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HomeMy Public PortalAbout9406 LAS TUNAS DR_Plumbing__ D.B.BriF/ 25M BETS 11-46 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERS COUNTY OF LOS ANGELES PLUMBING WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE - PERMIT-W. . - ROUGH FIXTURES COMPLETE _ HEATER CESSPOOL -+SEPTIC TANK RECEIVED BY READY FOR FIRST INSPECTION DATEISSUEDAS. MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION.ONLY 9 NAME M.1 C. NOTTINGHAM CO. ADDRESS ADDRESS 123 NO. Clovexly Ave. LOCALITY TEMPLE CITTL KALIF. �Ro 8 CITY ST d COUNTY L res CERT.No. EXPIRES �C. .NAME. - LOCATION OF SEPTIC TANK, OR CESSPOOL / Z MAIL .q r 3 ADDRESS ��0 dO NORTH O i v CITY X�i.. t,.c,t' -TEL.No. - I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED - - ABOVE. ►� a 3 OWNER i CORRECTIONS SOUTH - J DESCRIPTION OF WORK a z BATH TUB FURNACE E9 Q' - SHOWER DISHWASHER � _ D 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 I IROUGH PLUMI$ING I; METER GA9 SODA FOUNTAIN GAS PIPING OUTL .. _ GAS-VENT I- I . l'•. (,� -n`/�,�,/�,I�. - CESSPOOL - TOTAL NUMBER OF FIXTURES SEPTIC TANK I iI CESSPOOI SEPTIC TANK SEWER G� UTILITY CO.NOTIFIED �+f I TOTAL FEE L /� FINAL 76A667-CE#817 2-66 APPLICATION FOR PLUMeING PERMI COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION rNEAREST LDING JOHN A. LAMBIE, COUNTY ENGINEER DRESS v/�V COLEMAN W. JENKINS. SUPT. OF BUILDING CALITY r Le FOR APPLICANT TO FILL IN CRCOSS T. NUMBER FIXTURE OR ITEM EACH FEE OWNER ' WATER CLOSET 31.2S MAIL c� BATH TUB 1.25 ADDRESS lam, CITY �� TEL. NO fp zSQj SHOWER 1.25 LAVATORY 1.25 \ CONTRACTORS'-� L M B i r✓ SINK 1.25 J ADDRESS DISHWASHER 1.25 CI � TEL. NO LAUNDRY TUB 1.25 STATE LIC LICENSE NO. CLASS CLOTHES WASHER 1.25 DISTRICT NO. GROUP Z NE PRO /D BY WATER HEATER 1.50 `v _2 �� GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL _ 1 ��(? O OUTLETS OVER 5 PER SYSTEM .30 SPECTION aCORD U O H U W d �• ©O APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK Q OUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION' GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS A ES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LE AL IN OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBEDSID NTI PROPERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE FINAL I-.4-6/ VALIDATION JACK R. ALLEN CK. M.0. CASH SUPERVISING MECHANICAL ENG-R. l.i-'t`t:;O 0 7 2 3 SEP 1 5 D 13,00- I 76,A667.CE4817. '4-64 ,••/!7 %' `./�.• , •✓ APPLICATION FOR PLUMBING PERMIT . COUNTY OF .LOS ANGELES DEPARTMENT OF COUNTY ENGINEER - BUILDING AND SAFETY DIVISION BUILDING -� JOHN A.,LAMBIE, COUNTY ENGINEER ADDRESS WILLIAM A. JENSEN,-.SUP'T OF BUILDING - - .�- - LOCALITY — FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR,ITEM EACH FEE OWNER WATER CLOSET S1.2S MAIL BATH TUB 1.25 ADDRESS CITY TEL. NO. SHOWER, 1.25 LAVATORY- 1.25 CONTRACTOR SINg 1.25 jADMSSYf n DISHWASHER 1.25 CI L y L L�i-L -� I TEL.r, STAtE N LAUNDRY TUB 1.25 REGIS RATIIO O. �% COUNTY .