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HomeMy Public PortalAbout9123, 9123 1/2, 9125, 9125 1/2 LAS TUNAS DR_Plumbing__ r 76A667A" CSFI 17(REV.6/78) - C�J j APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS-ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGf of / NUMBER FIXTURE OR ITEM @ FEE ADDRESS /D( LOCALITY. WATER CLOSET NEAREST BATHTUB CROSS ST. SHOWER OWNERMAIL p y a LAVATORY ADDRESS �1>]f SINK CITY L� G_`* TEL.NO.'.� DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING.POOL RECEPTOR �j CITY -" ', TEL.NO.2 LAWN SPRINKLER SYSTEM STATE' �^ LIC. WATER HEATER ' LICENSE NO. r � CLASS GAS SYSTEM OUTLETS z e� APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING } GAS PIPING O GAS VENT V OC HOT WATER HEATER C PLUMBING FIXTURES GAS TEST 7 c N Platt Check fee UTILITY CO.NOTIFIED 0 _z PLUMBING PERMIT ISSUING FEE$ Lt Z TOTAL FEE zG� co FINAL Plan check applicant PLAN CHECK VALIDATION Name Address . .� 2—-2_5 City Tel.No. 1 HEREBY ACKNOWLEDGE THAT I.HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 2 ( 1 1. / A I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE #�e © 0 ® O 5 LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL - PROPERTY. �^ Z ® ® 1 000 SIGNATURE +9s^o 0000 0 0 0 OF PERMITTEE !!!/// ly t — ll Ll DISTRICT NO. PR ESSED BY 10.09-79 r� _ INDUSTRIAL WASTE APPROVAL I �6A667 (CE-817) - 175 APPLICATION F PLUMBING PERMIT {� JI COUNTY OF LOS ANGELES u DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING ADDRESS 9123 E. Las Tunas Drive HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY Temple Cit FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST Rosemead Blvd. NUMBER FIXTURE OR ITEM @ FEE� CROSS ST.OWNER John Ricci WATER CLOSET 2.00 MAIL BATH TUB 2.00 ADDRESS 9123 E. Las Tunas Drive 1 SHOWER 2.00 QU CITY Temple City TEL. NO.285-3224 LAVATORY 2.00 CONTRACTOR Johnny•s Plumbing Service SINK - 2.00 ADDRESS, 9123 E.' Las Tunas Drive DISHWASHER 2.00 CITY Temple City TEL. NO. 285-3224 CLOTHES WASHER 2.00 STATEr7 ry LIC LICENSE NO. 2(9681 CLASS C-36 SWIMMING POOL RECEPTOR 2.00 DISTRICT NO.GROUP ZONE CESSED B LAWN SPRINKLER SYSTEM 2,00 WATER HEATER 2.00 INDUSTRIAL WASTE APPROVAL a GAS SYSTEM OUTLETS 2.00INSPECTION RECORD V OUTLETS OVER 30 O 5 PER SYSTEM F— v W CIL_ y Z Plan check fee See Reverse PLUMBINGPERMITISSUING FEE $ TOTAL FEE APPROVALS D A jEQ, INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Kf Name ROUGH PLUMBING �� t9 Address GAS PIPING City Tel. No. GAS VENT v HOT WATER HEATER (� "h 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 GAS TEST PLUMBING. ' 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 1 AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE SCRIBED RESIDENTIAL PROPERTY. FINAL , SIGNATU RE ,- OF PERMITTEE PERMIT VALIDATION CK. M,O: CASH PLAN CHECK V4/(DATION CK. M.O. CASH' s s- - ;5 .a 7.5 p 76 A 6.67—CE 817 8/68 APPLICATION FOR PLUMBI G PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE WATER CLOSET 1.50 OWNER L 16 MAIL BATH TUB 1.50 ADDRESS SHOWER 1.50 CITY TEL. NO. LAVATORY 1.50 CONTRACTO > SINK 1.50 ADDRESS ` DISHWASHER 1.50 Ci- CLOTHES I TE CLOTHES WASHER 1.50 STATE � `�,G LIC LICENS NO. Y CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NQ-r--7GROUP ZONE P O Y off.. LAWN SPRINKLER SYSTEM 2.00 � /7 V WATER HEATER 1.50 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD V W OUTLETS OVER .3G N 5PER SYSTEM Z Plan check lee 2S% of above. See reverse. PLUMBING PERMIT ISSUING FEE 8 2 00 IOTAL FEE: 3,0 APPROVALS DATE INSPECTOR'S SIGNATURE Plan Check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel. No. HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST - PLUMBING. 