HomeMy Public PortalAbout5234 GOLDEN WEST AVE_Plumbing__ COUNTY OF Los ANGELES APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUILDING & SAFETY I L
WILLIAM J.TOX, County Engineer
" FOR APPLICANTS TO FILL IN D T 1 IM- 16
�
PLUMBERREADY FOR
REC D BY FIRST INSPECTION pDp�A% �
ADDRESS
CITY / TEL. No. ! G� ADOREBUILD.S (/�/ ��'J �J✓
LIOUNTY CENSE LOCALITY -77CNO!
EXPIRES
NEAREST
PERMIT FEES CROSS ST. 49 v
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL '
WATER CLOSET(TOILET) 0.50 ADDRESS
BATH TUB 0.50 CITY TEL. NO.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Q 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
"'CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
GAS SYSTEM OUTLETS O.5❑ OF THE RESIDENTIAL PERTY ESC 18 D BOV /
SIGNATURE OF
WATER HEATER 0.50 PERMITTE •••RRR
SLOP SINK ca 0.50 INSPECTION RECORD
FLOOR SINK Q 0.50
FLOOR DRAIN Q 0.50 _
DISHWASHER Q O.Sp
DRINKING FOUNTAIN @ 0.50 ;&- MMS- b0 exr e _A0T.419
URINAL (B 0.50
.Q
i
HOUSE SEWER @ 0.50 _ _ Z_
MISCELLANEO S — E7
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) 1.00 SEWER
PERMIT1.00 GAS TEST
UTILITY CO. NOTIFIED
TOTAL FEE 6
FINAL
76A667 DBS.#17 10/52
76A667 DBS 17 7.51 APPLICATION FOR PERMIT
" DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELESI .' 1
WILLIAM J. FOX, CHIEF ENGINEER
1 TR R P E .
FOR APPLICANT TO FILL IN
CEI ,RAL Irl:' ._ .,LA I a y
PLUMB RECEIVED BY READY FOR DATE ISSUED
311 E. tial. I 1 IA ,�pf,� FIRST INSPECTION
ADDRESS P p u 1Gvn
,~ BUILDING
CITY TEL. No. ADORES8 J //��.�(+9 �i• V`�
COUNTYLOCALITY T�iit'je JJP-
LIOENSE NO. - 'Y Q EXPIRES
�.p�� CRSSNEAREST j_ _
PERS FIM CROSS ST. /f��/rr(T�Lr A p
NUMBER TYPE OF FIXTURE OR ITEM iFEE OWNER J•S ��..6')..,.�f$C�'l�'
MAIL
WATER CLOSET(TOILET) 0.50 » ADDRESS
BATH TUB 0.50 CITY TEL Na.
SHOWER 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK CSS 0.50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY ® 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
GAS BYSTSM OUTLETS 0.50 OW THE RESIDENT t OPERTY DESCRIBED ABOVE.
BIGNATURE OF
WATER HEATER 0.50PfiRMITTE
SLOP SINK 0.60 INSPECTION RECORD
FLOCK SINK 0.50
FLOOR DRAIN 0.50
DISHWASHER 0 0.60
DRINKING FOUNTAIN 0.50
URINAL 0.50
Q
HOUSE SEWER 13.513 _Z
MISCELLANEOUS
A p
A "PROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL 1.00 CESSPOOL
SEPTIC TANKC SEPTIC TANK
DRAIN ( ) PIT ( ) 1.00 SEWER
PERMIT I 1.00 GAS TEST
TOTAL FEE
UTILITY CO.NOTIFIED
� / FINAL
D.B.S.17 25M SETS 12.44 - _ ' • ° APPLICATION-FOR PERMIT
DEPARTMENT OF BUILDING- AND SAFETY-•
COUNTY OF LOS ANGELES.• i L 1
rl
WM..J. FOX.'CHIEF ENGINEER
NATURE-OF INSTALLATION, u ` DISTRICT NO.-,- GROUP . ZONE, �yyPERMIT NO.
