Loading...
HomeMy Public PortalAbout4843 DOREEN AVE_Plumbing__ D.B.S.-17uAl SETS I2-45 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING COUNTY OF LOS ANGELES WM. J. FOX. CXIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT/NO. ROUGH FIXTURES COMPLETEJ RECEIVED BY READY FOR DATE ISSUED HEATER 1-1 1CESSPOOL SEPTIC TANK FIRST INSPECTION pJ GAB ' MISCELLANEOUS / / c _77-527 APPLICANT FILL,(IN HEAVILY OUTLINED POR ON ONLY ' JOB R NAME ADDRESS /�+�/•V Y ^ D B ADDRESS LOCALITY F �a /� O �B //\/H � - - NEAREST 6 CITY' (p 1 TEL.No. CROSS ST. COUNTY CERT.No. EXPIRES W NAME � ,. -/ LOCATION•OF SEPTIC TANK, OR CESSPOOL z MAIL 3 ADDRESS NORTH O CITY TEL.No. I AM THE LEGAL POV6ESSOR PF THE ABOVE L B ANGELES COUNTY CERT IP ATE OF LIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY OESCRISEO ABOVE. R OWNER CORRECTIONS SOUTH • J DESCRIPTION OF WORK ATN TUB FURNACE V• w ROWER DISHWASHER 0 / IAVATORY REFRIGERATOR ITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP LOP BINK FLOOR DRAIN T a S WASH TRAY URINAL _ APPROVAL _WATER CLOSET DRINKING FOUNTAIN y/DATE > IN6P[CTOR:H NANH _WATER H TER DENTAL LAVATORY ROUGH PLUMBI NO / /,^!J/ II-I ET] GAB RODA FOUNTAIN GAS PIPING `I OUTL GAS VENT I I CESSPOOL I TOTAL NUMBER OF FIXTURES �}_d SEPTIC TANK I CESSPOO' SEPTIC TANK SEWER I I 8 UTILITY CO. NOTIFIED TOTAL FEE I 5 FINAL D.6s."IV 3SM SETS 11-41 APPLICATION FOR:PERMIT DEPARTMENT OF BUILDING AND SAFETY �� � . COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER ' 11,10 PGAa TURE OF INSTALLATION DI9TRi .No. CROUP zo E -PERMITNO. IFIXTURES COMPLETE CE8HPOOL SEPTIC TANK RECEIYF�•BY READY FOR ppppAAAA/jg ISSUED M18CELLANEOUB F FIRST INSPECTION APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY ]o K NAME REBB m O B ADDRESS LOCALITY S D, NEAREST y CITY No. CROSS ST. - COUNTY CERT.No. EXPIRES C NAME W LOCATION OF SEPTIC TANK,OR CESSPOOL = MAIL 3 ADDRESS NORTH O CITY TEL.No. 1 AM THH LEGAL POSSESSOR OF THE ABOVE LOB AHIELE6 COUNTY CERTIPIC/�7H�UALIFJGr�T10N.!/y ((( RPSLLUUMMMBBBEER f/PJ 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. s 1 .2 O/ OWNER _I CORRECTIONS SOUTH DESCRIPTION OF WORK 1 i ATH TUB FURNACE _ ED HOWER DISHWASHER D LAVATORY REFRIGERATOR f= KITCHEN BINK WATER SOFTENER BR FLOOR BINK SANOTRAP SLOP BINK FLOOR DRAIN o WASH TRAY URINAL - APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE IMepECTON'9 NAME -WATER HEATER. DENTAL LAVATORY - ROUGH PLUMBING I METER GAB - SODA FOUNTAIN OUTL 6A8 PIPING . GAB VENT CESSPOOL TOTAL NUMBER OF FIXTURESSEPTIC TANK _CESSPOOL SEPTICTANK SEWER TOTAL FEE d unuTY co:Noi1F1ED /l I '/ FINAL 96A.6T APPLICATION FOR .PLUMBING .PERMIT 1 OBE17 ID.9e DIVISION OF BUILDING,AND-SAFETY Deportment of County Engineer - County of Los Angeles BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN _ NEARESCROSS ST., �OKf C� zUS OWNER �j ''� DISTRICT NO. GROUP ZONE BEADY FOR INSPECTION MAILADDRESSQ/� •R —� INDUSTRIAL CITY TEL. NO. t� WASTE APPROVAL " PLUMBER INSPECTION RECORD ADDRESS 8 -Co �9621 CITYl, 9�.t'14,y TEEL. NO c.) _ LICENSE NO. ILS L 0 0 / NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET.(TO I LET) @ $1.00 $ BATH TUB @ S1.00 SHOWER @ 51.00 , LAVATORY (WASH BASIN)' @ S1.00 KITCHEN SINK @ $1.00 DISHWASHER @ S1.00 ' LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ 51.00 WATER HEATER 1@ $1.00 GAS SYSTEM @ $1.00 _ APPROVALS DDATE/ INSPECTORS SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUMBING GAS PIPING TOTAL FEE GAS VENT ' I 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. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL'OWNER OF TH ABO UTILITY CO. NOTIFIED DESCRIBED RESIDENTIPtj PROPERTY. T SIGNATURE ^nom OF PERM ITT EE FINAL K 0. JOHN A. LAMBIE. COUNTY ENGINEER DVALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CN, M. CASH i:kC08 a o nuc 1 2.00 11 DEPARTHENT OF COUNTY ENGINEER PLUMBING 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES gUILDINO �/ WILLIAM J. FOX, COUNTY ENGINEER ADDRESS �T FOR APPLICANT TO FILL IN NEAREST BUILDI No .ate NEAREST �+ �. .. n ADORES8 o een. S`1 CROSS ST. 6�(�R--��� DISTRICTf10. GROUP iGNE PERMIT N� LOCALITY Q I C� \ S r� 5 1� IAC. v� NEAREST 1 _Wer p =V5� �• CROSS ST. F(! /1 RECEIVED BV ReeAy ter Inapeetioo DATE I7 EO �J'J /-/ 7-,5- T s s OWNER v1esT o ' MAIL INDUSTRIAL ADERESS Ee -57 WASTE APPROVAL CITY 2tin /r Ci 1 rEL.xo. INSPECTION RECORD PLUMBER ar • ierr ee /'�� '" i/i Ti 'Sr.wlo" ADDRESS 173163- CITY 31 .1 E. I rV�2 -D, v ~'. r CITY a. d W •a. arK TEL-NO.GO, 3 State Contractor's License No. 1 -3317/0 Claes 1O J L.A.County Contractor's r Q Registration No. .1 PERMIT FEES c� NUMBER TYPE OF FIXTURE OR,ITEM PEE a' WATER CLOSET(TOILET) 0 0.80 1 BATH TUB @ 0.80 ' SHOWER @ 0.80 _ LAVATORY(WASH BASIN) @ 0.80 R6 KITCHEN SINK @ 0.80 _ LAUNDRY TUB ORTRAY @ 0.80 SLOPSINK @ 0.80 _ FLOORSINK @ 0.80 FLOOR DRAIN 0 0.80 DISHWASHER @ 0.80 DRINKING FOUNTAIN @ 0.80 _ URINAL @ 0.80 GAS SYSTEM....... .....OUTLETS @ IAO _WATER HEATER @ IOu MISCELLANEOUS APPROVALS DATEL INSPECTOR'S SIGNATURE 'UNDER SLAB WORK (A,-4' PERMIT f 1 00 ROUGH PLUMBING. �� A .,n.CmP✓J TOTAL FEE A10 GAS PIPING ` I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GABVEMT CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE HOT WATER HEATER RE UTO r O ATING PLUMB NGLL COUNTY ORDINANCES AND STATE LAWS PLUMBING FIXTURES IBPEEOI AND/OR LICENSED AS REQUIRED Y LOS ANGELSCOUNTY GAS TEST AND STATE OF CALIFORNIA OR T AT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED q IDE TIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE 4A Of PERMITTEE...... ............ .... .. ............_. ......_. ._....-..... FINAL 76A667 DES 15 6/54 01 - 96A669 .OBS 19 11-6D APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN D STR GROUP ZONER IT O. ///1� � ' PLUMBER J-✓ RECEI ED BY READY FOR DATE ISSUED _ jY� FIRST INSPECTION ADDRESS •�^M� � V A/^,J' ( I BUILDING CITY TEL ND.tYIA.