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Home My Public Portal About8817 ELM AVE_Plumbing__ . C 76A667-CE817-12/59 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER " ' BUILDING AND SAFETY DIVISION strlLDirlGt JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS CA' L WILLIAM A JENSEN, SUPT OF BUILDING _ a —-- LOCALITY �S 1777 sr:r FOR APPLICANT TO FILL IN CROSS TT . NUMBER FIXTURE OR ITEM OWNER C WATER CLOSET MAIL BATH TUB ADDRESS CITY TEL. NO. SHOWER /+ LAVATORY CONTRACTOR COL_ c SINS ADDRESS DISHWASHER CITY G TEL. NO. CONTRACTOR'S / / p STATE o &J LAUNDRY TUB REGISTRATION NO. (. G COUNTY ❑ CLOTHES WASHER DISTRICT NO. I $OUP ZONrE� P SSED BY WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL _ C - INSPECTION RECORD a O V a 0 e O ui P. In z @ $1.00 PER ITEM ( f OR FIXTURE APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK TOTALFEE ROUGH PLUMBING 'r GAS PIPING AHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION .%; GAS VENT STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 7,. HOT WATER HEATER PLUMBING. I. 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. 1 AM T E LEGAL OWNER OF THE ABOVE t. DESCRIBED RESIDENTIAL PRO •-j UTILITY CO.NOTIFIED S16NATURE OF PERMITTEE � •w FINAL a �F'/ 4r✓ OF / VALIDATION ROBERT A. WOOD, / M.O, CASH SUPERVISING MECHANICAL ENG'R �a03 3 4 0 JUI 5 1 3 .00 UlvM 76A667 (CE-8 17)-4/7 2 � �. APPLICAT1 - N FORUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION f MAKE CHECKS PAYABLE TO: ADDRESS �I �= HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. (� NUMBER FIXTURE OR ITEM @ FEE OWNER WATER CLOSET 1.75 MAIL BATH TUB 1.75 ADDRESS SHOWER 1.75 CITY' r "rA TEL. NO LAVATORY 1.75 CONTRACTOR SINK 1.75 ADDRESS DISHWASHER 1.75 CITY TEL. NO. CLOTHES WASHER 1.75 STATE LIC LLGENS_E NO. CLASS SWIMMING POOL RECEPTOR 1.75 DIST ICT N� GROUP ONE FRO SS LAWN SPRINKLER SYSTEM 1.75 G`/•'� _� s WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL pr., GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD A % v OUTLETS OVER 30 .7 �� CD 5 P R SYSTEM Lua - -� Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE.$ 3 DO TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan Check applicant UNDER SLAB WORK Name �� _ ROUGH PLUMBING Address GAS PIPING City �Grj/ Tel. No. GAS VENT HOT,WATER HEATER I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS fORRECT AND AGREE TO COMPLY PLUMBING FIXTURES - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY R GISTERED AND/OR UTILITY C O. NOTIFIED LICENSED AS REQUIRE .�.OS ANGELES T AND STATE OF CALI FORNIA OR THAT I AM .THE LEGAL OW E O AND INTEND TO RESIDE IN THE ABOV IBED RESIDENT P PER TY. FINAL SIGNATURE JJ OF PERMITTE PERMIT VALDATIO PLAN CHECK VALIDATIZIN CK. M.0. CASH ar 3 0 0 77 AUG 4 .7 5 4 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER- BUILDING NGINEERBUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 8817 Eo. Elm ;7 WILLIAM A. JENSEN, SUPT OF BUILDING ! LOCALITY ' - i FORnAPPLICANT TO FILL IN' NEAREST MuscatelV CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER Charles MCF811: l WATER CLOSET $1.25 T. 25 MAIL BATH TUB 1.25 ADDRESS- 881. Eo• El ' l SHOWER 1,25 l 25 CITY Temple, CityTEL. NO. AT-6-1028 l LAVATORY 1.25 CONTRACTOR Andrews Plumbing Co. 1. 