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Home My Public Portal About5621 GRACEWOOD AVE_Plumbing__ 76A667 (EE-817)- 5/73 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: ADDRESS 621 N Gracewood Ave HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY cadia �-- FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM @ EE OWNER Frank R Urias WATER CLOSET 1,75 fy 11-C) MAIL BATH TUB �V� ,ter 1.75 ADDRESS 5621 N Gracewood Ave SHOWER ri ,75 / CITY Arcadia TEL. NO. 44 -O8 O LAVATORY 78 CONTRACTOR Economy Plumbing Mechanical LIT -if .7 ADDRESS 1580 F, Walnut St DISHWASHER •7 CITY P ry TEL. NO. _ CLOTHES WASHER 7k STATE L CENSE NO. 247�90 CIL SS SWIMMING POOL RECEPTOR 1'15 (ST141 RICT NO. f UP O E P CESSED BY LAWN SPRINKLER SYSTEM 1 5 � WATER HEATER1 5 INDUSTRIAL WASTE APPROVAL d GAS SYSTEM OUTLETS 75 INSPECTION RECORD CO.D OUTLETS OVER 30 5 PER SYSTEM O H U W Q. N Z Plan check fee See Reverse PLU BING PERMIT ISSUING FEE $ TOTAL FEE APPROVALS DATE INSPECTOR S 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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE D (BED RESIDE N IAL PROPERTY. FINAL �- SIGNATURE ` Lm;OF PERMITTEE �� ' ��-f i PERMIT VALIDATION CK._,JM,O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 0 7 2 [1 nrt% 1 5 U l y.`J U �'- 76A667 (qE-817) - 5/73 "��-,E� APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING ADDRESS )x621 N GraCeWOOd Ave HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY Arcadia - T C FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. L Ve Oak NUMBER FIXTURE OR ITEM I @ FEE OWNER Frank Urias WATER CLOSET 75 MAIL BATH TUB ,7 ADDRESS 5621 N Gracewood Ave SHOWER ,7 CITY Arcadia TEL. NO. 5-0890 LAVATORY 4 L CONTRACTOR Economy Mechanical SINK .7 ADDRESS P.O. BOX 5068 DISHWASHER 5 CITY Pasadena TEL. NO. 793-2375 CLOTHES WASHER 5 STATE LICENSE N0. 247190 CILASS 1221 SWIMMING POOL RECEPTOR 75 DISTRICT NO. GROUP �&N/� PTCESSEDBYY LAWN SPRINKLER SYSTEM 1 75 "S 10 } iF WATER HEATER 75 INDUSTRIAL WASTE APPROVAL a GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD v OUTLETS OVER 5 PER SYSTEM .30 x O F— V w z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ A3 jQ' TOTAL FEE APPROVALS DATE INSPECTOR'S SI,NATURE 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 REOUI RED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DTEC RESIDENTIAL PROPERTY. FINAL ' SIGNATURE OF PERMITTEE PERMIT VALIDATION CK.' M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 159 r17P i 5 u 1 3.5 ® a ,; 7BA667 17 9-49 ® 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. X -i 82:g�eC PLUMBER .� RE 1 D BY READY FOR DATE ISSUED FIRST INSPECTION �„ •-� py ADDRESS BUILDING CITY TEL. NO. ADDRESS COUNTY LOCALITYL Cc(J JtiI L/ LICENSE NO. EXPIRES NEAREST 2 PERMIT FEES cRoss sr NUMBER I TYPE OF FIXTURE OR ITEM FEE - OWNER �GJ/ MAIL WATER CLOSET (TOILET) @ 0.50 $ I_�'a ADDRESS 2 33 G�AC1�/o0 �O �i6ATH TUB @ 0.50 I CITY�_� �+=01j ry TEL. NO. �— SHOWER @ 0.501 I 1 HEREBY ACKNOWLE GE THAT I HAVE READ THIS �JLAVATORY (WASH BASIN) @ 0.50 I APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK " @ 0.50 I STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY.- @ O.50 ANGELES COUNTY LICENSE, OR 1 A THE LEGAL OWNER OF THE RESIDENTIAL PROPS TY7DE IBED ABOVE. I_ GAS SV9TEM__3—_OUTLETS @ 0.501 S� SIGNATURE OF x �I WATER HEATER @ 0.501 ''-a PERMITTE 7777 SLOP SINK @ 0.501 INSPECTION RECORD IFLOOR SINK @ 0.50 I� FLOOR DRAIN @ 0.50 % U DISHWASHER @ 0.501 DRINKING FOUNTAIN @ 0.50 I URINAL @ 0.501� �^ ? HOUSESEWER @ 0.501 1 Q Z MISCELLANEOUS I I I O I I APPROVALS I - DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1.00 I I CESSPOOL SEPTIC TANK: I I SEPTIC TANK DRAIN ( ) PIT ( ) n 1.001 I SEWER PERMIT . I 1.00 GAS TEST TOTAL FEE UTILITY CO. NOTIFIED I $ ;"� FINAL 70A557 17 11-50 (b 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 j _ RECEIVED BY READY FOR DATE ISSUED - FIRST INSPECTION ADDRESS i BUILDING - CITY TEL. NO. ADDRESS COUNTY LOCALITY �! LICENSE NO. EXPIRES NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET (TOILET) @ 0-sols ADDRESS BATH TUB @ 0.501 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 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.501 ANGELES COUNTY LICENSE, OR 1 AMTHE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS @ O.50 SIGNATURE OF WATER HEATER @ 0.501 PERMITTEE SLOP SINK @ 0.501 INSPECTION RECORD FLOOR SINK @ 0.50 1 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.501 DRINKING FOUNTAIN @ 0.501 URINAL @ 0.501 1 -j HOUSESEWER @ 0.501 I i Q Z MISCELLANEOUS I I U` ItO I� APPROVALS II DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT 1 CESSPOOL @ 7.001 d a 'x CESSPOOL 1 SEPTIC TANK: I SEPTIC TANK I DRAIN ( ) PIT ( ) @ 1.001 I SEWER PERMIT . I 1.00 GAS TEST UTILITY CO. NOTIFIED TOTAL FEE $ FINAL j 76A667 (CE-817)-8-71 APPLICA/TION FOR PLU/ME31NG �PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS, ? LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. I� NUMBER FIXTURE OR ITEM @ FEE OWNER WATE R'C LOSET 1.75 MAIL BATH TUB 1 75 ADDRESS ��C SHOWER 1 75 CITY -� TEL. NO LAVATORY 1.75 CONTRACTOR SINK 1.75 ADDRESS /D DISHWASHER 1.75 CITY TEL. NO �f� e I 4 CLOTHES WASHER 1.75 STATE LIC LICENSE NO. DC CLASS SWIMMING POOL RECEPTOR 1.75 , DISTRICT NO. GRO Z E P ES BY LAWN SPRINKLER SYSTEM 1,75 S D WATER HEATER 1 75 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1 75 INSPECTION RE RD V C OUTLETS OVER n 5 PER SYSTEM 30 d fT�' Z O F-' V W O. Vf z 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 ROUGH PLUMBING Address GAS PIPING City Tel. No. 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 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 LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER AND INTEND TO RESIDE IN THE ABOVE 41BEII RE )EN TI OPERTY. FINAL �V SIGNATURE OF PERMITTEE PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK M.0. CASH L,1,o0;4 FEB 16 5 D 4.75- D.B.S.-17 _5M SETS 12-45 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF L,OS ANGELES PLUMBING 1 Wm. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP; ZONE PERMIT NO. ROUGH _ FIXTURES COMPLETE HEATER CESSPOOL I ( SEPTIC TANK RECEIVED BY FIRST AINSPECTION D Y FOR DATE ISSUED GAS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB rm. ADDRESS ADDRI .jam LOCALITNEARESTZed • TEL. No. CROSS ST.. EXPIRESR NAME Y 41- LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL f I y _ADDRES NORTH 0 ------- CITY o. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMS[R I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED 1>4 ABOVE. Id Ip OWNER CORRECTIONS SOUTH DESCRIPTION OF WORK BATH TUB FURNACE SHOWER DISHWASHER LAVATORY REFRIGERATOR KITCHEN SINK _— WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY —URINAL APPROVALS WATER CLOSET --DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER—GAS SODA FOUNTAIN OUTL GAS PIPING _ GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES �` , SEPTIC TANK I _ CESSPO01 SEPTIC TANK SEWER UTILITY CO. NOTIFIED TOTAL FEE FINAL D.B.S.