1 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 INT E TO G RESIDE IN,THE ABOVE DESCRIBED RESIDENTI PPERTY. FINAL SIGNATUREJACK R. ALLEN, SUPERVISI.N GHANICAL ENG'R. OF PERMITTE �" PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. C SH f APPLICATION FOR PLUMBING PERMIT 76A887 � CE 817"B BUILDING AND SAFETY DMSION Department of County Engineer County of Los Angeles BUILDING / JOHN A. L.AMBIE,COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN,.SUPT OF BUILDING LOCALITY FOR APPLICAPIT TO FILL IN I NEAREST CROSS ST. t OWNER DISTRICT NO. GROU ZONE I READY FOR INSPECTION MAIL �f•� ADDRESS L. f INDUSTRIAL CITY TEI.. /1 WASTE APPROVAL PLUMBE . C-:r INSPECTION RECORD ADDRESS CITY / 7'6�C..7�b�+� Z 7/y LICENSE NO. AO (f NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 $ BATH TUB @ $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ $1.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ $1.00 WATER HEATER @ $1.00 GAS SYSTEM @ $1.00 APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUMBING S 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 FIXTURES PLUMBING. 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 0 THE AB t UTILITY CO.NOTIFIED DESCRIBED RESIDENTIAL PROPERTY. _� SIGNATURE OF PERMITTEE - FINAL .-�°' - C"}', ROBERTA.WOOD, JOHN A. LAMBIE,COUNTY ENGINEER V LIDATION SUPERVISING MECHANICAL ENG'R CK. M.O. CASH 76•A887.i,(CE817A) - 8/75 • Y`f' APPLICATION OR PLUMBING PERMIT • COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION n l -•MAKE CHECKS PAYABLE TO: FB RESS d � S sO .HARVEY T. BRANDT, COUNTY ENGINEER ALITYCFOR APPLICANT TO FILL IN (PRINT OR TYPE) RESTSS ST. (� NUMBER FIXTURE OR ITEM @ FEE Jd ,GC / WATER CLOSET OWNER MAIL BATH TUB ADDRESS >14 SHOWER CITY TEL. NO. 3 LAVATORY CONTRACTOR nJ ru SINK —' ADDRESS DISHWASHER CITY CLOTHES WASHER STATE LIC SWIMMING POOL RECEPTOR LICENSE NO. CLASS DISTRICT NO. GROUP ,�DN ESSE BY LAWN SPRINKLER SYSTEM G 6 t WATER HEATER INDUSTRIAL' WASTE APPROVAL GAS SYSTEM OUTLETS INSPECTION RECORD d OUTLETS OVER V 5 PER SYSTEM '06 ;�(;aa2 A u Lu tn V1 z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ TOTAL FEE APPROVALS DATE INSPE'CTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Nagle ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT �+ HOT WATER HEATER 1 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 1 �� LICENSED AS REQUIRED BY LOS A GELES COUNTY AND STATE OF CALIFORNIA OR THAT,1 AM THE L AL OWNER , AND INTEND TOr....- RESIDE IN THE ABOVE DE BED (DENTIA R PERTY. , FINAL J SIGNATURE '1PERMITTEE PERMIT VALIDATION cK. M.0. CASH PLAN CHECK VA D TION CK. M.O. CASH L WORKERS' COMPENSATION DECLARATION 20-0026-DPW 4/87 APPLICATION FOR PLUMBING PERMIT 1'Fcre oiff!rm-that I hWAc Ytertificate-of consent to self in- n s�tc o•certifican te of Workers'Compesation Insurance,or a CE 817(REV. 8/86) " certi ,Pd'copy,thereof.,(Sec. 3800, Lob C.) Pa COUNTY Company COUNTY,OF LOS ANGELES DEPT. OF PUBLIC WORKS Certif,.d copy'is hereby,furnished. , FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / Certified copy is filed with the county building inspection ADDRESS NUMBER FIXTURE OR,ITEM., @ 'department. FEE LOCALITY. D = WATER CLOSET(TOILET) ate Applicant NEAREST CERTIFICATE OF EXEMPTION FROM-WORKERS' BATH TUB CROSS SL ' COMPENSATION INSURANCE' SOWNER HOWER, Yt/ C C- ` (This•section need not be completed if the work involvedby MAIL the permit-is for one hundred dollars ($100)or less.) LAVATORY ADDRESS C I certify that imthe performance of the'work for which this per= .S CITY T N " ' ,, mit is issued, I'shdll not employ any-person in any manner so 1�/7 v v as to become subject to the Workers' Cmp nsati Laws. DISHWASHER CONTRACTOR Date r APPlicani / CLOTHES WASHER ADDRESS NOTICE.TO APPLICANT: If,,afterok' g this Certificate of Ex- SWIMMING POOL RECEPTOR empiion,'you should become subj to the Workers'Compen- CIT TEL. NO. sation pro-visions of•the Labor Code, you must forthwith comp- LAWN'SPRINKLER SYSTEM ly with,such provisions or this permit sholl.be deemed-revok- STATE UC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS-DECLARATION DISTRICT NO.