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'APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING•AND SAFETY DIVISION BUILDING r-/
ADDRESS to
JOHN A. LAMBIE, COUNTY ENGINEER y�
CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN Naos s.
NUMBER FIXTURE OR ITEM w
.OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS
SHOWER CITY TEL.NO.
LAVATORY CONTRACTOR
SINK ADDRESS ,�
DISHWASHER CITY TEL �p
LAUNDRY TUB CONTRACTOR'S STATE
REGISTRATION NO. B COUNTY ❑
CLOTHES WASHER
DISTRI?:j GROUP ZONE I READY FOR INSPECTION
WATER HEATER
GAS SYSTEMINDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
@ $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE
OR FIXTURE $ UNDER SLAB WORK
ROUGH PLUMBING
PERMIT S 7 00 >`/ ylr�/ 44
GAS PIPING
I TOTAL FEE S GAS VENT
1 HEREBY ACKNOWLEDGE THAT I 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 FIXTURES
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF if
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE A E 1 UTILITY CO. NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY. A
SIGNATURE FINAL <+t�
OFPERMITTEEQDS _y•y T .y-�f '�
ROBERT A. WOOD, r
VA L DATION SUPERVISING MECHANICAL ENG'R
CR. M.0. CASH
1 .ap-2 4 7.68R W 31 3 A 2.00
o:B 9r,17 asM SETS ,,•as APPLICATION FOR,P==
DEPARTMENT OF BUILDING AND SAFETY
COUNTY_ OF LOS ANGELES �`� '�G
WM.J.FOX.CNIEP ENGINEER
WATURE O 'INSTALLA ON o sTRl .N R.o. p zo E PERMIT NO.
ROUGH• FIXTURES .. COMP ETE. _ / e#
HEATER CESSPOOL I�SEPTIC TANK- REC d BY READY FOR ATE ISBU
= r FIRST INSPECTION
A8+ MISCELLANEOUS
• APPLI
C
ANT
FILL IN,HEAVILY.OUMINEID PORTION .ONLY,
Joe
NAME 1] 0 r DORE"_ �9 S f\ti &)el l,l '
ADDRESS _ LOCALITY \ . .. .Itj ll
j NEAREST
0 CITY,. TEL.No:. CROSf ST.
COUNTY A
CERT..No.. EXPIRESMC NAME Y %T T 17
•LOCATION OF SEPTIC TANK, OR CESSPOOL 3 MAIL
AD.nREBS .� �- r`tt "✓ v
i NORTH O '
CITY �:�/'Ti �il�lY
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
' PLUMBBR
r I AM'THE LEGAL-OWNER OF TFrE PROPERTY DESCRIBED
_ ABOVE. ff7 �
CORRECTIONS
SOUTH
(DESCRIPTION OF WORK � � � � a
BATH TUB' FURNACE
HOWER DISHWASHER Q
LAVATORY REFRIGERATOR _
VKITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY •- URINAL
APPROVALS
WATER CLOSET DRINKING POUNTAIN, y DATE IN R'o'NAMs
WATER NEATER DENTAL LAVATORY ' ROU.GH PLUMBING
ETER GAS
O.UTL SODA FOUNTAIN - GA8 PIPINm. i
OAS'4ENT
CESSPOOL
TOTAL NUMBER OF FIXTURES.
� _ .SEPTIC TANK r•
CESSPOOL- - SEPTIC TANK SEWER
UTILITY CO.NOTIFIISD'
TOTAL FEE•
r FINALr.