-17 95M SETS 12-4s APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMING 1 Wm.J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. I GROUP ZONE PERMIT NO. ROUGH FIXTURESCOMPLETE _ HEATER CESSPOOL —I SEPTIC TANK RECEIVED BY FIRST AINBPECTION DY FOR DATE ISSUED GAS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB - r E NAME ADDRESS W rr S ADDR -Q LOCALITY E NEAREST a CITY '' T L.No. —CROSS ST. COUNTY '�/ �,.n CERT.No. EXPIRES C NAME �t /�J'" LOCATION OF SEPTIC TANK, OR CESSPOOL M 2 MAIL ADDRESS =r NORTH O CITY TEL. No. I AM THE LEGAL POSSESBOR OF THE ASOVQ LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. ` PLUMBER 1 I AM THE LEGAL OWN""OF THE PROPERTY DESCRIS[D ABOVE. p A M OWNER CORRECTIONS t i r fin J� f SOUTH ►.a DESCRIPTION OF WORK BATH TUB FURNACE H SHOWER DISHWASHER 0 LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAM[ WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER GAB SODA FOUNTAIN GAS PIPING OUTL GAS VENT f CESSPOOL TOTAL NUMBER OF FIXTURES _ SEPTIC TANK CESSPOOI aEPTIC TANK _ SEWER I I UTILITY CO.NOTIFIED TOTAL FEE FINAL 7GA667 17 6-49® APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING 1 COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO. PLUMBER RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS BUILDING CITY TEL. NO. I ADDRESS COUNTY LOCALITY LICENSE NO. EXPIRES NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET (TOILET) @ 0.50 $ ADDRESS t` BATH TUB @ 0.50 CITY TEL. NO. va 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 bCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING. J�gt 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. / AS SYSTEM OUTLETS @ 0.50 SIGNATURE OF 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 URINAL @ 0.50 ,,,I HOUSE SEWER @ 0.50 I Q Z MISCELLANEOUS 0 it O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING CGAS PIPING GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK I DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT . I 1.00 GAS TEST UTILITY CO. NOTIFIED TOTAL FEE I $ FINAL =T,'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT Ft hereby affiPrn that I have a certificate of consent to self 76A667A Insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy tt�h��erre�eof (Sec. 3900, Lab. C.) COUNTY OF LOS/ANGELES BUILDING AND SAFETY ec�Nd?�1_Company rte~ ❑ Certified copy Is hereby furnished. FOR BUILDING Certified copy Is filed with the county b Ildlnp Inspec- sM TO FILL IN(PRINT OR TYPE) ADDRESS r7 Hon department. NUMBR FIXTURE OR rrEM 0 FEE Ly LOCALITY DateApplicant d WATER aOSET NEAREST a.-L 4'C_ CERTIFICATE OF EXEMPT" FROM WORKERS' d BATH TUB CROSS ST. COMPENSATION I URAfJ4�E (Thissection need not be corrsplefed III the work In"hred bMAIL ery SHCrASR AIL 1 1 the pmlt Is for one hundred dollars (=100)or less.) LAVATORY ADDRESSM I certify that In the performance of the work for which this permit Is Issued, I shall not employ any person In any manner t SINK CITY TELNo-qqs6qjo so as to become subled to the Workers Compensation Laws. DISHWASHER CCNJTRACTCKt KVL 44_ S PJ AtA- Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: if, after making this Certificate of ADDREss31S E f4cwtiloc--t Dik- Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY I Ar TEL �q7q tql with comply with such provisions or this-permit shall be STATE L1616,-4 UG deemed revoked. WATER HEATER L1CBdSE tJO. / CLASS LICENSED CONTRACTORS DECLARATION 6 00DISTRICT NO. ID BY I bereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 51 oY (cpmmercing with Section 7000) of Division 3 of the Business OUTLETS OVER d and Professions Code,and my license is In full force and effect. s PER SYSTEM FINAL DATE V LIDATION u License ,�N,u�mybar (�1 Ic. Class Con actr }orr"s'L9 Yl`� FI 0 e BY r ❑ I am exempt under Sec. % i B.BP.C. for this reason Plan check fee ;R40Q2A Date: FEE PERMIT ISSUING E i # o o,o o o 5 Signature TOTAL FTE A o o 4 Q 5 0 Plan check applicant SINGLE FAMILY o 0 0 4 Q 5 06 HOME OWNER-BUILDER DECLARATION NameKJ�EA ffS kj —ACI—T- I hereby affirm that I am exempt from the ContractorsLlcense Address p 22.1 —86 Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ 1, as owner of the property, will do the work and the structure Is not Intended or offered for sale (Section ' 70;", 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.). Lenders Name A/n certify that I have read this application and state that the , bove Information Is correct. I agree to comply with all County xdinan as and State laws regulating Plumbing, and hereby iuthorl raprosentntivei of this County to enter upon the boyo- ntloned property or nspecilon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Ignatu of Permittee Date WORKER'S COMPENaATION DECLARATION 2606f?E DPW Wag hereby affirm that I have a oortlTloate of consent to sell Insure, '°"°°'" APPL ATION FOR PLUMBING PERMIT LLJJ or a oertMoate of Workers Compensation InsursnUfl os, or a oered t Copy thof ere (Sea 3800 Lab.C.) Poeoy -��Company ��' �r� COUNTY OF LOS ANGELW DEPT.,OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. ❑ Ce'dw--Py is, hereby hsrtSshed FOR APPLJCAtI f TO F11 IN(PfiNT OR TYPq BU1LDl1(j ADDRESS ❑ {{ b Mid with the county buri�p V01500000 FOR ENURE OR FIN FEE LOCALITY Data 1U-♦-9 Appi{oa. lb.0 p�(�C!�� WATER CLOSET NEARr Br cRoa3 er. CERTIRCATE OF E)MMPTiON FROM WORKERS' BATH TUB COMPENSATION INSURANCE ASSESSOR (Phis Motion need not be oompletpd H the work lnrolvsd by the SHCwER NAP BOOK _ PAGE PARC✓3 permtt is for one hundred dollar(1100)or lees.) Ow"ER Uf�- I oerUty that In the performenoe of the work for whloh this permit LAVATORY LLAXL Is Issued, I shell not employ any pension In any manner so as to SCK ADDD RESS f✓ beoome subject to the Workers'Compensation Lawil. v' �Q DISWASHEA CITY 0'jv/r TEL NO. C Date Appl]oa" CLOTHES WASHER CONTRACTOR IU NOTICE TO APPLICANT: If, after making this Certlfloate of Exemption,you should beoome sub)"to the Worker'r;ompensatkm SWIMUM POOL RECEPTOR 1 provlslons of the Labor Code, you must forthwith cgmply with suoh ADDRESS YQ 'On i provlelor or this permit shall be deemed revoked. LAWN SPRVpQ�l 8YSTEY' LKXN$E1)CONTRACTORS DECLARAT)ON WATER HEATER CITY p TEL,NO. L&)I hereby affirm th7JOU a (com enoing wfth�tSectionI am lll ; of ed underprovisions 3 ofithe Buslne"' 'and STATE / LIC. Professions Code,and my Ilpense t•In full fence and sifeoL QAS SYSTt31 OUTLETS LYCE7�78E NO. (p CLASS �� (i'� Q' OUTLETS OVER DlSTFdCT NO/'},� PROCESSED BY License Number � 0 � Lk,Class - -3�r E PER SYSTEM �!/l✓ RNAL Contr,dorS ,�VA1 61/l t7rf�Ost. In—_3 - FINAL _ ❑ i am exempt wider 84 BY I ITEMS - — & P.C.br titre reason TOTAL 42 - 60 Date. Plan check fee I PLUMBING PEAMrr MMINo FEE S C$EC:r, ' 42.60 I{ TOTAL FEE a G ❑ Pian dwa appkam , SMLE FAWLY HOME OW NCR-BUILDER DECLAFIATiON Name 4/ 6/95 I hereby affirm that I am exempt from the Contractor's Lloen" Law for the following reason (Section 7031.5. Business and Profsesbna Address 9rs14 I Am u: Code). Tel.Na ❑ I, as owner of the Property,*ill do the work laid the structure Is not Intended or offered for sale (Section 7044,Business and Professions Code). , CONSTRUCTION LENDING AGENCY I hereby affirm that there to e constntotlon lendl6g agency for the performanoe of the work for which this permit is Issued(Seo. 3097, Civ.C.) Lenders Name Larders Address I ow"that I have read this applloation and state that the above , Inforn4ffloh to gptreot I agree to oomply with all County ordlnsnoee and Stets laws regulating Plumbing, and hereby authorize, representatives of this County to enter upon the above-mantloned property for I p SEE FEVMiSE FOR EICPLANATORY t ANO lA13E 8 reof DW y