(� �,J ADDRESS / COUNTY LOCALITY L ENSE NO. - EXPIRES NEAREST PERMIT FEES CROSS ST. NUMBER ryPE OF FIXTURE OR ITEM FEE OWNER l MAIL WATER CLOSET(TOILET) Q 0.50 S ADDRESS NUMBER TUB Q D.SOCITY �(.. TEL No. SHOWER Q 0.50 I HEREBY ACKNOWLED THAT I HAVE READ THIS LAVATORY (WASHBASIN) Q X0.50 ICATION AND STATE THAT THE ABOVE IS CORRECT ANDLAGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB LAUNDRY TUB OR TRAY 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL OPERTY DEB RIBED ABOVE. GAB SYSTEM—OUTLETS D.SO SIGNATURE OF WATER HEATER Q 0.50 PERMITTE SLOP BINK 0.50. INSPECTION RECORD FLOOR SINK ® 0.50 FLOOR DRAIN Q 0.50 1 DISHWASHER Q D.SD DRINKING FOUNTAIN Q 0.50 URINAL Q 0.50 Q HOUSE SEWER Q 0.50 Z MISCELLANEOUS l7 O { APPROVALS DATE IN6PEOTOR•S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL Q 1.00 CESSPOOL SEPTIC TANK• SEPTIC TANK DRAIN ( ) PIT ( ) Q 1.00 SEWER PERMIT 1.00 GAS TEST UTILITY CO.NOTIFIED TOTAL FEE S / S� L FINAL � �'�J F-e, 76 A 567 - CE 817 7-69 APPLICATION FOR PLUMBING PERMIT • COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER IS —SISISMEMENIG. BUILDING AND SAFETY DIVISIONBUILDING JOHN A. LAMBIE. COUNTY ENGINEER " ADDRESS. /Y COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY 1 FDISHWASHER CANT TO FILL IN PR NT OR TYPE) NEAREST CROSS ST. FIXTURE OR ITEM EACH FEE OWNER CLOSET 1.50 MAIL UB L50 ADDRESS 1,50 CITY I TEL. NO. ORY 1.50 CONTRACTOR - 1.50 ADDRESS SHER 1.50 CITY TEL. NO. ES WASHER 1.50 STATE LIC LICENSE NO. - CLASS NG POOL RECEPTOR 1.50 DISTRICT NO. GROUPZONE I PROCESSED BY LAWN SPRINKLER SYSTEM 2.00 WATER HEATER 1.50 INDUSTRIAL WASTE APPROVAL V GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD z OUTLETS OVER. .30 0 -_5PER SYSTEM W o_ N Z Plan check fee 25% of above. See reverse. 13LIJNIBING PF1011T ISSUING FEE S 2 00 TOTAL. FEE APPROVALS DATE INSPECTORS SIGNATURE L check applicant UNDER SLAB WORK e ROUGH PLUMBING ess GAS PIPING GAS VENT Tel. No. HOT WATER HEATER REBY ACKNOWLEDGE THAT 1 NAVE READ THIS APPLICATIONTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FI%TURES ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGGAS TEST ING.REBY CERINFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED SED AS REQUIRED BY LOS ANGELES COUNTY ANO STATE OF RNIA OR THAT 1A THE LEGAL OWNER OF.AND INTEND TO IN, THE ABOV[OE IBEO RESIDENTIAL PROPERTY. FINALTURE JACK R. ALLEN, SUPERVISING MECHANICAL PERMITTEE PERMIT-VALIDATION <K. . M.O. CASH" PLAN CHECK VALIDATION C;. M.0. CASH i �!'^6718�R 1 5 D 3.50 WORKERol I have cIONDECLARATION '01 of once APPLICATD®�I'FOR PLUMBING PERMIT _ ',I'hereby affirm Shat have a certificate of consent to self. ]6A667A I . . ' ,,imure ar o certificate of,Workers' Compensation Insurance, CE 817(REV. 10/81) - -'or acertified copy thereof (Sec 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY _ - Policy No Company _ _. .: Certified copy is hereby furnished. ❑ - ,... FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING. 7/7 N ` . �- � /• Certified copy a`filed with the county building inspec- ADDRESS. ATL r3 y.L 6 /' . tion department. NUMBER FIXTURE OR ITEM. FEE r /) CL - LOCALITY -T<-- WATER Date� /2, da4•Appl i4a nt 0i r �N "`1*EC�L � WATER�CLOSET �� NEAREST / CERTIFICATE'OF EXEMPTION FROM WORKERS'' BATH TUB - it CROSS ST. L. O