❑ CLOTHES WASHER 125 _DISTRICT NO. GROUP ZONE PRO BY WATER HEATER 1.50 ; io g GAS SYSTEM OUTLETS 1'� INDUSTRIAL p} WASTE APPROVAL 0 OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V - m ' O H w a `APPROVALS DATE - INSPECTOR'S SIGNATURE . PERMIT $ 2' 00 UNDER SLAB WORK ROUGH PLUMBING ' TOTAL FEE' GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS .APPLICATION GAS"VENT AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY- WITH OMPLY WITH ALL COUNTY ORDINANCES AND, STATE LAWS REGULATING ,HOT WATER HEATER PLUMBING. - - I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING,FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER.OF,AND INTEND'TO GAS TEST - " �✓, # o RESIDE IN, THE ABOVE DESCRIBED IDENTIAL PROPERTY. ., - .UTILITY CO.,,NOTIFIED- - ,SIGNATURE OF PERMITTEE - FINAL �-- 7✓G VALIDAT ROBERT A. WOOD CK. M.O cA5H SUPERVISING MECHANICAL ENG'R y 9-G=6I.� G 2 5: fl 3 5, O M. 76AB67 DBS 17 „-SD APPLICATION FOR PERMIT DEPARTMENT OF' BUILDING AND SAFETY; COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEr-ENGINEER DISTRICT .O. O • FOR"APPLICANT TO- FILL IN ( 7 04)p f - READY .. . J. PLUMBS - i RECEI D BY � DATE ISSUED -. - _' , FIRST INLq@ECT( N /.,,,,•y.y Z ADDREB - Lam ..�� as BUILDIN13 {.. - ' CITY TENoy. ,�� ADDRESSQ.�'G�/-7U TU/" S . - Y CO �.. NTY ,/ ��LOCALITY ' r �.�L1.... LICENSE NO. I! t - EXPIRES """ ®-� - PERMIT FEES NEAREST 'i CROSS`BT. NUMBER TYPE OFFIXTURE OR ITEM. FEE OWNER LTF.^�-f�/ rM,/��`�® ` 9 .MAIL 6 �o.J i:T"tt=/7p,_). WATER CLOSET(TOILET) (� 0.50, $ , ADDRESS - - BATH TUB 0.50 - CITY T.EL. No. BHOWER @ 0:50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS' LAVATORY (WASH BA91N). @ 0.50 ' APPLICATION AND STATE THAT THE-ABOVE IS CORRECT, AND AGREE TO COMPLY WITH ALL'COUNTY ORDINANCES KITCHEN SINK - @ 0.50 AND STATE LAWSREGULATING PLUMBING. _ I CERTIFY THAT 1 " SSESS THE ABOVE VALID LOB - _ LAUNDRY TUB OR TRAY .50 - ANGELES COUNTY'LID€NSE,.GR, I-AM THE LEEpAL'OWNER. OF THE RESIDENTIAL+ RO RTY DE C IBE -ABOV GAS SYSTEM OUTLETS @ 0.50 ". SIGNATURE OF - WATER HEATER @ 0.50 PERMITTE _ JJ1"'�+�_ BLOP SINK @ 0.50 F INSPECTION RECORD. FLOOR SINK @ 0.50 FLOOR. DRAIN @ 0.50 - DISHWASHER O.BO DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 J HOUSE SEWER _Z MISCELLANEOUS ! 3 APPROVALS . - - DATE INBP�ECTOR/'9',TAME ! I ROUGH PLUMBING GAS PIPING GAS VENT CESBPOOL - - -@ 1:00 CESSPOOL - - SEPTIC TANK: - SEPTIC TANK- DRAIN M ) PIT M ) @ 1.00 SEWER PERMNIT I -1.00 GAS TEST A UTILITY CO.'NOTIFIED - TOTAL FEE -Is ' _ l O FINAL �✓7/Z% D.B. 77 25M SETS 72-43 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING 7 COUNTY OF IAS ANGELES WM.J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH FIXTURESCOMPLETE RECEIVED BY READY FOR DATE ISSUED HEATER CESSPOOL -I SEPTIC TANK FIRST INSPECTION �f A8- MISCELLANEOUS .dl'T�1�/� ✓ Q7 APPLICANT FILL IN HEAVILY OUTLINED PORTION �ONLY �Z NAME "�. .