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Home My Public Portal About6115 CAMELLIA AVE_Plumbing__ 76A667C (CE-8178) -975 APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM @ FEE ADDRESS 6115 C*FTJ.TA AVE- WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST. SHOWER OWNER YAEGER, RICHARD LAVATORY MAIL ADDRESS S,+' SINK CITY iEZ4PU CITY TEL. NO.446-3045 DISHWASHER CONTRACTOR iRC]LYLH HCC CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY TEL. NO.579 LAWN SPRINKLER SYSTEM s WATER HEATER STATE CENSE NO. 265094 CILASS C-20 r d 1 GAS SYSTEM 1 OUTLETS 3 00 DISTRICTNO. GROUP Z.AN5 RO SSE_ D BY ��CLCL OUTLETS OVER x 5 PER SYSTEM U INDUSTRIAL WASTE APPROVAL LLJ O INSPECTION RECORD Z Plan check fee PLUMBING PERMIT ISSUING FEE $ TOTAL FEE Plan check applicant �v Name APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel. No. GAS PIPING I I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REOUI RED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESI IAL PROPERTY. UTILITY CO. NOTIFIED SIGNATU RE OF PERMITTEE AlIx FINAL PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 7 0 6'r--APR 15 5 1 J7.5 0 .- 76^667 17 8-49® APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING ��' COUNTY OF LOS ANGELES WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. PLUMBER '` ✓ RECEIVED BY READY FOR DATE ISSUED �{ FIRST INSPECTION - ADDRESS ` BUILDING • 5 CITY TEL. NO. ADD ESS f Y , -l�'�M 0-1 L e A`I c COUNTY LOCALITY I fE Md-. LICENSE NO. EXPIRES NEAREST CROSS ST. J� {.» PERMIT FEES ! /'. /+� NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER L- h�. cp-c.d- MAIL WATER CLOSET (TOILET) @ 0.50 $ ADDRESS M ORE .A fir``t / BATH TUB @ 0.50 CITY J, -IO\t �+ TEL. NO.r SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND LAVATORY (WASH BASIN) @ 0.50 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING. I CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB 05 TRAY @ 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER GAS SYSTEM ' OUTLETS @ 0.50 OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. SIGNATURE OFl� �..._ .{ WATER HEATER @ 0.50 PERMITTEE SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 1 1- URINAL @ 0.50 „J HOUSESEWER @ 0.50 Q _Z MISCELLANEOUS U' O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT F::] CESSPOOL @ 1.00 I CESSPOOL SEPTIC TANK: SEPTIC TANK I DRAIN ( ) PIT ( ) @ 1.00I SEWER PERMIT . . I 1.00 GAS TEST UTILITY CO. NOTIFIED TOTAL FEE FINAL SII APPLICATION FOR PERMIT .:.PARTMENT OF BUILDING AND SAFETY �� G COUNTY OF LOS ANGELES WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DI NO. GROUP I ZONE tP (R�MIT N � r PLUMBER EIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS EftflLDiNG CITY TEL. NO. ADDRESS COUNTY LOCALITY ' LICENSE NO. EXPIRES • NEAREST PERMIT FEES CROSS ST. NUMBERTYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET (TOILET) Q O.50 $ ADDRESS BATH TUB @ 0.50 CITY TEL. NO. SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ O.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS @ 0.50 - SIGNATURE OF � WATER HEATER @ 0.50 PERMITTEE -' SLOP SINK @ 0.50INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50E- DISHWASHER .50DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 HOUSE SEWER @ 0.50 Q Z MISCELLANEOUS 0 O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT . 1.oo GAS TEST UTILITY CO. NOTIFIED TOTAL FEE $ FINAL JA 7GA667 17 25M SETS 7-48 APPLICATION FOR PERMIT DEPAPT MENS OF BUILDING AND SAFETY PLUMBING 1 ` COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER i DISTRICT RO P ZONE PERIAll Nu. FOR APPLICANT TO FILL IN PLUMBER O•KEITH BAKER SEWAGE DIS• C • RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS 791 El Ravin �,(T1 CITY a } TEL. No. JOB COUNTY ADDRESS 517/!.L eltlple LICENSE NO. EXPIRES LOCALITY Temple City I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS NEAREST ANGELES COUNTY LICENSE. CROSS ST. Geri hal r3 i OWNER Yr • Flag MAIL PLUMBER ADDRESS PERMIT FEE IS $1.00 FOR THE FIRST FIXTURE OR CITY TEL. No. ITEM LISTED BELOW, PLUS 50c FOR EACH ADDITIONAL 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROP- ITEM. FOR EACH SEPTIC TANK AND PIT OR DRAINFIELD ERTY DESCRIBED ABOVE. $1.00. MINIMUM FEE FOR ANY PERMIT $1.00. EACH GAS SYSTEM IS A SEPARATE ITEM. OWNER NUMBER TYPE OF FIXTURE OR ITEM WATER CLOSET (TOILET) CORRECTIONS BATH TUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINK LAUNDRY TUB OR TRAY --- GAS SYSTEM OUTLETS WATER HEATER SLOP SINK Q FLOOR SINK _Z FLOOR DRAIN O _ DISHWASHER Q' O DRINKING FOUNTAIN URINAL MISCELLANEOUS — APPROVALS DATE INSPECTOR'S NAME —__ ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL SEPTIC TANK - DRAIN ( ) PIT ( ) $ SEPTIC TANK 1 CESSPOOL $ SEWER HOUSE SEWER a5 _ GAS TEST TOTAL FEE fpY UTILITY CO.NOTIFIED """"'"""III LLr�i�� FINAL I�-I i 76.AE%7.77a$BM SETS 7-48 APPLICATION FOR PERMIT DEPkF#TMEN�f OF BUILDING AND SAFETY PLUMBING ' . COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER DISTRICT NO. GROUP ZONE FIERmii Nu. FOR APPLICANT TO FILL IN PLUMBER l READY FOR 7� RECEIVED BY DATE ISSUED FIRST INSPECTION r..., ADDRESS CITY TEL. No. JOB _ ADDRESS -a� t COUNTY LICENSE NO. EXPIRES LOCALITY I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NEAREST ANGELES COUNTY LICENSE. CROSS ST. �"�'�A R1 /3 H L 11 J OWNER �/�&," L,. W 7- ~- A Gr•C� MAIL PLUMBER ADDRESS_?6 [ PERMIT FEE IS $1.00 FOR THE FIRST FIXTURE OR CITY f TEL. NO.r"' Q ITEM LISTED BELOW, PLUS 50c FOR EACH ADDITIONAL 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROP- ITEM. FOR EACH SEPTIC TANK AND PIT OR DRAINFIELD ERTY DESCRIBED ABOVE. $$1.00. MINIMUM FEE FOR ANY PERMIT $1.00. EACH GAS SYSTEM IS A SEPARATE ITEM. OWNER NUMBER TYPE OF FIXTURE OR ITEM WATER CLOSET (TOILET) CORRECTIONS BATH TUB SHOWER �� 1-7— 9� % LAVATORY (WASH BASIN) KITCHEN SINK LAUNDRY TUB OR TRAY GAS SYSTEM--2t--bUTLETS % WATER HEATER �� +- SLOP SINK Q FLOOR SINK .Eco l Z FLOOR DRAIN DISHWASHER O DRINKING FOUNTAIN URINAL MISCELLANEOUS APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL SEPTIC TANK - DRAIN ( ) PIT ( ) $ SEPTIC TANK _CESSPOOL $ SEWER J HOUSE SEWER --S GAS TEST TOTAL FEE UTILITY CO.NOTIFIED FINAL WOR}<F 11 C011pEN8ATION DECI"TFON 20-0028 DPW 0/00 I reby affirm that I have a certHlcate of oonsent to .elf Insure, 7°"°°7A APPLICATION FOR PLUMBING PERMIT or a certiflcate at Worker's Compensation Insurenoe, or a oertifled oopy 01reof(Seo.3800 Lab.C.) _i COUNTY OF LOS ANQELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DN. ❑ No company Qw fled oopy he herby hanished. ❑ the FOR APPLICANT-TO RILL JN(PHI NT OR TYPq ADDRESS c«tified Dopy V rued.11:h.11:hcounty buiSdtrrg kspeotion v depart— _ NUMBER FD(TUFE OR ITEM FEE LOCALITY D.t. Appfoert S�b4Il4t�D �� WATERCLO6Er NEAFEST f.ATE OF B<BwTioN FfiOM WOAtE CROSS 8T. caTrF BArH rug - COMPENSATION PMRANCE ASSESSOR (Th .action need not