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10-SB APPLICATION FOR PL1J1111BINd PER1001IT •�
IBB.17
DMSION OF BUILDING AND SAFETY
Deportment of County Engineer '
County of Los AngeLINTY E ADDRESS
UILDING
JOHN A.LAMBI.E. COUNTY ENGINEER 4'
CASSATT D,GRIFFIN,SUPT OF BUILDING +
LOCALITY ���-•L-r/ y�, .
FOR APPLICANT TO FILL IN NEAREST Ov�99
CROSS ST. "3
•
OWNER DISTR)S.YNO. IWhOup I ZONE I READY FOR INSPECTION
MAIL. L` pe I ® �,Z.
ADDRESS ® �Cbn 1A
• �pf(' INDUSTRIAL
CITY M�•
2TEL.N,0 WASTE APPROVAL
PLUMBER j?j1 1C0 f �N•i/ri• • i SID INSPECTION RECORD
ADDRESSS6de.*, -,
7--
8 I�
CITY ,/' dr, e•�� TEL.N ." •e� 0
LICENSE NO. 4�a/ 9
NUMBER TYPE OF FIXTURE OR IT& FEE
® WATER CLOSET (TOILET) @ $1.00
BATH TUB @ $1.00 n C
SHOWER @ $1.00 (� 3�7 /J.I�l,,• 21A r• /-�
LAVATORY (WASH BASIN) @ $1.00 —�/
KITCHEN SINK @ $1.00 ( d AIN �V rW
DISHWASHER @ $1.00 1?f lefa)60 /111 Iris
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00 `
WATER HEATER @ $1.00 ��, n
GAS SYSTEM @ $1.00 , 1
P;zh SNED
APPROVALS
DATE INSPE/CCTOR's SIGNATURE
UNDER SLAB WORK )�', % 1J,V• I..R�r���
PERMIT $ 1 00 ROUGH PLUMBING ! 7 C-t ` 4
GAS'PIPING
TOTAL FEE 00 GAS.VENT
I HEREBY ACKNOWLEDGE THAT 1HAVE 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. PLUMBING FIXTURES
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL 0 NER OF' THE ABOVE UTILITY CO.NOTIFIED --�-
DESCRIBED RESIDENTIAL PROPER e
SIGNATURE 1 �
OF PERMITTEE. 1 %• FINAL -� �; lriQ,f O Ca
0
IOHN A.L.AMBIE.COUNTY ENGINEER VALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
C6. B.0. CASH
L 204� 8�' SEP 6 3 400 M