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76A667-CE*817 4-64
APPLICATION FOR PLUM ING PE IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISIONBUILDING
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEos$TT.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 51.25
HATH TUB 1.25 ADDRESS /
SHOWER 1.25 CITY NO
LAVATORY 1.85
CONTRAC 11
SINS 1.25 ADDRESS
DISHWASHER1.25 CITY r TEL. NO. 6 4S/J
LAUNDRY TUB 1.25 EGINSTRA ON STATE
NO. �/,Z COU
CLOTHES WASHER 1,25 DISTRICT GROUP ZONE P � Y�
WATER HEATER 1.50 V /�
a•
GAS SYSTEM OUTLETS 1.50WASTEINDUSAAPPROVAL O
ASTB
OUTLETS OVER 5 PER SYSTEM AD INSPECTION RECORD V
w
0
V
W
d
N
Z
APPROVALS DATE INSPECTOR'B SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE �J V GAS PIPING
1 HEREBY ACKNOWLBDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT=..L.lr...NTIAL
OWNER OF,AND INTEND TORESIDE IN,THE ABOVEPROPERTY. /UTILITY CO.NOTIFIEDSIGNATUREOF PERMITTEE 7
FINAL
VALIDATION ROBERT A.WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
L.ALO 0 4 9 ?- MAR 15 5 D 3.5 0 Iq