be oonH ed pMted the work hrvotvby ttw BNo4VE�i MAP isPAGE PARCa pertaft is for one hundred doIlore($100)or bee.) LAVATORY OWNER O R LI Y I oerttty that In the performanoe of the work for which this permit MArL M Issued, I shall not employ any person In any manner so as to g AWFIE88 become subject to the Worker'Compensation Laws. %� ``,Q, r� NSWA8hER CITYtiy TEL NO. Dade — AM.M V o//+r SCJ UCS CLOTHES WABFf� CONTRACTORNOTICE TO APPLICANT: If, after making this Certificate of ExempOon,you should beoome sub)sot to the Worker'Compensation SWIM MAW POOL RECEPTOR provisions o1 the Labor Cods, you must forthwtth comply with suoh ADDRESS provisions or this permh shall be deemed revoked. LAWN SPRIi(LM 8Y8TEM LICENSED CONTRACTORS DECLARATION CITY TEL NO. I hereby affirm that I am Iloenead under provislons of Chapter 9 WATER REATER• STATE (oommenoing with 8ectlon 7000)of Division 3,of the Business and LK13M NO Prale"ons Code,and my Iloense is M full Woe and effeot. CHAS SYSTEM Q TLETS . MASS OUTLETHOVER DIBTRNCT NO. PROCE88Ei)BY.. . 6 PER SYSTEM ,O G C/ License Number Lim Clue R""' .VA.61DATION DATE C DeL r ❑ I am am, wider Seo. FINAL 'r 0.Cf. BAP.C.for thh ninon ITEM E Dade: lan check fee TOTAL 40. 65 SWORtuire PLUMBING PERMIT ISSUING FEF$ DECK ❑ TOTAL FEF Ole S •rr`� SINGLE FAMILY Plan ofwok WpD=rrt ■w FI)ME aW wxwnpt trom AAAA ContrIONactor's Name +n n�v—UlJLI i 6/28/93 I hereby affirm that I em exempt from the Contrantors LJcenae Law �.)following reason (Seotion 7031.5, BuWneee and Professions Address Tea,No. 1 AMG:CC' I,as owrwr of the property,will do the work and the structure Is not Intended or offered for We(Seotion 7044, Business and Profseslons Code). , CONSTRUCTION LENDING AGENCY I hereby aMrm that then Is a-construction lending agency for the performarwe of the work for whish this permit Ib Ieeued (Seo.3097, C1v.C.) LarKWs Name Landeea Address I wrtffy that I haw read this application and state that the above ► Information Is oorreoL I agree to oompty wtth all County ordlnanoes and State laws regulating Plumbing, and hereby authorize representaitvee of this County to enter upon the above-mentioned prop"for I on purposes. NM FIEVERBE F0(j E�PLAIRATOBY LANGUAGE v Slgrmftre Of Data WORKERS'COMPENSATION DELI-APATION DPW 4/a7 ' APPLICATION FOR PLUMBING. PERMIT I hereby, affirm that I have a certlflcate of consent to self In- 76A667A sure,or a Ceftlficate of Workers'Compensation Insurance ora CE B17(may a/c) certifiedco the f Lab. C. ` COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy NC/ ny Certified copy is hereby furnished.. Certified copy Is filed with the co g spa Ion FOR APPLICANT TO FILL IN(PRINT OR TYPE) pIDRIE55 /JS' C , -a department. NUMBER HxruRE OR ITEM B FEE L . Date Appllc t WATER CLOSET(TOILET) NEAREST CEW KI=RS' BATH TUB RTIFICATE OF O CRS ST COMPENSATIO SURANCE SHOWER OWNER. (This section need not be Cbmplefed 1f the work Imrolvod by MAIL the pormft Is for'on*hundred dollars (;100) or less.) LAVATORY ADDRESS 1 certify that In the perf ante of th work for which this per- mit Is Issued, I sha l not mploy any, .n In any manner so SINK CITY TEL'NO as•to become subject t the Worke 'Compensatlgn Lgwa. DISHWASI-ER CONT ✓J rn Date App Ito CLOTHES WASHER NOTICE TOAPPLI If, after oking this Certificate of Ex- ADDRESS yj� 'Sy emptlon,you sho become su lact to-the Workers'Compen- SWIMMING POOL RE=CR ' sation provlslons