ROUGH FIXTURES • COMPLETE -�/ .n - -�,- 1 7 .'.-
HEATER CESSPOOL I I SEPTIC TANK �5 RECEIVED 13Y READY FOR DATE ISSUED-
_ -FIR8T INSPECTION'
GAS '- MISCELLANEOUS -
APPLICANT_ .,FILL IN HEAVILY OUTLIN/ED PORTION ONLY�/1=/p"
NAME _ s JOB' .I& �O `...e,P� 4 ►" s+-"1�•- ,�,�''
ADDRESS
ADDRESS - LOCALITY "e,", t-
0,
NEAREST
a _. - r -_ C CROSS
IL CITY TEL.NO. -
COUNTY A �
1. CERT.No.- - ' - EXPIRES.
LOCATION OF SEPTIC TANK, OR CESSPOOL' 3 MAIL' v/�►'/d
ADDRESS 1, 7 •!0• (. '�
NORTH O 7.
"CITY—l' TEL.-No.
K 1 AM .THE'LEGAL- POSSESSOR OR,., THE ABOVE L08
I - ANGELES,COUNTY CERTIFICATE OF QUALIFICATION.
s i
. 1 AM THE LEGAL-OWNER•OF THE PROPERTY DESCRIBED,.
ABOVE.
CORRECTIONS
SOUTH a
DESCRIPTION-OF WORK. 7
"BATH TUB FURNACE a ••Y p$
+aHOWER DISHWASHER e d O
AVATORY,' iREFRIGERATOR y
KITCHEN SINK WATER SOFTENER 1
FLOOR 91 K, AND TRAP-
RLOP SINK . a RLOOR DRAIN
WASH.TRAY, URINAL- y APPROVALS
{NATER•CLOSET " ^RINKING'FOUNTAINI DATE - INSPBCT0R'9 NAM19•-
`
'WATER HEATER DENTAL LAVATORY - •I' - - '�• I<" a;• - _ '
J ROUGH PLUMBING
METER' SAS +;OD'A FOUNTAIN ilJ GAS PIPING I I
i - OUTL
.. ; GAS VENT I - .'I - •, - ••
CESSPOOL' I//,(0 .L'•
TOTAL NUMBER OF FIXTURES ' SEPTIC TANK - ---oI fill
-. - -CESSPOOL�.�_SEPTIC V
TANK' 'F. . • SEWER ` ' ' . - I I -
8
TAL FEE UTILITY CO.'NOTIFIED
OT �' D ', r
FINAL - -
76A667 (CE-817( 1/79 /Q,"� /. Jae &[�
APPLICATION FOR PLUMBING .PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO ADDRESS.5234 N. GOLDEN WEST
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY TEMPLE CITY
FBA
APPLICANT TO FILL IN (PRINT OR'TYPE1 NEAREST •
CROSS ST
FIXTURE OR ITEM @ FEE
OWNER
ER CLOSET,. 2
MAIL
H TUB CN 2 0 ADDRESS ,ABOVE.
WER t000
CITY - TEL. NO 286-8789
ATORY CONTRACTOR J,S�,J COPPER PLUMBING CO.
K 200 ADDRESS 07 W•RTCHARDSON LANE
HWASHER 00 CITY GLENDORA TEL No. 963-1093
THES INASHER 2 0 STATE - LIC
LICENSE NO - -303946 CLASSC36
MMING POOL RECEPTOR 2 J10
DISTRICT NO.GR P ZJa� OC SED BY
LAWN SPRINKLER SYSTEM ,pp K ,
WATER HEATER 00 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 2. 0 INSPECTION RECORD o
OUTLETS OVER 0 v
5 PER SYSTEM
CD
U
W
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
APPROVALS DATE INSPECTOR 8 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO. GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I 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
PLUMBING. . GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REOU IRED 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 PROPERTY, FINAL .�'"/(/•'��
SI GNATU RE ,
OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK V4VDATION CK. M.0. CASH
45 G 1 5 1 U.GJ
41—r i .
