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DBS-17 f0-S9 APPLICATION FOR PLUMBING PEPERMIT .1
BS-17
DMSION OF BUILDING AND SAFETY
Deportment.of County Engineer
County of Los Angeles BUILDING
JOHN A.L.AMBIE, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING
LOCALITY czd/ I
FOR RA" TO FILL IN NEAREST
CROSS ST.
OWNER DISTRICT NO. GROrP READY FOR INSPECTION
MAIL y
ADDRESS // I I
INDUSTRIAL I
CITYL.NO. WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS /-
CITY TEL.NO. O 76/�p/-
LICENSE NO. / 3 !�'0 1.4
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY'(WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
DISHWASHER @. $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE (SAS VENT
I HEREBY ACKNOWLEDGE THAT 1 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. PLUMBING FIXTURES
I 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 OWNER OF T ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTI�ROPERTY.
SIGNATURE
OF PERMITTEE FINAL
IQHN A.L AMBIE.COUNTY ENGINEER ALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
CH. M.e. ' CASH
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3 2'1 TLA, FEB 20 3 200