2 SINK 1.25 ADDRESS 5391 Poplar Blvd. DISHWASHER 1.25 CITY , 16S Angelespp TEL.'NO. 223-2590 COWTRACTOR'SLAUNDRY TUB 1.25 REGISTRATION NO. STATE215/1.3 COUNTY ❑ CLOTHES WASHER 1.25 c DISTRICTNO. P .ZONE PROC SSED> BY WATER HEATER 1.50 GAS SYSTEM OUTLETS 1.50 INDUSTRIAL d WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD RANGE 75 ` 'a� "i� b AIA,, � � o W.H.-30:--- -30W. ' c� . - ---- 45 y DRY ............20 1-1 e/�� IiI��.�� z�v�`� z. - .e LTL 25 - �w¢s % ,9� BBQ .----- a , REF -- FAU. ........-- / 77 APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 'OO UNDER SLAB WORK - 5 ROUGH PLUMBING TOTAL FEE ` GAs PIPING 1 HEREBY ACKNOWLEDGE THAT, I.HAVE READ THIS APPLICATION GAS VENT i AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY c WITH ALL COUNTY:ORDINANCES AND STATE. LAWS REGULATING HOT WATER HEATER l PLUMBING. I HEREBY CERTIFY THAT 'I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES -LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST 'CALI FORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO ! RESIDE IN,THE ABOVE SCRIBED E RSIDENTI tL PROP '^ UTILTY CO. NOTIFIED - SIGNATURE OF PERMITTEE LLL.. Y��✓Y'�//��•" y FINAL V' LIDATION ROBERT A. WOOD CK-. M.O. CASH SUPERVISING MECHANICAL ENG•R 78A687 -GEttB� 12.64 APPLICATION FOR PLUMB NG Ih E R ��I(GG��CP 1r COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING ,- LOCALITY s FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER � WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS SHOWER 1.25 CITY TEL. NO LAVATORY 1.25 CONTRACTO (_L-G'e _ SINK 1.25 ADDRESS DISHWASHER 1.25 CITY TEL. NO CONTRACTOR'S LAUNDRY TUB 1.25 ST TE REGISTRATION NO. COUNTY CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE P OCB WATER HEATER 1.50 1 �" GAS SYSTEM OUTLETS 1.50 r INDUSTRIAL f WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD E� ,///i'�./l�.e _...�✓irsFer.r.�1't�.x�'...�4 -•r*M�....t��Rr� � APPROVALS ' DATE INSPECTOR'S SIGNATURE' PERMIT 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE Gas PIPING 1 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. 'q ' I HEREBY ,CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ;'I PLUMBING FIXTURES ' LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFA. GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ROVE D RI D RESIDENTIAL PROIE TY. 'I UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE _,,R FINAL �� '�� C CK. LIROBERT A. WOOD M..0.O. CASH SUPERVISING MECHANICAL ENG'R 76A667 (CE-817)-4/72 + 0 ° APPLICATION OR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER n LOCALITY / ' - �•.� FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST `� r . V t� C�► NUMBER FIXTURE OR ITEM @ FEE CROSS ST. _ ' OWNER �N� �A`fNp64"' WATER CLOSET 1.75 MAIL f� A ,l BATH TUB 1.75 ADDRESS ,` !� SHOWER 1.75 CITY T,�5p L. NO LAVATORY 1.75 CONTRACTOR SINK 1.75 ADDRESS DISHWASHER 1.75 CITY TEL. NO. CLOTHES WASHER 1.75 STATE LIC LICENSE NO. CLASS, SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. GROUP ZONE CESSED BY LAWN SPRINKLER SYSTEM 1.75 '09 WATER HEATER 1.75 INDUSTRIAL CJ ! is WASTE APPROVAL 0. GAS SYSTEM OUTLETS 1.75 7� INSPECTION RECORD V OUTLETS OVER 5 PER SYSTEM .30 p U W Cl Cl) Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name e1c, c� �'4 ovi5 ROUGH PLUMBING Address �� ad GAS PIPING City GAS VENT C A� F J Tel. N0 S=S HOT WATER HEATER I HEREBY ACKNOWLEDGE TH I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST I HEREBY CERTIFY 7 AM PROPERLY R GIST ED AND/OR UTILITY CO. NOTIFIED LICENSED Al.REQUIRE BY LS ANGELES COU TY STATE OF CALIFORNIA R THAT A E LEGAL OWNER p�F, D INTEND TO RESIDE IN THE ABOV RIBED RESIDENTIAL SRO TY. FINAL %..• SIGNATURE OF PERMITT L PERMIT VALIDATION CK. M.0. CASH ' PLAN CHECK VALIDAT N CK. M.O. CA 0 .5 2 9-3 APR 12 5 D 4,7 5 N Y I 76A667--•CE817.5/70 APPLICATION FOR PLUMENNG PERWT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER -BUILDING AND SAFETY DIVISION BUILDING C .,r. JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS `Gt V,C_ COLEMAN VV. JENKINS. SUPT. OF BUILDING LOCALITY �/JyJ106 FOR APPLICANT TO FILL IN(PR NT R TYPE) NEARESYS CROSS T. NUMBER FIXTURE OR ITEM EAC FEE !/O OWNER WATER CLOSET 1.5 MAIL - HATH TUB 1.5q I ADDRESS SHOWER 1.5 CITY / TEL. NO. LAVATORY 1.5 CONTRACTOR' SINK • 1.5 ADDRESS DISHWASHER 1.5 CITY CLOTHES WASHER 1. 0 STAT LI LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1. 0 DISTRICT NO. GP .ZDNE - C.% 8 `/„J�`J R O SSE YBY LAWN SPRINKLER SYSTEM 2. 0 WATER HEATER 1. 0 a-WASTE IP ROVAL GAS SYSTEM OUTLETS i. 0 INSPECTION RECORD Q� 5 PERETS SYSTTEMR x.30 Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE $ 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE a Plan check applicant UNDER SLAB WORK Name = ROUGH PLUMBING Address GAS PIPING r GAS VENT. City Tel. No. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES ,AND STATE LAWS REGULATING �,' GAS TEST 7 PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ,. UTILITY CO. NOTIFIED LI # : CENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL FA7ERTY. FINAL SIGNATURE OF PERMITTE JACK R. ALLEN, SU ERVISI N•G'M E�CH ANICAL EN G'R. _. c �� PERMIT VALIDATION/ M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH Lk 1 1 8 `=4 3 FB22 5 D 4.75 ., WgRKER'S COMPENSATION DECLARATION 720-0026 PW 9f89 6A667A APPLICATION ®� PLUMBING PERMIT ' I hereby affirm that I have a certificate.of consent to self insure, ora certificate of Worker's Compensation4nsurance, or a certified copy thereof(Sec.3800 Lab. C.) Policy NCompany (- COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. o Uj � . . �Kertified ertified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING copy is filed with the county building inspection ADDRESS dep me pp Date Applicant NUMBER FIXTURE OR ITEM @ FEE LOCALITY" �S ~ rt I l WATER CLOSET " NEAREST _ C TIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR � 7 (This section need not be completed if the work involved by the SHOWER MAP BOOK (1 / PAGE D PARCEL, j� permit is for one hundred dollars($100)or less.) OWNER ff__ I certify that in the performance of the work for which this permit LAVATORY O✓L is issued, I shall not employ any persAIL on in any manner so as to SINK q , _ ADDRESS q 1 / �!J become subject to the Workers' Compensation Laws. DISWASHER I CITY �Q. l-e 1��,, EL.No. Date Applicant g CLOTHES WASHER CONTRACTOR /y V / G NOTICE TO APPLICANT: If, after makin this Certificate of ! L 6 Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR n G 0 /1 provisions of the Labor Code, you must forthwith comply with such ADDRESS81 provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY ��o. /n T )C5 d I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000)of Division 3 of the Business and STATE LIC. /1 0 Professions Code,and my license.is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. 5 3 CLASS U OUTLETS OVER DISTRICT NO. PROCESSED BY a:�5 3. 5 PER SYSTEM4 D.ff Q License Number -Lia Class �! Q V FINAL IJ DATE 3_��L VALIDATION a Contractor L`'� f Date G J J J FINAL Dp� ;'r't a Z F1 am exempt under Sec. BY QG(4 ` °- B.