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7SA66-M17 10-M
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEP�A�RTT IENTp�OpF g COUNTY ENGINEER
JogoLASH L" DIVISION sonDDaa 3
JO I OUNTY ENGINEER ADDHERB
WILLIAM A JBN8ZN, SUPT or BuILDixa
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FOR APPLICANT TO FILL IN T
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET NAQ.
BATE TDB ADDRESS
SHOWER CRT TEL NO.
LAVATORYCOMTRACTO
RINE ADDERS
DISHWABEER CRT TEL NO
LAUNI)RT TDR 8E715TEATIOS NO. Cm
CLOTHES WAS® DISTRICT NO BY
WATER HEATER
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WARTS APPROVAL
/ 1 INSPECTION SECOND O
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• SIM PER ITEM
OR FDITORE S APPROVALS DATE INSPECTOR•SIGNATURE
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TOTAL FEE rJ ROUGH PLUMBING
J OAS PIPING
1 NER®Y ACRNOV if THAT 1 NAVE RIWC) "to APPLICATION
AND
ITATI[ TRAY TI-Ii AROVi IS CORRICT ANO AGRR TO COYRY GAB VENT
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FI.UMRING HOT WATER HEATER
1 IRROY CIRTIrY THAT I AN PROr Y RSGIITi1RD ANOION PLUMBING FIXTURES
LICIMIm AI RIGUIRID RY COS ANOILiI COUNTY ANO STATE OI GAS TEST
CALIFORNIA OR THAT I AM THE Ult A OWNp1 Or THC AROVS
DESCRIR[D RiS1D[NTIAL MOF UTILITY CO NOTIFIED 1
SIGNATUREN .N//
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VALIDATION ROBERT A WOOD
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
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NUMBER FIXTURE:OR ITEM OWNER Q E'L7 S
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LAUNDRY TUB HEC®TBATION COUNTY
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APPROVALJ3 DATE INSPECTOR 8SIGNATURE
PERMIT f 2 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAB PIPING
1 HEREBY ACLNONLEDGE THAT I HAVE R[AD THIS APPLI CA GAS VENT
AND STATE THAT THE ABOVE I8 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY OEDIBANCES AND STAT[ LAB'S HiOULATItlG
PLUMBING HOT WATER HEATER
1 XEREST CERTIFY THAT 1 AM PROPERLY B9GIMlUlO AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
GLIFORMIA OR TXAT 1 NB OYM OF THE ABOVE
OEBCEIESD RESIDENTIAL BTY UTILITY CO NOTIFIED
SIGNATURE
OF PERM ITTEE FINAL
of VALIDATIOOBERT A WOOD
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T APPLICATION OR PLUMBI G PERMIT
D� CO ///... OF LOS ANTYGIIFS /
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J Y NO�INEEER ADDBffiB (�33� /��'�7 (, l
WILLIAM A JENSEN SUPT OF BUILDING
LOCALRY
FOR APPLICANT TO FILL IN NEAREST
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NUMBER FIXTURE OR ITEM OWNER 0 ae•`!t% N,EvSE�P
WATER CLOSET
RATE TUB
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SHOWER CITYL/ TEL NO / 3o�,/
LAVATORY CONTRACTOR
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DISHWASHER CRY TEL NO
CONTRACTORS STATE Ef
JAUND13T TOB REGISTRATION NO COUNTY
CLOTHES WASHER DISTRICTNO GROUP I ZONE P BY
WATER HEATER . O -Z7 If
OAS SYSTEM RIDUSTEBL
WASTE APPROVAL
INSPECTION RECORD
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PPROV DATE INSPECTOR B SIGNATURE
PERMIT f E 00 UNDER AS WORK
TOTAL FEE O ROUGH PLUMBING
TEAR PIPING
1 HSKEET ACKNOWLEDGE THAT 1 HAVE READ THIS APFUCATIUM GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AN AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND CTAT[ LAWS REGULATING
PLUMBING HOT WATER HEATER
1 HEREBY CERTIFY THAT 1 AB PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED LOS ANGELES COUNTY AND RAT[ OF GAS TEST
CALIFORNIA OR THAT TX LEGAL OWNER
0! THE
ADO"
DESCRIBED RESIDUA P[ 1 / UTILITY CO NOTIFlHD
SIGNATURE /��/r-`+^I�--
OF PERMITTEE FINAL
or ROBERT A WOOD
6,,Alf!ATION
p� SUPERVISING MECHANICAL ENO R
LAC06 6 4 6 SEP ?0 5 0 18 CSO
7aARes M s" ® APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY w
COUNTY OF LOS ANGELES (�
WILLIAM J FOX CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO GR UP ZON PERMITNO�•
,C
PLUMBER REC� Y kREADY FOR DATE ISSUDD
FIRST INSPECTION C — \rte yb
ADDRESS
BUILDING
CITY TEL NO ADDRESS
COUNTY
LICENSE NO EK IRES LOCALITY - '� �•L
NEAREST of
PERMIT FEES CROSSST
NUMORR TYPE OF FU[TURA OR ITEM FEE OWNER
MAIL
WATER CLOSET TOILET) O SO ADORESB
BATHTUB O SO CITY TEL NO
SHOWfiR O SO I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY !WASH BASIN) O 60 APPLICATION AND STATE THAT THE ABOVE IB CORRECT AND
AGREE TO COMPLT WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK a O SO STATE LAWS REGULATING PLUMBING
I CERTIFY THAT I POSSE" THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY O SOI ANGELES COUNTY LICENSE OR 1 AM THE LEGAL OW ER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
GAS BYBTfiM OUTLETS O SO SIGNATURE OF ✓ A' <' /, , / +
WATER HiATi ® O 60 PERMITTEE
SLOP BINK a O SO V INSPEbTION RECORD
FLOOR SINK a O SO
FLOOR DRAIN O 60 2
DISH WASH iR O SOI I
DRIN KING FOUNTAIN O SO U
URINAL 050 ,.1
a
HOUSE SEWER O 60 ¢ Z
�MISCELLANEOUS XtJ7)Nti . 7-P urn
1 7-e--M FSFR' 1! °
Y
70 a IV
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APPROVALS
N DATE INR CTOR• MAME
ROUGH PLUMBING
GAS PIPING
GAD VENT
CESSPOOL ® 100 CESSPOOL
SEPTIC TANK I SEPTIC TANK
DRAIN ( I PIT ( ) a 1 DO SEWER
PERMIT / 1 00 GAS TEST /
I UTILITY CO NOTIFIED
TOTAL FEE / D/
FINAL