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D IEPARTMENT
DEPARTMENT OF BUILDING AND SAFETY : APPLICATION FOR PERMW
--
" COUNTY OF LOS ANGELES �`������ '
WM J FOX. CHIEF ENGINEER
NATME OF INSTALLATION 1917!70 1 ZONE
rADDR
.PIXTURW CONFECT[ _� '
CESSPOOL SEPTIC TANK N READY FOR a_
FIRST INBPQCTION J�
GAS
APPLICANT FILL IN HEAVII.Y OUTLINE PORTION NL
.NOB /
/ ADDRESS /LOCALITYTEL No CROSSST
IV EIPIR[H C NAMErOF SEPTIC TANK, OR CESSPOOL 3 MAILADDRESS
NORTH O v
CITY TEL No
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOC
ANGELES COUNTY CERTIFICATE OF QUALIFICATION
PLUNDER
I AM THE LEGAL OWNER OP THU PROPERTY DESCRIBED
ABOVE
owwNa
CORRECTIONS
SOUTH J
/ DESCRIPTION OF WORK _i
ATH TUB FURNACE 0
C
NOW ER DISHWASHER 0
VATORY REFRIGERATOR
ITCHEN SINK WATER SOFTENER
R SINK SANDTRAP
P SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET OR INKING FOUNTAIN
DATE IH -of
___J_WATEN NGTEER/ DENTAL LAVATORY ROUGH PLUMBING
RW�.LAA SODA FOUNTAIN OAS PIPING /C
OUTL
GAS VENT
(^ CESSPOOL
TOTAL NUMBER OF FIXTURES 1�s 0 SEPTIC TANK
_4z"SPOOu 0EPTICTANK , Cl <,J SEWER
SIDDS 0 UTILITY CO NOTIFI! S
TOTAL FEE
SO IN S
D IEPARTMENT OF BUILDING ASAFETY APPLICATION FOR P$RffiT
DND
COUNTY OF LOS ANGELES �`���'�G '
WN J FOX,CNIV ENGINEER
W-XT-UWOF INSTALLATION
fLMATION
►UITUR® COMPLETE CD //
HEAT COfA00L •@TIC TANK R[C[R/LD BY READY FOR DAT[ ISSUED
FIRST INSPECTION Q �
RAS
'APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY?
,of
ADDROS74
_ of
S O' //� ^ � LOCALRTNEAREST TEL No CROSS ST
QPIREf I NAM[ Ii1.� 'I OF SEPTIC TANS, OR CESSPOOL MAIL
NORTH ADDRESS
CRY TEL No
IAM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIF TRI OP QUALI►KATION
mfg.-/-r C/L
PLUMED
I AM THE LEGAL OWNER OF E PRO RTY ESCRIBED
ABOVE
(A 4ALLL
OWNO
CORRECTIONS
SOUTH J
DESCRIPTION OF WORK
ATH TUB FURNACE °
rc
MOWER DISHWASHER O
--Z--LAVATORY REFRIGERATOR
ITCHEN BINK WATER SOFTENER
R SINK MANDTIIAP
P SINK -----FLOOR DRAIN
/ WASH TRAY URINALUVZW
APPROVALS
WATER CLOSET DRINKING FOUNTAIN
J DATE IM VECTOR•MAYi
�LWATL)1 N[�R DENTAL LAVATORYBING
EYE" /,ZOAY/ SODA FOUNTAIN
OUTL
GAS
TOTAL NUMBER OF FIXTURES®SPOOI SdrTIC TANK NOTIFIED
TOTAL FEE i` �{�
74AM n B-so ID APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY 1 w
COUNTY OF LOS ANGELES (�
WILLIAM J FOX CHIEF ENGINEER
FW APPLICANT TO FILL IN =113TRICTNO GROUP I ZONE PERMITNO
PLUMBQi .IQ�i�' /� RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION �/
ADDRESS A AV /
BUILDING
CITYLION/Adr '&,IrTgt. NO ooS
a
+ ADDRESS
COENB NO g1rIR 6—J0'1r.// LOCALITY
CROSS ST
PER= FEES
Numb%N TYLE OF FIETURE OR ITEM FEE OWNER
.41,OA4AO 04
MAIL
WATER CLOSET TOILET 050 ADDRSSS
BATH TUB a O EO CITY TEL NO
SOWER @ O EO I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY WASH BASIN O BO APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
_AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN BINK @ O BO ISTATE LAWS REGULATING PLUMBING
1 CERTIFY THAT 1 POSSESS THE ABOVE V D OS
LAUNDRY TUB OR TRAY O BO ANGELES COUNTY LICENSIC ORHlLEAA O 8R
OF THE RESIDENTIAL PERTY HD A
EAS SYSTH OUTLETS ® O SO
S16NATURB OF
WATER NEATER O EO PERMITTEE e.