76A667 (CE-817) - 1/75
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO. ADIDRESGIN � f/
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 200
MAIL
BATH TUB 200 ADDRESS
SHOWER 200 CITY jij / TEL. NO.-
LAVATORY 200 CONTRACT
SINK 2.00 ADDRESS -
DISHWASHER 2 00 CITY TEL. NO.
CLOTHES WASHER 200 STATE' LIC --
SWIMMING POOL RECEPTOR 200 LICENSE NO CLASSDISTRICT NO, UP ZONE [—Pr_ CESSED
BY
LAWN SPRINKLER SYSTEM 200
JL
WATER HEATER 200 INDUSTRIAL
WASTE APPROVAL
GAS YSTE OU LETS 2 00 INSPECTION RECORD
OUTLET VER 90 U
5 ER S M'
O
3G
- W
z
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE S
TOTAL FEE
APPROVALS DATE INSPECTOR 9 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO. GAS VENT
HOT WATER HEATER..
I HEREBY ACKNOWLEDGE THAT I HAVE REA •THIS APPLICATION
AND STATE THAT THE IS CORRECT A AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL
COUNTY
DINA ES AND STA E LAWS REGULATING GAS AS TEST
I HEREBY CSE FY THA I AM PROP L REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS/R "RED LOS ANGE OUNTY AND STATE OF
CALIFORNIA/0 THAT M HE LEGA W ER OF, AND INTEND TO
RES I DEBT ABO ES ED RES E IAL PA RTY�,• FINAL
SI GNA•� � �G��
OFA MhTTE
PERMIT VALIDATION CK, M•0. CASH
PLAN CHECK VALIDATION CK M O. CASH
3 27t-1-SPR 14 5 U 7.5 0 ��Ir;
COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of Engineer �'
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
DISTRICT GROUP ON .
Fp�CR APPLICANT TO FILL IN
PLUMBER READY FOR
I i YN 0 Y� RECEIVED BY DATE ISSUED
x FIRST INSPECTION
A41
DDRESS ) �, /p r (�J' / ,0 ' 7
r�.�raA� �✓ d
BUILD
CITY LI TEL No. !'! L �/1 7.7 I ADDRESS
G
COUNTY I , LOCALITY_ ,p L)
LICENSE NO. / EXPIRES ,
NEAREST /
PERMIT FEES CROSS ST. �� ,,,/� �„ ✓"
J� a v^. , H T
UMBER TVP[OF FIXTURE OOWNER 105 as,ITEM FEE —e-.-� _
MAIL Ivo+ _
WATER CLOSET(TOILET) IN 0.50 $ Q _ADDRESS y.� /1Y.rx,/�S p�„ kl, �"T� /.J.Yji
C3.90 BATHTUB p� CITY p/-(o�(�•i (, TEL. NO.
SHOWER O. O / I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Q 0.40 $® APPLICATION AND STATE THAT THE ABOVE 19 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0,40 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ O.5 ANGELES COUNTY LICENSE, OR I AIM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM— OUTLETS 0.5
SIGNATURE ❑F
WATER HEATER @ 0.5 PERM ITTE
SLOP SINK @ 0.5INSPECTION RECORD
FLOOR SINK 0.5 _
FLOOR DRAIN- @ 0.5 9 ��
DISHWASHER O.5 C-, -7�
DRINKING FOUNTAIN 0.5 .G/y FCJ� 6✓ Q
URINAL O.5 CO ' V.QTE"c �r,� �"� .7 J
J Q
HOUSE SEWER 0.5
MISCELLANEOUS d vC �� � .� � �
,APPROVALS
D T@� IN9PECTORNF�iM�E
ROUGH PLUMBING �'4�4YI�"9
GAS PIPING
GAS VENT
CESSPOOL 1,00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) 1.00 SEWER
PERMIT 1.00 GAS TEST
,(/� UTILITY CO.NOTIFIED
TOTAL FEE CeT
FINAL
76A667 DBS#17 10/52
o.B.s. 17 zeM SETS Iz-aa APPLICATION FOR PERMIT,-.
