City of Los Angeles
NOTIFY THE FOLLOWING:
(5 DAYS PRIOR TO ACTUAL TEST)
1. Street Services Investigation and Enforcement Division, (213) 847 - 6000
2. Department of Building and Safety, Plumbing Division (213) 977-6135
3. Los Angeles City Fire Department, (213) 485-6185

COMPANY INFORMATION:
=== ( * ) ARE THE REQUIRED FIELDS. ===
COMPANY NAME *
CONTACT PERSON *
ADDRESS *
CITY *
STATE *
ZIP *
TELEPHONE (Area Code 1st) *
FAX (Area Code 1st)
E-MAIL

JOB SITE ADDRESS: *


LOCATION OF TEST: *
Start Time: *
End Time *


DATE OF INSPECTION: (mm/dd/yy) *
TYPE OF PAYMENT: *


Please attach a scanned document below.
File to upload: