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Home My Public Portal About5742 GOLDEN WEST AVE_Plumbing__ -54 APPLICATION FOR PLUMBING PERMIT oB5.17'ZDIVISION OF BUILDING AND SAFETY 7 Deportment ofCounty, Engineer County of Los'Angeles WM.'J. FOX, COUNTY ENGINEER BUILDING ADDRESS �L CASSATT D. GRIFFIN, SUPT OF BUILDING - � LOCALITY FOR APPLICANT TO FILL IN CROSS s .�12'•r� OWNER ► - - DISTRICT NO. 5 GRIPE READY FOR INSPECTION MAIL , ADDRES t �y �, ' pp JJ'' INDUSTRIAL CITY Q TEL NO. _ 4- WASTE APPROVAL PLUMB INSPECTION RECORD ADDRESS - - CITY TEL NO. LICEN NO NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) - BATH TUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINK DISHWASHER LAUNDRY TUB OR TRAY , CLOTHES WASHER - - ti - TOTAL NO. @ o so' APPROVALS DATE INSPECTOR'S,SIGNATURE GAS SYSTEM OUTLETS @ 100 - - WATER HEATER @ 1 00 UNDER SLAB WORK • - ROUGH PLUMBING }a 3p 1a - PERMIT $ 1 00 GAS PIPING i TOTAL FEE I OD 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 REGdLATING PLUMBING FIXTURES PLUMBING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO NOTIFIED CALIFORNIA OR THAT AM THE,.LEGAL OWNER OF THE ABOVE _ DESCRIBED RESIDENTIA PRO RTY. SIGNATURE _ 1 n OF PERMITTEE "' +� FINAL WILLIAM J. FOX, COUNTY ENGINEER VALIDATION BY (^/ BS-17 DAPPLICATION FOR PLUMBING PERMIT Bs.,7IZDIVISION OF BUILDING AND SAFETY 7 1 Department of County Engineer . County of Los Angeles WM.J. FOX, COUNTY ENGINEER BUILDING ADDRESS CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALIT FOR PLICANT TO FILL IN NEARESTCROSS ST OWNE - DISTRICT NO. GROUP ZONE READY FOR INSPECTION MAIL ADDRESS INDUSTRIAL - 1 CITY EL NO WASTE APPROVAL I PLUM E 'INSPECTION RECORD . ADORE-S CITY TEL. NO LICENS NUMBER TYP OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) S BATH TUB SHOWER' LAVATORY (WASH BASIN) KITCHEN SINK DISHWASHER LAUNDRY TUB OR TRAY CLOTHES WASHER TOTAL NO. @ 0.80 APPROVALS DATE INSPECTORS SIGNATURE GAS SYSTEM OUTLETS @ 100 UNDER SLAB WORK WATER HEATER Q- 1.00 ROUGH PLUMBING PERMIT $ I 1 100 GAS PIPING TOTAL FEE GAS VENT I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER _ AND STATE THAT THE ABOVE IS CO RRECT'AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGWLATING PLUMBING FIXTURES ` PLUMBING 1HEREBY CERTIFY THAT I AM P REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED B LOS GELES COUNTY AND STATE OF UTILITY CO NOTIFIED ' CALIFORNIA OR THAT 1 M LEGAL NER OF THE ABOVE DESCRIBED RESIDENTIAL RO RTY. - 1 SIGNATURE OF PERM TTE FINAL 6I `o ftl,.�,- WILLIAM J. FOX, COUNTY ENGINEER VALIDATION -2209R m 4 3 1BO BY - ,- DEPUTY WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 76A667A APPLICATION FOR PLUMBING PERMIT «IJJJ I hereby affirm that I have a certificate of consent to self insure, ,or a certificate of Worker's Compensation Insurance, or a certified ,copy thereof(Sec 3800 Lab C) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No Company - - • Certified copy is hereby furnished FOR AO FIL IN( TOR TYPE) El 'Certified TLPRIN Certified copy is filed with the county budADDRESS inspection T / department NUMBER FIXTURE OR ITEM @ FEE - LOCALITY +� M •' - {; •t i .1 �•, , Date Applicant WATER CLOSET I'' f NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE ASSESSOR (This section.need not be completed if the work involved by the a PAGE P SHOWER ? MAP BOOK _ ARCEL permit is for one hundred dollars($100)or less.) OWNERS I certify that in the performance of the-work for which this permit LAVATORY MAIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS s r•+( .. j` become subject to the Workers' Compensation.Laws DISWASHER CITY TEL NO Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of I CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such, _ ADDRESS } provisions or this permit shall be deemed revoked "y LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NO O I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE LIC V (commencing with Section 7000) of Division 3 of the Business and { GAS SYSTEM OUTLETS LICENSE NO CLASS LLI Professions Code,and my license is in full force and effect ,J OUTLETS OVER DISTRICT NO .PROCESSED BY, 5 PER SYSTEM License Number Lic Class ` FINAL DATE VALIDATION Qom' Contractor Date ❑ I am exempt under Sec FINALBY B&P C for this reason UJI Date Plan check fee PLUMBING PERMIT ISSUING FEE$ } Signature F-1i TOTAL FEE •_;• SINGLE FAMILY Plan check applicant a� • - 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) • ti fSW��" °'t«y'��.',`+ •::,:<. ❑ City Tel No l,-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 iereby affirm that there is a construction lending agency for the ormance of the work for which this permit is issued (Sec 3097, Name dress I have read this application and state that the above correct '1,agree to comply with all County ordinances sregulating Plumbing, and hereby authorize of thislou nto enter upon the above-mentioned ecUori purposes t „o V �, r � SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1212050010 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT (LEGAL ID _ 1 FEES PAID 1 BUILDING ADDRESS: I ITR 6561 LT 455 UN. 002 I I 5742 GOLDEN WEST AV 1 IFEE DESCRIPTION- QUANTITY UOM AMOUNT I TEMP CA 917802503 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET LIVE OAK 18587-028-016 101 PERMIT ISSUANCE FEE 27 60 I THOMAS PAGE 597 GRID A3 LOCALITY TEMPLE CITY CAI 1 107 BATHTUBS/SHOWERS 2 00 FIX 32 40 I 1 ITENANT 113 DISHWASHER(S) 1.00 FIX 16 20 (ISSUED ON PROCESSED BY . PLAN BY. I I 125 LAVATORIES/SINKS 8 00 FIX 129 60 112/05/12 SR I I 126 MISCELLANEOUS FIXTUR 1 00 FIX 16 20 1 I (OWNER TEL NO- _145 WATER CLOSET/URINAL - 3 00 FIX 48 60 IFINAL D TE FINAL BY: CODE I IPIERCE PAUL R (626) 209-0634- I TOTAL FEES 270 80 1 �I� 4 15742 GOLDEN WEST AV 1 r I ITEMP 917802503 1 IDE CRIPTION OF WORK _ 1 I IREPLACE BATHTUB/SHOWER, DISHWASHER, LAVATORIES, SINKS, 1 I I ISTEM UNIT AND WATER CLOSETS (APPLICANT TEL NO 1 SAME AS OWNER .. ISPECIAL CONDITIONS - I I I 1 I I _ ICONTRACTOR TEL NO. - I (APPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - 1 - - I I I LIC NO i 1UNDER SLAB WORK I I I I - I IWATER SERVICE I I I I I IPLASTIC Y/N METAL Y/N "1ARCHITECT OR ENGINEER TEL. NO II II I ROUGH PLUMBING . 1 - LIC NO 1 _ - - I - IGAS PIPING 1 1 I IGAS VENT I I I I I I- I I I - IHOT WATER HEATER 1 1 1 I 1 IPLUMBING FIXTURES 1 I I 1 I ILAWN,SPRINKLERS 1 I 1 GAS TEST I _ i I I. I I (UTILITY COMPANY NOTIFIEDI I 1 I ICWV I 1 I I IGRAY WATER SYSTEM 1 1 I I IREPORT ID: DPR263 ROUTE TO BS0508 I I I I I I I I I I :1MORKERS�°COMPENSATION'DECL°ARATION'' - y 'i \ ,,P ) ` e, , >: , rn. X20-0026FDPW4/87 APPLICATION_ TOR �PLUMBIN,C" PERMIT" h hereby,,a�firm that-I,�avg q%c6(tifrpte of'consent,.to self,in- 76A6674�;^ sure,or'a-certificaJe of Wor 6rs'-Com ensei ioh.Insurance,.ora a PfC �� ,CE817,(REV 8/.86)` certified copy ihereof.(SeE-+3800, Lab'IC'-)'' ,;' _ �� -COUNTY.OF-LOS'ANGELES " DEPT. OF PUBLIC WORKS, } `" 3' 'Pthi y.No Company �. Cerhfied coPYis,herebyfuinished�� .a ,' S` i f�� 'FOR•APPLICANT•TO FILL IN 'PRINT OR TYPE - 'BUIhDING -24 - "7-,CertifieWcopy is filed'v�ilh th'e:c6u'6ty buiidit g'•ins'pe'ction s "" ( _ ) rADDRESS. -2 4 �¢ Qr�. tw '�•' department° s `rti - `NUMBER `'A IXTURE'OR,.ITEM1 , @�; FEE. q:;- t ;LOCALITY 'Dae fir' ( �• r:', ;' �, WATER;@LOSET(TOILET,) .'+ —• , a .:z _' Applica Ll i:o. yv' 'f, nr- a'• a t .f- k - NEAREST • ,. "CROSS ST ', r 1 �t?' ,.'-y'•. . CERTIFICATE:OF EXEMP-TIOOM WORKERS'ON FROM neATH'TUB;°' G i w��G3 COMPENSATION INSURANCE, ?•' - 'r• ,� •�OWNE �', _ '"-' i` .'(This section need nof.b'e' SHOWER 4`" a `s- '(_ completed if,the work'inSol`vedtiby M'PIL3 the,'permit`,is'for�one hu'nilr`ed�dolldrs (5100),orless') - ��` _LgVATORY�>" r /` ' ' -� ADDRESS .,� - - N <'' Ya Y.�, '� _ SS, A^:..- � :,�7.4'.�,'r 's•c� , ,r I'certif, tho't'm`the` erforrra`nce oflthe ovork f s a ad ^5, Y. P, oi,wHich�ihisper,-� e*, 1, 'a+ i�.r ' -MITI IS issued,Z'l shall;not-employ any Penson m'any�man er's_o �r�� `�,;',SINK, -� �, ;,CI'Y �f'`�y�,°E'er �. JEC�NO' `aseto•become'�sublect�"to.the Work'ers;Coinpensathon Laws "T .' r •a .-t`.- - DIS4R CONTRACTOR- .< Date Applicantti` L'OTHES'WASHERS NOTICE7T� 'APP (CANT If; ftty, O C d er'_m"along`this Certificate of Ex- � + q ADDRESS' ,g o; empiion;-you'szould-become subject tootheWorkers'Compen,' SWIMMING POOL'RECEPTOR"� »� - sation pr vi V �,> TEL' NO. ao sionstof,the;L"abor.Code,Yy,ou•rriust:fo�ihwith comp- x;��sz �'CAWN SPRINKLER-SYSTEM' r" '� �' ly'oVith,such,provisionslor.this;per""mit shall;be`8eemed'revok- ' STATE ed �5e F .. ,�,' �a� w \14ATER HEATER '?, � .°i' �k3 e `y:.LICENSE'NO,- -^t "CLASS, LICENSED CONTRACTORS�'DECLARATI N�-"�' tit � �� '�+ * , -E r .r"Q GAS SYSTEM, _ ?�SICTNO ROCESS Iherebyaffir nthatil,am'licensed`undertprovisions,of Chapter ;; UTLET(commencmg,with Section 7000)of D,vision3 of the Busi'riess �t'° "OUTL'ETS OVER and-Professions y cense is,m,full'force,and<ef', 5 PER SYSTEM ` Code, and'm �'li s' ;g� " �. �, s, FINAL G�. ALIDATION � -t :� `a� `'' � ..-a'.-, - z DATE � 0, .d licenseNumbe� Lir "Class° " s= R' - b= _ :;- �'U "FINALSK'' ' 1AC6nTrOCt6r ,ro. a•,.; A "f t,6 r'5 - 7,.}C_. _ . �I-.`1, Fq• h. '3 e` � rrV BY'D_ 'i - f _ ,-r' 0,., �Y':I,am`ezernpT una' 'Secy •`� �� + •_ r .ti `�. .. .,r3 °, tIL B 8P C for.