&P.C.for this reason =-ti# 411 Plan check fee f i -til'_. Date: PLUMBING PERMIT ISSUING FEE$ Q - • Signature ,E_t t HL 41 - 35 ❑ TOTAL FEE A HECK. 4 Plan check applicant SINGLE FAMILY °.Hf•iNGE HOME OWNER-BUILDER DECLARATION Name ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address ° Code): 0000-))_=}1 i0i ❑ City Tel No. 1,as owner of the property,will do the work and the structure A" 1 'r 10 is not intended or offered for sale (Section 7044, Business and Professions Code). PIP 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, Civ.C.) Lender's Name Lender's Address I certify that I have read this application and state that the above - information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this Co ty to enter upon the above- entioned P ro ty for ins tion p AS SEE REVERSE FOR EXPLANATORY LANGUAGE leo._, ,► l0 Signature of Permittee Dale i WORKER'S COMPENSATION DECLARATION 720-0026 6A667A PW 9/e9 b" P UCAT ION FOR Pn 6 pMMIG PER�� T I hereby affirm that I have a certificate of consent to self insure,' �W�IIf LL�J d�J Illfll �1. or a certificate of Worker's Compensation Insurance, or a certified copy thereof.(Sed:3800 Lab. C.) Cc COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy Not '�i 'Co�pany �df�i SC El Certified copy is.hereby furnished. j l BUILDING f �•��y Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN OR TYPE)) ADDRESS d partment. NUMBER FIXTURE OR ITEM @ FEE LOCALITY. - `�l f£t��Jt� I Date A7 + Applicants}" ( WATER CLOSET NEAREST � 1 CROSS ST. CERTIFICATE'OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE ASSESSOR _ (This section.need not be.completed if:the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars $100 or less. OWNER. /�,, t" II certify that in the performance of the work for.which this permit LAVATORY !!'1. Y i(r is issued, I shall-not employ an erson in an manner.so as to MAIL - -i P Y Y P Y SINK,' ADDRESS become subject to the Workers' Compensation'Laws.' DISWASHER CITY r I 'i :i+� TEL.NO Date - Applicant q _ CLOTHES WASHER i + J NOTICE TO 'APPLICANT: If', after making this Certificate of CONTRACTOR ./�. �. Via, i�•, .,Q- r" ';r. k Exemption;you should become-subject-to!the Workers'Compensation SWIMMING POOL RECEPTOR ! b y ADDRESS. r k ✓ a provisions of the,Labor Code, you must forthwith comply with such r j4 .:r �,ti i.� Yr,. fes. fj ► �, provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM } LICENSED CONTRACTORS DECLARATION - CITY TEL.NO ' + I hereby affirm that I "am licensed under provisions of Chapter 9 WATER HEATER d (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS ' �� LICENSE NO. "+�� rSTATE f CLASS LIC o Professions Code,and my license is in full force and effect. ' OUTLETS OVER DISTRICT NO. PROCESSED BY` cc 5 PER SYSTEM I O License Number •� ' ,� / Lic.Class 4 v ~ FINAL VALIDATION U �� I, �t 4 e" ��/tr DATE VJ_9 a Contractort .l, r"N Date F 6 [ (� f/) ❑ FINAL Z I am exempt underSec. BY B.&P:C.for this reason Date: Plan check fee _ PLUMBING PERMIT ISSUING FEE$ Signature ❑ TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION c Name _ I hereby affirm that I am exempt from the Contractor's License Law 1 for the following reason (Section 7031.5, Business and Professions Address Code): El City Tel.No, w i i: 4:- ". I,as owner of the property,will do the work and the structure µ, - is not intended or offered for sale (Section 7044, Business '_ and Professions Code). 