DEPORTMENT OF- BUILDING AND SAFETY;
CWm.J. FOX.,CHIEF ENGINEER OUNTY OF LOS ANGELES Pium ��'
NATURE, OF,INSTALLATION DISTR�hCyT NO:• `GRgyP , ZZO E PERMI
ROUGH, FIXTURES COMPLETE *�✓ 4{ r'J � ��
HEATER CESSPOOL SEPTIC TANK } RECEIVED BY READY FOR, DATE ISSUED
'�FIRBT IN8PECTION
-GAS MISCELLANEOUS
yr� L '. '•� `• r�� YS �Y�y�
APPLICANT",FILL IN HEAVILY.-OUTLINED-p , r PORTION�ONLY
K; • NAME - - .� -ADDRESS - al� -
T pe
•m, ADDRESS' A
LOCLITY
"
NEAREST: >- .• - :F
IL
CITY•• ' , TEL•No i I, .-�CROBS ST: .17 ,
COUNTY
`CERT.No. EXPIRES i' ' ,NAME •/y �Q (.{'-,� ,�'Cf4A" '
LOCATION OF SEPTIC'TANK, OR CESSPOOL Z. -MAIL
3 ADDRESS- _
r. NORTH p
-j• . - ,:P CITY - ' TEL.No. - -
I AM ,THE LEGAL POSSESSOR•OF THE ABOVE' LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
17,
- - ' PLUMBER '
T - - -- 1 AM THE LEGAL-OWNER OF THH'PRO_PE Y DESCRIBED
- - - CORRECTIONS
der exp17
SOUTH a
DESCRIPTION OF WORK z
BATH TUB i FURNACE "z
►�-
SHOWER - - nIBHWASHER - - - - + - -
t 'LAVATORY •. - REFRIGERATOR':' •� _ _ - - - _
KITCHEN-SINK `i. WATER SOFTEN ER
RLOOR SINK' :—SAND- TRAP..,'
-, _
SLOP SINK FLOOR DRAIN'
WASH.TRAY. URINAL - APPROVALS
—WATER CLOSET DRINKING FOUNTAIN DATE_' INSPECTO•'15 NAM[
f a WATER HEATER DENTAL LAVATORY
ROUGH PLUMBING •=
'j x 4
METES- -l•- 'GAB eODA FOUNTAIN 6A8 PIPING
OUTL -
t GAS&VENT
' - - "•CESSPOOL'
TOTAL NUMBER OF PIXTURES' : ' •-�� '
SEPTIC TANK'
CESSPOOI SEPTIC TANK SEWER_ • - " I r
UTILITY,CO.NOTIFIED I '
TOTAL FEEI . X0
FINAL
WORKERS'COMPENSATION DECLARATION 76A667A
I hereby affirm that I have a certificate of consent to self cE'e17 (2-66;' APPLICATION FOR PLUMBING PERMIT
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec 3800,Lab C) COUNTY OF LOS AN E LES,0� BUILDING AND SAFETY
Policy No.�Company -
Certified copy is hereby furnished. 'FOR APPLICANT TO FILL IN-(PRINT OR TYPE) BUILDING
ADDRESS
Certified copy is filed with the county bu mg i pectlon NUMBER FIXTURE OR,ITEM 0 FEE
de LOCALITY
WATER CLOSET
Datei� Applicant NEAREST
BATH TUB CROSS ST.
CERTIFICATE OF
O
ENSAT ON INSURA
COMPCEORKE SHOWER OWNER PO
MAIL
LAVATORY
(This section need not be completed if the work involved ADDRES
by the permit is for one hundred dollars ($100) or less.) SINK CITY ` j TEL NO _ OU
I certify that in the performance of the work for which this DISHWASHER / 1O O
permit is issued, I shall not emplo ny person any manner CONTRACTOR L� /7
so asWtocoa bject to the rker ' Com ensat� Laws CLOTHES WASHER J> U
ADDRESS /4DatApplicantLLJ
SWIMMING POOL RECEPTOR CL
N CE TO APPLICANT I , after mak ng.this Cert.fic t of CITY TEL NO Cn
CL
.Exemption, you should become subject to the Wor ers' LAWN SPRINKLER SYSTEM STATE LIC / z
Compensation provisions of the Labor Code,'you must forth- �� LICENSE NO CLA
with comply with such provisions or this permit shall be WATER HEATER
ZM
deemed revokedGAS SYSTEM OUTLETS DIST T NO. P CESSE Y
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATE ! I!