- OCESSED.BY . I`hereby affirm than am licensed under provisions of Chapter . GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division'3 of the-Business OUTLETS OVER }. PER.SYSTEM and Professions Code,.and my license is in full force and ef- 5 FINAL VALIDATIO >- fect. DATE d License Nu ber Lic. Class FINAL V fr Contractor ate ^ .�J� BY p. i V I a exempt.uf der Sec. aW B.&P.C. for this real Plan che&iee Z' Dat l. .. ► _ PLUMBING PERMIT ISSUING FEE$ Signature - TOTAL FEE .. GLE FAMILY r HOMEJN R-BUILDER DECLARATION. Plan.check applicant I hereby affirm th,t I a exempt from the Contractor's License -Name.- ssZ Q Law for the folio i reason (Section-7031.5; Busineand _ s es Professions.Code); Address 330 22.50' I, as owner of the property, willdo the work and the City Tel. No. structure is not intended or offered for sale(Sectio_n 7044, 1 TE Business and Professions Code). TOAL 22 50 a 'CONSTRUCTION LENDING AGENCY [I } e5 1 hereby affirm that there is.d construction lending agency for the performance of the work for which this permit is issued CHAN 0130 (Sec. 3097"Civ. C.). FJ q' e_� G.] 3> ':J3 Le'nder's Name jlil'€�C1 789 1 r-- I-- Lender's Address .323 1 v 2 I certify that.I have read 'this application.and state that the above information is torr ct. I agree to comply with aIl,County r-+ ordinances and State, regulating Plumbing, and hereby authorize p sento rve of thi unty,to-enter yon the above-me do a pr pe ty'for 'ns ction'p6rposes. `� SEE REVij�S�FOR ;KPLANATORY LANGUAGE Signatur f Permittee Date ! �Ly- r n �7 WORKERS'COMPENSATION DECLARATION APPLICATIQN FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 L� it stye, or a certificate of Workers' Compensation Insurance, 76A667A U or a certified copy thereaf (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. 17FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS J tion department.. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant LIZ WATER CLOSET / NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCEJ (This section need not be completed if the work involved by SHOWER OWNER the permit is for one hundred dollars $100 or less. / AIL P ( LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY O. so so as to become subject to the Workers'Compensation Laws. DISHWASHER 4 CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION r DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS J �� �j L%�E (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER f and Professions Code,and my license is in full force and effect. PER SYSTEM FINAL VALIDATION phi / DATE._,3_7 O. License Number Lic. Class U FINAL Contractor Date BY ❑ I am exempt under Sec: V� B.BP.C. for this reason Plan check fee N Date: PLUMBING PERMIT ISSUING FEE$ J Signature T1 TOTAL FEE gg e,- Plan Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name '"`-tr' =7 I hereby affirm that I am exempt from the Contractor's License i V1, r the following reason (Section 7031.5, Business and Address ---. ions Code): Cit Tel. No. i Y 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 i API _ 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 represent ives of this County to enter upon the abov m ntioned r perty f n ection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Sig at re of Permittee Date WOR;<ERS'.COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I hgve a.certificate of consent,to self 20-0026 DPW 6/87 °, insure, or a certificate of Workers' Compensation Insrance, 764667A 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. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ' n y, Certified copy is filed with the county building inspec- ADDRESS ,Jr -4/A �7 >`f tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY �'�Pt Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS S7. COMPENSATION INSURANCE OWNER J� SHOWER (This section need not be completed if the work involved by MAIL f the permit is for one hundred dollars($100)or less.) I LAVATORY U ADDRESS 9L 3 S I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner, SINK CITY TEL. so as to become subject to the Workers'Compensation Laws. DISHWASHERA, �' L c� CONTRACTOR /v /) Date Applicant CLOTHES WASHER ADDRESS S NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE ? "� LIC. deemed revoked. WATER HEATER LICENSE N , CLASS LICENSED CONTRACTORS DECLARATION TRIC?NO. PROCE _BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL V LID a 5� DATE Q, License Number � Lic. Class U. / i �" FINAL Contractor ate� BY � O. ❑ I a exem t nder Sec. W B.BP.C. for this reason 0' Plan check fee �te: r}'� Z PLUMBING PERMIT ISSUING FEE$ V Signature �`� TOTAL FEE c 5 150 Plan check applicant c SINGLE FAMILY - HOME OWNER-BUILDER DECLARATION Name q T .s. C7�.•`t•s c 9' I hereby affirm that I am exempt from the Contractor's License Address - c 1 Law for the following reason (Section 7031.5, Business and •_I ! 3t,.ti, Professions Code): City Tel. No. ._ ❑ I, as owner of the property, will do the work and the I 1 LEMS structure is not intended or offered for sale (Section , TOTAL 35 -50 7044, Business and Professions Code). CHECK 35.50 CONSTRUCTION LENDING AGENCY f �� �.� I hereby affirm that there is a construction lending agency for CHANGE of 0 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name il!I0th_10101 5/ �I/ 0 Lender's Address I)+ 9 1 1 f f'`� 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-n5"ntion property r spZction purpos SEE REVERSE FOR EXPLANATORY LANGUAGE 1. 16 ' S1,�o Signatur� Permittee V Doke WORKERS'COMPENSATION DECLARATION LUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A667ADPW 4/90 APPLICATION FOR P sure,or a certificate of Workers'Compensation Insurance,or a y n certified copy thereof (Sec. 3800, Lab. C.) U Policy No. Company - COUNTY.OF LOS ANGELES DEPT. OF PUBLIC WORKS ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ❑ Certified copy is filed with the county building inspection ADDRESS /ql lir 6i ,,i __z S department. NUMBER FIXTURE OR ITEM, @ FEE LOCALITY ,a Date Applicant WATER CLOSET(TOILET) CERTIFICATE OF EXEMPTION FROM WORKERSBATH TUB 'CROSS S7. . COMPENSATION INSURANCE SHOWER OWNER Z-� (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL. NO. mit is issued, I shall not employ any person in any manner so' as to become subject to the Workers'Compensation Laws. DISHWASHER //� l� t / CONTRACTOR /�Jrw Date��� s, '� � A AZ Applicant✓_ CLOTHES WASHER ADDRESS 1 L NOTICE TO APPLICANT: If, after making' s Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject tot a Workers'Compern CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS �L fW A ly with such'provisions or this permit shall be deemed revok- STATE rte, / �/ LIC. ed. WATER HEATER LICENSE NO. y C f1 CLASS LICENSED CONTRACTORS DECLARATIONDISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 49 9(commencing with Section 7000).of Division 3 o the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL 'O VALIDATION fect. HOSE BIB.' DATE License Number Lic. Class �� a FINAL 0. Contractor Date d - ! -� BYU * ACCT. it ❑ .I am exempt under Sec: 3303 43.44 t B.BP.C. for this reason Plan check feepop. y Date: PLUMBING PERMIT ISSUING FEE$ 3� Z Signature • TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant 1 ITS I hereby affirm that I am exempt from the Contractor's License Name � �t TOTAL '�-.S�' Law for the following reason (Section 7031.5, Business and Professions Code): Address P ❑ I, as owner of the property, will do the work and the City -t Tel. No. CHECK 43.40 structure is not intended or offered for sale(Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY , GME 400 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.). 0000-0001 Lender's Name 8/22/95 Lender's Address 1941 I certify that I have read this application and.state that the 1 AM 9:19 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 property for inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE nety�f Permittee —�-�=-. :Date