1 = -= CONSTRUCTION LENDING AGENCY r=-F. i� I hereby affirm that there is a construction lending agency for the I� ......._ performance of the work for which this permit is issued (Sec. 3097, ^,- Civ. C.) Rit Lender's Name Lender's Address I certify that I have read this application and state that the above "Cv information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this Coun,y to enter upon the above mentioned ro r for ins ec(Apurposes--k ur oses.� � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date- I�p FOR Imp V WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 /,A(i�P �y�/�T�®II'�1 FOR 1�"LhI�JIII!lUl�NG I�I�Ir"1111C9 T 20-002 A /r`ilir'Ir L� �y/r~'i� dVl I hereby effspm+that I have a certificate of consent to self insure, or 6 certificate oP Worker's Compensation Insurance,or a certified cony thereof(Sec.3800 Lab. C.) 67q 7f � h COUNTY OF LOS ANGELES . DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Polic o. mpa�Y - EV Certified copy is hereby furnished. FOR.APPLICANT TO,FILL IN(PRINT OR TYPE) BUILDING / ❑' Certified copy is filed with the county building inspection ADDRESS J L - dep menta• - NUMBER FIXTURE OR ITEM Q FEE r LOCALITY Date Applicant'— NEAREST r G WATER CLOSET ` CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB J COMPENSATION INSURANCE. ASSESSOR Q '- (This section need not,be completed if the work involved by the SHOWER MAP BOOK -D J PAGE PARCEL* , permit is for one hundred dollars($100)or less.) LAVATORY- OWNER C- I certify that in the performance of the work_for which,this permit is issued, I shall not employ any person in any manner so as to SINKMAIL .. . become subject.to the Workers' Compensation Laws. ADDRESS DISWASHER CITY TEL.NO. Date Applicant CLOTHES WASHER CONTRACTOR C C.h S NOTICE TO APPLICANT: if,'after making this Certificate of t, an/ v Exemption,you should become subject to the Workers'-Compensation SWIMMING POOL RECEPTOR provisions of the.Labor Code, you must forthwith comply with such ADDRESSd ? 4, J, t provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM,. �r LICENSED CONTRACTORS DECLARATION CITY' TEL.N o -7 /j a WATERHEATERJ I hereby affirm:that I am licensed under provisions of Chapter 9 STATE LIC. (commencing with Section 7000) of Division 3 of the Business and LICENSE NO. CLASS /qty \ O Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS / i! OUTLETS OVER DISTRICT NO. FAOCESSED,BY 5 PER SYSTEM 0 License Number Lic.Class O FINAL// V1ATIOIV 7 �'E sLU /h' DATE 7j- - °' �'�a Contractor 4 ti W�lL�a a f §ITEMS U� ❑ FINAL i I am exempt under Sec. 1 BY N I 30 B.&P.C.for this reason IZ7 7111 Plan check fee Date: /� PLUMBING PERMIT ISSUING FEE$ (! �(�' CHANGE Signature q r _ TOTAL'FEE ,J D f ... ...... ... . El Plan check applicant }#?II4—;;#�IJy ` :' �' SINGLE FAMILY HOME OWNER-BUILDER DECLARATIONName` i s _,,•i,- I hereby affirm that I am exempt from the Contractor's License Law _ s351 �" ' for the following reason (Section 7031.5, Business and Professions Address Code): i _ City Tel.No. ElI, 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 , hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec.3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby.authorize representatives of this County to enter upon the above-mentioned proper or inspection purp/pp�sses. ^ -6 SEE REVERSE FOR EXPLANATORY LANGUAGE IL Signature of Permittee D e