w L r . , J, COMPENSATIONINSURANCE - V OWNER SHOWER. • (This section need not be red dollars she work less.) Involved by O MAIL' she permit is for one hundred dollars ($100)or lass.) 1 LAVATORY - ADDRESS. I certify thatinthe performance of the work for which this - - .permit is issued, I shall not employ any person in any manner 'SINK - - CITY' -Q 4 7- EL, NO. {�✓f!7 37 so as to become subject to the Workers'Compensation Laws. DISHWASHER , - - CONTRACTOR Dote Applicant CLOTHESWASHER ADDRESS ' NOTICE'TO APPLICANT: If, 'after making this Certificate of " Exemption, you should become subject.to-the Workers' - SWIMMING POOL RECEPTOR Compensation-provisions of the Labor Code;you must forth-. - - LIN TEL. NO, with comply with such provisions or this permit' shall be LAV✓N SPRINKLER SYSTEM _ P Y P STATE LIG - deemed_revoked.. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION ,r _ , .. - - - DISTRICT No. P ESSED BY -I hereby affirm That I am licensed under provisions of Chapter 9 - GAS SYSTEM OUTLETS - `' / ' /(' - (commencing with Section 7000)of Division 3 of the.Business OUTLETS OVER - tq and Professions Code, and my'license is in full force and effect. 5 PER SYSTEM FINAL /•�• V 1DATION - O License Number - Lic. Class - DATE iS - V r' TINA • O Contractor Date - - BY 1— V V 1 am exempt under Sec. N B.BP.C. for this reason Z Plan CF10CR fee Dale: PLUMBING PERMIT ISSUING FEE$ SU©' 24037:A. Signature - I I TOTAL FEE SU '# a v� •.5 - Plon che_ck applicant SINGLE FAMILY - 1 • • 3 k 5`Q, ' HOME OWNER-BUILDER DECLARATION Name I hereby affirmthat am exempt fromithe Contractors License - - '• • •$ Q, rj'Q " Law for the following reason (Section 7031.5, Business and Address Professions Code): _ - City Tel. No. _ _ • Q 2l 2 �c8 b �LgLf} I, as owner of'the property, will do the work and the structure is not intended or offered for sale (Section" 7044, 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 Ihis.permit is issued (Sec. 3097,Civ, C.). Lender's Name Lender's Address I certify Ihat.l have read this application and state that they - above information is correct. I'agree to comply with cill.County ordinances and State laws regulating Plumbing, avid.hereby authorize representatives of this County to enter upon the - ove-mentioned property for inspection purposes. - - '(� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature oVermirtee Date - _ _ WORKERS' COMB aSATION DECLARATION " APPLICATION FOR, PI.UAflBIIVIG: PERMIT I hereby affvm that'I have a ceFnficateof can sent to self in 20 0026 490 - ' sure, or a certificate of-Workers'Compensation lnsuronce,-ora - - certified copylhereof;(Sec 3800 Lab C:)",- COUNTY OF-LOS-ANGELES DEPT. OF,PUBLIC"WORKS Policy No. Company - - "Certified copy is herebyfur a ished BUILDING _ r Certified copy is filed with the county'building nspecfion FOR APPLICANT TO FILL _ - ADDRESS NUMBER FIXTURE OR ITEM.- ' �. department_ - OR TYPE) FEE' LOCALITY (PRINT Td 7 d WATER CLOSET(TOILET) Date � � - Applicont - �' .. ,,.. _ �,,NEAREST ' CERTIFICATE OF EXEMPTION'FROM,WORKERS' 'r - BAiwrue ' 'CROSS ST.' ,E. COMPENSATION INSURANCE _ -' , •' - OWNER - .. - ,; SHOWER ' .. . d6Y?NNq ' .(This section need not undredp dollars it th�$10 workii s`s.) d by - ,. _ .MAIL,, ••'' oo ` ' the permit is torose hundr�d.Hollers($100)or Iasi.) 'r -- 'LAVATORY - - ADDRESSr - -. " I certify that in the:performance of the work for which this per- - - ` mitis'issued, Ishall not empoyany person in ony.mSINK=anner so "' CITY 7`Cyyo�E' - TEL. NOJ� �d' / C as logbecome subject to the Workers,Compensation Caws.), DISHWASHER' y _ i_. - _ - _ .. .. . :, CONTRACTOR .. Date Applicant " �" 'CLOTHES'WASHER'• - :NOTICE TO APPLICANT:.If,.aftermaking`ihis'Certificate of Ex-- - " ,SWIMMING POOL RECEPTOR . ' ADDRESS sation m;you sh 'of t become Cods6bie,yi3 'Fn Workeiw Compen- - CITY � � TEL. NO. ' sation provisions'of the Labor Code youmust forfhwith,tomp- -^ _ ' « LAWN SPRINKLER SYSTEMS - ' ly'with suchprovisionsor:this permit$boli'be deemed revok- ••' - STATE' - LIC ed t" . , - WATER HEATER ' .• - '� '... - LICENSE NO. CLASS' LICENSED CONTRACTORSDECLARATION ,,. _ DISTRICT.NO. - - PROCESSED BY - ,GAS SYSTEM` OUTLETS I (commencing that Loc Blessed u f Djrisrovisiof sof the.B aptersiness >• !Gop , 9(com mencing wifhSection7000)of Dwision.3 of the.flusiness- - � OUTLETSOVER- ,- ,; '' -� ` .- :• is ,• and Professions;Code, and my license Win full force and of 5'PER SYSTEM- - fINAL - VALIDATION - fe<t. - HOSE.BIB DATE Y License Number - LicClass _ ._ - _ .0 - : - FINAL U Contractor - Date _ - _�: BY kam-axempf under Sec.- ' - •. F_ B&P.C. for this reason Wrc Plan check fee ® - - H Date: - -PLUMBING PERMIT ISSUING FEE$ - - Z Signature'• - - TOTAL FEE SINGLE FAMILY HOME ONER-BUILDER,DECLARATION: Plan checkup .. W plicarit I.hereby;offirrn,;haf l am exempt;from'the Lontra<tor'skicense - -Name - _ � '' •, ' Law for'ihe following reason '(Section 7031.5,. Business and Professions Code)" - - Address- ,'I, as ddress,I, as owner of the,property will da the work and the City, - .- Tel. No. structure is not intended or offered.for salel(Seciion 7044 m Busessand Professions Code). - CONSTRUCTION-LENDING AGENCY „ :hereby affirm that there is a:construction lending agency for - his'performance of the work for which this permit-isissbed _ - (Sec 3097, Civ.'C.). - - ,Lender's Name - - - .. GJ p � ,4J c"7 ca.o. _,Z, :> `�- - t Lenders Address - - C3 M 41. ry L,certify'that I have read this application and'stote that the " - C3 - 'm. above information is correct.l agree,to comply wdh all County ordinances and,Staie lows'regulating Plumbing,,and hereby-. - k r - - • '� - - - � - , author'�e re pre ntatives of this County,to enter upon the - obov - enLon d propanyfor inspection p rpos 9 SEE,REVERSOR EXP114TORAlAN_GUAGE XSignature of Per U,,e - Date ti 9 C3. V "' - - • - •' OO '4 t - - .. WORKER'S COMPENSATION DECLARATION 76A667DPW 9/89 APPLICATION FOR- PLUMBING PERMIT IJ I"hereby affirm that I have•a certificate of consent to self insure, ]BA66]A or,a certificate of Workers Compensation Insurance, or a certified copy1hereof,(Sec.3800 Cab:IC.