKNOWLEDGE THAT 1 HAVE REAO THIS APPLICATION
AND 'TAT[ THAT 1HE ABOVE It CORRECT AND ACRIQ TO COMPLY GAS VENT
TY
W"m ALL COUNORDINANCE' AND STATR LAW' R[OULATINO
PLUMBING HOT WATER HEATER
I MEREST CERTIFY -,4I AY PRGF'RLY REOI'T'REU AND/OR PLUMBING FIXTURES
ucSHIED AS R'GUIRE LOO G'LBCOUNTY AND COUNAND STATE OF GAS TEST
CALIFORNIA OR THAT AY LEGAL OWNER OF TN'
13 O 1BED REnDENTu R UTILITY CO NOTIFIED
SIGN
OF PERMITT6 FINAL
If r �RLIDATION ROBERT A WOOD
CIL M o CASH SUPERVISING MECHANICAL ENO R
VCo9 9 9 at2 JN22 5 D 13.75- V
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• APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENG24M
B INCA {.�BIN�D SAFETY }DMSION / Jq
JO N A LAMBIE COUNTY ENGINEER �W l._ 6 S
GR WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN cam TT
NUMBER FIXTURE OR ITEM EACH PEE OWNEa S
WATER CLOSET 8125 Op I/AIL
HATH TUB 1.15 2 d ADDRESS
SHOWER 125 CITY TEL NO
LAVATORY 125 Oaa CONTRACTOR D
SINK 125 B' SJ ADDRESS
DISHWASHER 125 RTS' Hawthorne TEL NNSISTATEY
LAUNDRY TDB 125
CONTRACTOR
REGIS�TRATIIONNO 193617 C-36
CLOTHES WASHER 145 DISTRICT NO G OUP ZONfi P ESSED BY
2 WATER HEATER 1 50 w60
-GAS SYSTESN OUTLETS 150 dd INDUSTRIAL
WASTE APPROVAL
OUTLE78 OVER 5 PER SYSTEM .80 INSPECTION RECORD !
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APPROVALS - DATE INS'[CTOR 0 SIGNATURE
PERMIT Sjl�ND
DD UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEEGAS PIPING
1 HERCRT ACKNOWLEDGE THAT I HAVE BRAD THTION GAS VENT
AND [TAT[ TNAT THE ABOVE 12 CORRECT AMO AGELY
WITN ALL COUNTY ORDINANCE[ AND [TAT[ uWTING HOT WATER HEATER
PLUMBING
I HEREBY t[RTVY THAT I AM PROPERLY REGID/OR PLUMBING FIXTURES
LIC[NEED AS REQUIRED BY LOB ANGELES COUNTY OF GAS TEST
CALIFORNIA OR THAT 1 AM TME LEGAL OWNER OF ANDD TO RUID[IN THE ABOVE D[BCRI[ED RESIDENTIAL PROPUTILITY CO NOTIFIED
SIGNATURE
OF PERMITT Inc~ FINAL
OALMATION ROBERT A WOOD
<K M o CASH SUPERVISING MECHANICAL ENG R
LfiL'o 2-4 6 7G Mit 2 5 5 D 2 5.5 0
CANCELLED AT MtI, T OF PERMITTEE ��