tbeLabor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM C v Tri ly wlth.iuch provisions or this permit shall be deemed revok- STA (��s LCC ed. WATER HEATER LICENSE NO. 7 L 3. C1AS5 LICENSED CONTRACTORS DECLARATIOND Nq PROCESSED BY ' I hereby affirm that I am licensed under provlslor)s of Chapter GAS SYSTEM r OUTLETS 9(commencing wLth Sectlon 7000)of Division 3 of the Business OUTLETS OVER and Professlons Code, and my license Is In full force and f- 5 PER SYSTEM fact. DATE a -' VALiDA N License NuAbLIc. Class O U FI Con , c t �r BY O ✓) lvw7 U I am exempt under Sec. W B.BP.C. for this reason plan check foe a Dat �<PLUMBING PERMIT ISSUING FEE$ Signaturo I o °'1 � TOTAL FEE SI LE FAMILY HOW OWNER-BUILDER DECLARATION Plan check applicant G o'01 6 5 %'6 1 hereby affirm that I am exempt from the Contractor's License Name- O 8 tS Law for the folP� -d. reason ( Ion 7031.5, Business and Professions CodAddress I, as owne prope will do work and the City Tel. No. structure Isended or ffered for a(Section 7044, Buslnesr♦afealons ode). pop COCT LENbING ENCY I hereby affirm ere I a conatructl n lending agency for the performpnce rk for whI this permit Is Issued (Sec. 3097, Cly.(_ender's Name Lender's AddresI certify That I ead this oppllcaflon and state that the above Infoorrect. I agree to comply with all County , ordlna and S t laws r latlnq Plumbing, and hereby au ze re tives of his County to enter upon the a e-me Ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Peft#eW Dq e I r a WO"ERS'COMPENSATION DECLARATION .� APPLICATION FOR PLUMBING PERMIT herr�6y Irm that I have a cefi icate of consent to self 7�7A Insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) y � fit c then (Sec. 3800, t b. C.), COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy o. CompAj any Certlfled copy is hereby furnished. FOR APPLtG41JT TO Fla IN(PRINT OR TYPE) BUILDING Certlfted copy Is filed with the toupty building Ihspec- tlon department. NUMBER FIXTURE OR rrEM O FEE LOCALITY Date 1-6 4:5 AppllSant Q• P AY a&? WATER ac3sET NEAREST CERTIFICATE OF D(F-APTIpN FROM WORKERS' BATHrTUB CROSS ST. COMPENSATION INSURAN(3_ SHOWER O'WrL-R (7'hls Fectbn need not be &ted tF the work Involved by MAL the permh 7s For one hundred dollars(=100)or kms j LAVATORY ADDRESS I certify that In the performance of the work for which this t r permit Is Issued, I shall not employ ahy person in any Mahner 54 NK CTT ' TEL NO. `•t so as to become subject to the Workers'CompenWIon WW's. DISHWASHER , L OONTRP.CTOR 1 Data Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: if, after making thn Certificate of SWVA&4J NG ) Exemption, you should become subject to ,the Workers' POOI RfC�TOR TE3__ NO Cornpensatlon provlslons of the Labor Code, you must forth- LAWN&PRiNKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LK1114SE NO, CLASS C: LICENSED CONTRACTORS DECLARATIONNO. y I hereby affirm that I am licensed under provtsloru of Chapter 9 GAS SY$1EM OUTLETS (commencing with Sectlon 7000) of Division 3 of the Buttress i OUTLETS OVER and Profosslons Code,o6d my Ilterne to fn full foFce and effect. S PER SYSTE* FINAL VALJ TION DATEi License Number `��r"�`'r�c�u �I Ic. Clau F\JOrTT 1fLV,Vlk�f�{irit BY NAL $. ' Contractor a o� I am exempt under Sec. I— B.aP.C.for this reason Plan check fee CUUJ U) slgrwturb, _ (�� PLUMBING PERMIT ISSUING FTE; b 8 Q 4 A R TOTAL Fly . Plan check applicant # c o o io,0 5 SINGLE FAMILY HOME OWNEP-BUILDER