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF,PUBLIC WORKS DIV.' Policy No. .. Company _ _ . _ - - ..• . Certified copy is herebgfurnished. p1.a BUILDING ' ❑ - -FOR,APPLICANT;TO FILL IN(PRINT OR TYPE) - - ADDRESS. Certified copy is fled"with the county building.inspectian+, department. - NUMBER -FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET - - t NEAREST - • CERTIFICATE OF EXEMPTION.FROM WORKERS' BATHTUB CROSS ST./0/,&v(', 9,ZLAPAq - - x COMPENSATION INSURANCE ASSESSOR - O completed if the work involved b the SHOWER MAP BOOK S PAGEO,� PARCE (This section need not be cam P y /� permit is for one hundred dollars($100)or less.) _ OWNER i .('Uf NN�I I certify that in the performance of the,work for which this permit LAVATORY - - - - - YENN is issued, I shall not employ any person-in any manner so as ioSINK - - MAIL •_ /JON become subject to the Workers' Compensation Laws. ADDRESS `D DISWASHER _ CITYTEF/P(E C�// - TEL NO.(0418��6 11 p Date ' Applicant CLOTHES WASHER - y 07 NOTICE TO APPLICANT: If;atter makingthis Certificate of. - CONTRACTOR .. Exemption.you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Lobar Code, you must forthwith comply with such ADDRESS � 1 provisions or this permit shall be deemed,revoked. LAWN SPRINKLER SYSTEM r _ LICENSED CONTRACTORS DECLARATION .., CITY TEL.N0. I hereby'affirm that I am'licensed under'provisions ofChapter.9 'WATER.HEATER - d (commencing with Section 7000)of Division'3 of the Business and STATE LIC.. O Professions Code,and my license is in full farce and effect. _ GAS SYSTEM OUTLETS LICENSE NO. CLASS OUTLETS OVER DISTRICT NO. PROCESSED BY 5 PER SYSTEM �D� ---Li Q License Number -Lic.Class - U v FINAL B_S yt VALIDATION d DATE Contractor Date � (n ❑ I am exempt under Sec. FINAL A /� / Z - B.BP.C.for this reason Date: Plan check fee Signaturep PLUMBING PERMIT ISSUING FEE$ tf ❑ NOTAL FEE 3/ Q Plan check applicant 1 SINGLE FAMILY 5. ' -HOME OWNER-BUILDER DECLARATION Name' I hereby affirm thaDl am exempt from the Contractor's License Law ^, _ - ' _ Cf�(K '.7 for the fallowing reason (Section 7031.5, Business and Professions Address -�!? Code): City as owner , � C City ._ Tel. No. _ ,>1 - 1 r ` _ ❑ of the property,will do work and the structure _ - j, I hal ' ® . , _ is naLintentletl or offered for sale (Section 7044, Business - 45V -40 and Professions Coda). - - -' '• - C�ECK i; 11 CONSTRUCTION LENDING AGENCY r. • - t •,. - - --- -. - - *�,'- ,)lI) 1 hereby affirm that there is a construction Iending,agency far the - -� performance ofthe,work for which this permit is issued (Sec. 3097; Civ.C.) - - IF_I!1TII—OCI'I_ ^,' 'f 1z Lender's Name Lender's Address I certify that I have read thisapplication and state that the above - informali is correct. I gree to comply with all County ordinances and S to laws regu sting Plumbing, and hereby authorize - repre ntatives oPthl County to anter upon the above-mentioned - prop rty for inspecti purposes. - 'SEE REVERSE FOR EXPLANATORY LANGUAGE Signature ofPbrilnitilee Date