effect 00
!f� FINAL
Numb e..I
License � �J Y Lac ass BY
Contracto
I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in'my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lic.or Reg.No Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section 7031 5, Busi- City Tel.No.
ness and Professions Code)
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project pt 5.3 O,7 A
(Section 7044, Business and Professions Code). # o,0 0 o o'5
CONSTRUCTION LENDING AGENCY 2 0`-0 1 Q Q
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.) 0-0 0 1 '6 O 0,F2
Lender's Name
0518-81
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of t s County to enter upon the
above-m caned property fo nspect n purpo s
4 Ft ture f rm it Ve D to C y
V WQRKERS'COMPENSATION DECLARATION 76AG67A
I hereby affirm that I have a certificate of consent to self ce 617 (z-eo) APPLICATION FOR PLUMBING PERMIT
insure, or a certificate of Workers'Compensation Insurance,or C'
a certified copy thereof(Sec 3800,Lab C.)
23107900779 Ca. Casualty, l ndemn i ty COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Company
—
0 Certified copy is hereby furnishedBUILDING
FOR APPLICANT TO FILL IN (PRINT OR TYPE)
ADDRESS 5234 N Goldenwest
® Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE
department CLOSET LOCALITY
WATER Temple City
Date 12—!9—19 n Applicant E_ I - PAYN E f.nMPANY NEAREST �_
BATH TUB CROSS ST. Las Tunas. Drive
CERTIFICATE OF EXEMPTION FROM WORKERS' -
COMPENSATIONINSURANCE SHOWER OWNER Mr. and Mrs. H. Piggott
LAVATORY MAIL
(This section need not be completed if the work involved ADDRESS 5234 N. Goldenwest a}_
by the permit is for one hundred dollars ($100) or less.) SINK CITY ' TEL NO. 0
Tem le C -8789
1 certify that in the performance of the work for which this DISHWASHER CONTRACTOR E. L PAYNE 358-6630
permit is issued, I shall not employ any person in any manner . Q
so as to become subject to the Workers' Compensation Laws CLOTHES WASHER ADDRESS 166 W. Lille Oak Avenue ~
Date 12-9-80 ApplicantE. L. PAYNE COMPANY SWIMMING POOL RECEPTOR w
NOTICE TO APPLICANT If, after making this Certificate of
CITY Arc TEL No- 446-6118
,
Exem tionyou should' become subject to the Workers' LAWN SPRINKLER SYSTEM Z
Exemption, Y ] STATE LIC.
Compensation 'provisions of the Labor Code, you must forth- LICENSE NO 120228 CLASS C-20
with comply with such,provisions or this permit shall be WATER HEATER
deemed revokedDISTRICT NO. PRO SSED BY
GAS SYSTEM OUTLETS
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter l 5 PER SYSTEM 3 00
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL
ness and Professions Code;and my license is in full force and DATE r z -(7 VALIDATION
effect. r�pm�/p,�y--�,r�.r��`�' ,��J'- • ��
License Number 120228 Lic.Class C-20 BY AL
Contractor E_ L_ PAYN E Date 12-9-80
F1I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ 7 OO
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code) TOTAL FEE 1 O OO
Lic.or Reg No Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section 7031 5, Busi- City Tel No 2 3 3 q 8 A
ness and Professions Code)
0 1, as owner of the property, am exclusively contracting # o o'o o o 5
with licensed contractors to construct the project
(Section 7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCY I. 0 0 0 1 0,0 0
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is 1 2 1 1 —80
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws ulating Plumbing, and hereby
2tha presentatives f his County to enter upon the
en Toned proper ms ectwn purposes
jtv 12C-§-80
ignature of Per ittee Date