`thisr'reason # - 4 �,: v t ,�` +✓4' "° sVl, Plan.check4fee Date' ;• -''. PLUMBING PERMIT ISSUING FEEz$ -t �% s �.i "t. � `si" ,4' c i :�:'. �TOTALFEE e• s ;� r� .SINGLE FAMILY �t� ' „ _ _s`-. ,F - •'d;-.,' r'� •Plan,'check a hcant �<T, HOMEOWNER�BUILDER`DECLARATION p �PP. .�� ,,' i'' ,A; �., �� iw_ F.� r• .�. :I,hereby affirm that=l,-am.exempt from tF e-ConTtacfors,License' c. „ Name"_,_--',,,.„ „' ' `_-: + � �. .�;':a" y.•� _'1 Laid"for the(followind-�ea'son.(SecTion 7031 5, Business and;t. =� ate'„ _ �''",� ,�� _ =�-" - 3_ �� :� �• o ^' ,t' .7 t- ;i, yam. �_ n • �� . aY,.!.Y vProfessi ns-Code)'' e: 's• � � t, ',Address'.ix` t, ^w; . : +�, .� s - e- "� `�" �'. I'� �(`7 I>as owrier 'f aheY�r art' Crt � Teh No o pope ty;_vLill.:do the and�the Y. �� f`, tITEMS, �.str•ucture'is not intended or offere8 fog sale(Section '" `Bus`ihess'and,Professions Code,)s �p ; .- �'n'�• "a; "'d t• :S� z' w - ,��, t•;E r�n%1' -'i' 'q.' a ;i .h, u.,1,.. ,- S: :aa�. -� ... b t- -!fi;( r. �.'�,�. 50" , LCC)NSTRUCT,ION"LENDING.AGENCY 'y- �,�� "gig:•�,r' * , X2 44. _� >s< ((jj �J =r u.,�I�' 'S -r }. -a ,. ��ii _ �hhereby'affiim ihat'tF ere`is'a construction,'lending,agencypfor �� _' `' .;,, •r,SS`s°' r ,rem tKe perforrnanceof-the'work�;for^which this peimit°ismissued '�w_'`'; +� 1y (Sec =3097;C'v,C )a �� ,';�• y -'�.� ��` <- ry,� l' �. � ,. ; ' �• "Fr My ,r i� a. '-s,pi c,a' �`�, _ ,+`"'�,- °••.r,: a" <" ,' _ .•�, `�,� - �' _ ,,'° s, ..,, '� P:, a �� ;` •1 '� a .f�y� - ., - �,• �� ,!�#L ,r= ,c .��,.. �'{� a1;, �,,:11.' _ "r n... ,�' "�� ;� .'y• — _ Y' v NF JY •} . •-4 r`, s 1 r�i ': ' i� V L:en�deL'sNa'rre� � ; . .,r ''�f ". � ��VVV� 12/i�. 1�r Milo. .4 L'ehder'sAddress� , e`rti'fy'that�l'have.read-ahis-application'andstate,that th'e, "i'' " ` � t "� b•• ' - ��.'` ? '' ` _'�`. -�. � � p'abo- mf motion is"correct I agree,to,comply witF ah-County 8•, ,'r ordman`e and Stafe'Ib fe`ulatm Plumbih 'and hereby' � � autHo ze repre e tatry of thisrCounty',to enter upoh_,the tion ; pro rty'for"mspection'purposes x ti 'SEE;R ,3 � , . ,• ,� EVERSE�F,OR EXPLANATORY LANGUAGE` ti ;• ' .` .; Signatur-e"o Permittee 's Date �Sti.'+`• (-r 1 a'8 ',i' n r vr,' •y.:� - �� m .� .'_ �� 9, ,& `'� X . �.� �� r-'?✓ _ ,i - - . ..WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No Company Certified copy is hereby furnished BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS ' Certified copy is filed with the county building inspec- tion department NUMBER FIXTURE OR ITEM @a FEE ` LOCALITY Date Applicant WATER CLOSET ✓ NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST Q� COMPENSATION INSURANCE OWNER (This section need not be completed If the work Involved by SHOWER the permit Is for one hundred dollars $100 or less. MAIL p ( ) ) LAVATORY � ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL NO Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO- PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �0 p (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and m license is in full force and effect 5 PER SYSTEM >= Y FINAL VALIDATION (V DATE 7 License Number Lic Class € is o T 0 FINAL , t`cr_c im Contractor Date', BY -7(,- + - ❑ I am exempt under Sec rTC B 8P C for this reason S2 _ 95 o- Plan check fee 1,_ U) CHECK ® '_K Signature PLUMBING PERMIT ISSUING FEE$ TOTAL FEE �a Plan check applicant SINGLE FAMILY j1i (JL^I:R 1({ Id HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's LicenseAddressEN Ct'�'_ Law for the following reason (Section 7031.5, Business and Professions Code)- City Tel No 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 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 authonz epresentot e this County to enter upon the abov t ed p rt for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I hereby affirm that I have a Eertifwate of consent to self insure, or a certificate of Worker's Compensation urance, or a certified copy thereo IS c 800 Lab C) ` _. - - - COUNTY OF-LOS ANGELES DEPT. OF PUBLIC WORKS-, DEPT.OF PUBLIC WORKS DIV. Policy No Company ❑ Certified copy is hereby furnished BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE), - ADDRESS 1,5� �, f Certified copy is filed with the ounty budding inspection arLmept NUMBER FIXTURE OR ITEM ,@ FEE ,/ LOCALITY Dat 7r Applicant WATER CLOSET � � NEAREST JV CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB _ ASSESSOR COMPENSATION INSURANCE (This section need not be completed if the work involved by the / SHOWER / MAP BOOK PAGE PARCEL ' permit is for one hundred dollars($100)or less) �i LAVATORY P OWNER I certify that in the performance of the work for which this permit MAIL is issued, I shall not employ any person in any manner so as to SINK become subject to the Workers' Compensation Laws ADDRE - DISWASHER Date Applicant CLOTHES WASHER CONT ! NOTICE TO APPLICANT If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such - ADDR � provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CI i } I hereby affirm-that I am licensed under provisions of Chapter 9 WATER HEATER- a TATE LIC /-7 (commencing with Section 7000) of Division 3 of the Business and / GAS SYSTEM OUTLETS LICENSE NO CLAS (p O Professions Code, and my license is in full force and effect 5 UTLETS OVERQ ^� DISTRICT NO PROCESSED BY PER SYSTEM �1 �O' n ~ Q License Numbea Lic Clas � U FINAL `�� VALIDATION LU DATE _ d Contract D U) ❑ t' D,SE - I am exempt under Sec FINAL ZBY B&P C for this reason Plan check fee Date Signature PLUMBING PERMIT ISSUING FEE$ a ElTOTAL—FEE3oZ t Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law o for the following reason (Section 7031 5, Business and Professions Address Code) •r••r--r• ' City Tel No i ❑ 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 "' Nil 4t�t,7'_C (,rf 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 I 272751,27';' i Fri 1:`o i i� Lender's Address certify that I have read this application and state that the above ' P information is correct I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize re esentatrves of this County to enter upon the above-mentioned pr pert ino 1 purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date