SLOPSINK O EO ,INSPECTION RECORD
FLOOR BINK a 050
FLOOR DRAIN a O SO `
DISHWASHER 050
DRINKING FOUNTAIN O BO O
URINAL 050 J
HOuSBSEWER O SO Z
MISCELLANEOUS I✓ / TS//OULU
` r IRe RrPZ#cr9aW RAC of °
IE
NG 1) SiAlkE�` s o
e I E wrRotl
l✓ - FN
APPROVALS
DATE INSPEOTOR• NAME
ROUGH PLUMBING Z
GAB PIPING
GAB VENT
CESSPOOL 1 00I CESSPOOL
SEPTIC TANK SEPTIC TANK
DRAIN I ) PIT ( ) 100 I SEWER
PERMIT 1 00 OAS TEST
S �w UTILITY CO NOTIFIED
TOTAL FEE L
FINAL
DO L 17 LM ESTE 12 u APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY p
COUNTY OF LOS ANGELES PL�����V
WM J FOX. CHIa ENGINEER
NATURE-OF INSTALLATI Aa
ROUGH FIINTUR® COMPLETE / I HEATER CmQ►SOL Y�TICTANK T INSADY FOR
►=RST INSPECTION,APPLI FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
S D F• DRESS 3MARKET
C TdCROW ET
CNAMLOCATION C TANS, OR MAaDRESS
NORTH O
CRY Td N1 AM THE LEGAL POSSESSOR OF THANGELES COUNTY CERTIP E P .==P M1 AM THE LEGAL, -m OF THE PRO=DVKOWM
CORRECTIONS
SOUTH
LWA
ESCRIPTION OF WORK
UB �JIURNACE
Da ftIexwABHoI
O
ORY REMUNERATOR
EN SINK WATER SORQNEI
SINE IAND TRAP
INK OOR DRAIN *Q
TRAY PRIMAL' APPROVALSCLOSET ^RINKING=OUNTA N DATE NEATER ^ENTAL LAVATORY ROUGH PLUMBING�GOAG _SODA POUNTAW
OUTL GAG PIPING
GAS VENT
/�NUMSENOPFURUR® AV SEPTIC TANK
OL off"IO TANK SEWER
G UTILITY CO NOTIFIED
TOTAL FCB 1496 -G 9L
n
TAA"" OMIT II-w APPLICATION FOR PERMIT
DEPARTMENT OFNG AND SAFETY U I�G I I�G
COUNTY LOS ANGELES
WILLIAM J..OF
LOS PDX, CHIEF ENGINEER
FAPPL TO IN 7
54.9
PLUMBER R[ [IVSD W READY FOR DAT[ IBBUED/
FIRST INSPECTION
AD E•B
C73c�3 ILDINGSITY TEL MO ADDR<D (� �
COUNTY Y / 3.4 ,^ LOCALITY
ungmer. NO.
ac+ NEAREST
PERMIT FEES CROSH Sr
MYMBEN TYF{OF FI%TIQ On IT[Y FEY OWNER
MAIL
WATER CLOSET(TOILET) 0 [LOU • ADDRESS
RATH TUB 0 Cl CITY TEL ND
SHOWER ago 1 Hill ACKNOWLKDO[ THAT I HAV[ READ THIO
LAVATORY (WASH BASIN) ® 6HVE
60 APPLICATION AND STATE THAT THE ASOI• CORRECT
AND ACRE[ TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ O,SO AND STATE LAWS REGULATING PLUMBING
t CERTIFY THAT 1 PORS®B THE ABOVE VALID LaS
LAUNDRY TUB OR TRAY 0 6R0 ANGELES COUNTY ENBE, OR 1 AM THK,L [R
SAS SYSTEM OUTLETS 0 C.SO OF THE REBID[ PROP[�RIS AS 7I
SIGNATURE O
WATER HEATER 0 O BO PERMI
BLOP BINK m DBD INSPECTION RECORD
FLOOR BINK O O.SO
FLOOR DRAIN 0 C BD
DISHWASHER 0 O.BO
DRINKING FOUNTAIN 0 OBC
URINAL 0 coo A
a
HOUSE SEWER ® D.SD =
MIBO[LLAN[OUB
C
APPROVALS
DAT[ IneF[Drnr[ NAME
ROUGH PLUMBING
GAB PIPING
GAB VENT
CESSPOOL 0 IDC CESSPOOL
SEPTIC TANK SEPTIC TANK
DRAIN ( ) PIT ( ) 0 100 REWER
PERMIT .
1.00 GAB TERT
UTILITY CO.NOTI►1[D
TOTAL FEE • �O
rINAL ,(+