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APPLICATION FOR 'PLUMBI G PERMft
COUNTY OF LOS ANGELES
DEPARTMENT F COUNTY�ENGINEER sa'LDn�c
B OHN=A HIAA--HEIS�oU—N-Tr rENnol�HieOn� ADDS' Lje"A&
WILLIAM A JENSEN SUrT OF BUILDING LOCAI]TT L
FOR APPLICANT TO FILL IN F T
BY
NUMBER FIXTURE OR ITEM EACH FEE
OWNERNAM F WATER CLOBET 1125 �QI QBATH TDD 125 DHEER L E CSHOWER 125 CITTrf C TEL NO
LAVATORY Ila L p CONTRACTOR LSINK 115 r ADDRESSDISHWASHER Ila CITY TEL NOLADNDHY TDD 1 2sCONTRAA OK NO,�/3 O
CLOTHES WARNER 115 DISTRICT
O G�� ZONi P EYCED BY
WATER HEATER 150 (!jam i0 -41 r
a
OAR ETSTOV—OUTLETS M 160 WAASTD�LPRAP OVAL
OUTLETS OVER a PER SYSTEM--
30
A INSPECTION RECORD �
- - Z
AX
APPROVAL6 DATE INSPECTOR 5SIGNATURE
PERMIT SjO UNDERSLAB-WORK
ROUGH PLUMBING V I /�F,s'r✓� �✓
TOTAL FEEGAS PIPING
I HERESY Acl(NowL[00[ TNAr I HAVE READ THIS APPLICATION GAS VENT
AMO RATE THAT THE ABOVE I[ CORRECT AND AGR[[ r
WITH ALL COUNTY ORDINANCES AND RATE LAW[ G
PLU MEINO HOT WATER HEATER I
I HER®r CERTIFY THAT I AM PROP[RLv REGISTEREDR PLUMBING FIXTURES
LICENSED AS REQUIRED NY LOS ANGELES COUNTY ANOF GAS
TEST -�
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF ANDORmO[ IN THE ANOV RIE[o R[nD TIAL PROPERTUTILITY CO NOTIFIED
SIGNAOF PERMITTEFINALATION ROBERTAWOOD
M o CASH SUPERVISING MECHANICAL ENG R
e918 4 63 JM 9. 5 0 1. 0.75^' V
TOAenT•CERSIT 5163
APPLICATION FOR PLUM NG PER?4(T
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUUDIIvc� T SAFETY IMION 7F AL—, 7_ /, c' >; ipc
JOHN A M IE COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN SUPT OF BUILDING USS
LOCALS! •CT
FOR APPLICANT TO FILL IN a �A j q wN
NUMBER FIXTURE OR ITEM EACH FEE
�'7�— /}
WATER CLOSET _ $125 OWNER +`� 'J�^ !� ✓ G •Vr-C
WILM
BATH TDB 125 DAD RESS V7 f�6w �• - '-
SHOWER 115 CTT! TEL NO
LAVATORY 115 CONTRACTOR 3,CI /f C Q
SINK 115 ADDRESS / L S'9n/elmi4 Rvt
DISHWASHER 115 CR* CCjaA^lv'J- TEL No Aro SYS
��� T� 125 se°arRAail°oTiNo Zl D Sia Comm
CLOTHES WASHER 125 DISTR� ROUE ZONE P BY
WATER HEATER 150 _Jj r
a
RAS SYSTEM Ot77LE78 I so WASTEINDAPPROVAL 0
OUTLETS OVER 5 PER SYSTEM 10 INSPECTION RECORD
0
f—
o_
/1
Z -
APPROVALS DATE INSPECTOR S SIGNATURE
PERMFT S 2 00• UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE
GAS PIPING
I X[R[!Y ACKNOWLEDGE THAT I HAV[ NSAD THIS APPLICATION GAS VENT
ANO STAT[ THAT Tn[ ADOV[ 1[ CORRECT AND AGN[[ TO COMPLY
WITH
ALOL COUNTY ORDINANCES AND STAT[ LAWS NL HOT WATER HEATER
I n[ p� / I
REST CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS MQUISSO CY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT JyyJyy��yyyAAMMMMMM TX[ LEGAL R O AN4 INILS{D dtl GAS TEST
RSJt1O[ IM TX[ASO `Itl� MT V -
// UTILITY CO NOTIFIED
SIGNATURE b
OP PERMITTEE G
FINAL
, 1 MMAT[ON ROBERT A WOOD
(` cK M O CASH SUPERVISING MECHANICAL ENG R
; _ \ L&OO 6 8 7a JN30 5 0 3.50- q