DECLARATION Name J,- o T 6 5 0 1 hereby affirm that I am exempt from the Con 1, Llcenm Addreu o 0 0 5 Q Law foot the following reason (SeGtlon 7031.5-Buslneu and (Profeufons Code): City Tel. No. a,l I, as owner of the property, will do the work and the 3 8 7 E stryc'ture Ip not Intended or offered for sale (Section , 7001, Business and Professions Code). f CONSTRUCTION LENDING AGENCY (/ I hereby affirm that there Is a constructloiv lgnding agency for the performance of the work for which this permit Is issued (Set. 3097, CIv. C). Lender's Nam& Lender's Address I certify that I have read this appilcatlon and state that the above Information Is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize repre;entotives of this County to enter upon the above-mentioned property for Inspection purpose;. SEE REVERSE FOR EXPLANATORY i.ANGUAGE Siginciture of Permittee Date '"�KERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT ,� her�by.afflrm that I have a certificate of consent to self 7�7A nsure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) u e"19f1 C') r COUNTY OF LOS ANGELES BUILDING AND SAFETY I yam. Company I � Certified copy I} hereby furnished. FOR APPLIGINT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy Is filed with the county bulldln Inspec- ADI tion depart NUMBER FIXTURE OR ITEM O FEE LOCALITY Dat Appll WATER CLOSET NEAREST CERTIFICATE OF E) M4INRANCE WORKERS' BATH TUB CROSS ST. COMPENSATSHOWER OWNER (T'hls section rseed not be completed If the work Invohred by MAt1 r — m the permit Is for one hundred dollen (:100)or loos.) LAVATORY App{�S lLJ I certify,that In the performance of the work for which this permit Is Issued, I shall not employ any Person In any manner SINK TEL NO. to as to become subject to the Workers Compensation Laws. DISHWASHER OR J Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS n Exemption, you should become subject to the Worked' POOL TEL Compensation provisions of the Labor Code, you must forth- LAWN SPRIWLER SYSTEM CTTY with comply with such provisions or this permit shall be STATE LIG deemed revoked. WATER HEATER LICENSE NO. CLAM LICENSED CONTRACTORS DECLARATION GAS SYSTEM OUfLE1S D Nq _ BY I hereby afflrm that I am IIcertsed under provisions of Chapter 9 [Cd (corhmencing with Section 7000) of DlvWon 3 of the Buslntew OUTLETS OVER and Professlons and m I Is in full force a 5 PER SYSTEM FINAL VA ATION a DATE Ucerse Number Ic. Class '�I� Contractor � t ' L r, r 7� to FNAL BIY ❑ I am exempt under Sec. B.BP.C. for this reason Plan check fee 6 8 Q 0 A ww O.' Date: Cf) PLUMBING PERMIT ISSUING FEE$ # 0 0 0 0 0 5 Z Signature TOTAL W �j S ( o o.1 6 5 Q - Plan check applicant SINGLE FAMILY .o o o 5.0 6 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address 0 i�0 8 7 Law for the following reason (Section 7031.5, Business and Profusions Code): City Tel. No. ❑ I, as owner of the property, will do the work grid the structure Is not Intended or offered for sale (Section pip7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued {Sec. 3097, Clv. C-). Lenders Name Lender's Address I certify that I have read this application and state that the Poo. Informatlon Is correct. I agree to comply with all County ordinances and State laws slating Plumbing, and hereby uthori'a repre1antatives of Is County to enter upon the a ,mentioned prop f Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE (:�Xgl of Permlttea Data