�✓�C..2/t ADDRESS (0 e�r•�. ] 1 C,$_011�£ /l3 m ADDRESS / LOCALITY '�''� NEAREST IL CITY ��� TEL.NO. CROSS ST. COUNTY n Q CERT.No. EXPIRES W` NAME LOCATION OF SEPTIC TANK, OR CESSPOOL 2 MAIL ADDRESS NORTH O CITY TEL.No. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE-OF gUALIFI dAT ION., s PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. M1I a 3 i OWNER CORRECTIONS SOUTH .1 DESCRIPTION OF WORK z_ BATH TUBFURNACE SHOWER DISHWASHER „' 0 LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER a 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 i METER GAS SODA FOUNTAIN 6AS PIPING OUTL GAS VENT11111111111110101 I CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK CESSPOOI SEPTIC TANK l SEWER I I r / U"V UTILITY CO.NOTIFIED I I TOTAL FEEIII/ j FINAL F;L- �' APP D.B.S.17 25M SETS 12.44..- .�.. LICATION FOR PERMIT_.. - DEPARTMENT, OF BUILDING AND SAFETY COUNTY OF'LOS ANGELES PLll�A�I�IE9 �' Wm'. J.-FOX, CHIEF-ENGINEER NATURE OF 'INSTALLATION DISTRICT NO . MI GROUP ZONE" PERT NO ROUGH FIXTURES COMPLETE' _ .' -READY FOR--! ' HEATER CESSPOOL SEPTIC TANK RECEIVED BY DATE.ISSUED; FIRS -I PECTION ,r j q GA9 MISCELLANEOUS Q 'uV1 / �1' /A�fPPLICANT'_FILL INH�EAVILY' OUTLINED PORTION._O-NL'Y�j/ �. - JOB NAMEk9 - .�.f^"f -::l(. E"�.-. ADDRESS T y' F� tsW/ .'`.v' ADDRESS - L /`% ,.�.,✓ j LOCALITY // NEAREST C. -CITY ''-' r'; :TEL:'IVQ / 6► CROSSST. COUNTY- .. �"- _ CERTrNo. r - 'EXPIRE ,rw �' NAME' LOCATION OF`SEPTIC TANK, OR"GESSP'OOL z^ -MAIL - -.3: ADDRESS NORTH f/ O '.CITY 7. TEL.No. _ ' i _ • _ 1 ,AM. THE LEGAL. POSSESSOR.-OF THE ABOVE LOS. j - E CERTIF.ICATE•Q>;.QUA� NGLE9 COUNTY I IFICATION. - y+A // • / f PLUMBER i - - t AM THE LEGAL�OWNER OF`THEPROPERT.Y D SZRIBED ABOVE. .OWNER { �, ORR f,CTIONS • " - -'.SOUTH._ ., [ - - - -_ _ - DESCRIPTION OF WORK BATH TUB' - ` ^FURNACE.. -� ,DISHWASHER- - - - - . O' ,• LAVATORY,. �REFRIGERATOR - - KITCHEN SINK 'WATER SOFTENER••` .. .. FLOO R,SINKQ AND,T.RAP •SLOP SINK- . • 'FLOOR DRAIN:- WASH TRAY , URINAL- `.•..' APPROVALS WATER CLOSET - DRINKING,FOUNTAIN - ,DATE - IPISPECTOR s.IigMe - WATER HE ER -• DENTAL LAVATORY . I L..� d, _! --t: �•I \,ff�Il ,lj ROUGH PLUMBING �CiT � F METEF�UTL _GAS1RODA FOUNTAIN GAS�•PIPIN6 .• i. ��� `�."I. GAS V ENT ,- -" USE= CESSPOOL i_ _CTO:*i,LPL��ou MBER OFFIXTUREB .. V`" SEPTIC•TANK '. .�- SEPTIC TANK - SEWER ' 8' TOTAL FEE UTILITY CO.NOTIFIED I - - I •. FINAL g�j D.S. 17 2 S SETS 12743 l - ]DEPARTMENT OF BUILDING AND SAFETY.' APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM.J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE P iNIT NO. ROUGH FIXTURES-,--.— COMPLETE 1 HEATER CESSPOOL I —I SEPTIC TANK R E (/VED B READY FOR DATE ISSUED _! t FIRST INSPECTION L _. AS .:. MIBCELLANEOU$ .�I f�- ,,.�... .6 41 -(t V APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLYJOB ' NAME ] ...� y 't, t p�h �,•I,7 ADDRESS W G gADDRES8 ALITY p J NEAREST - �• Ay�,rs g IItTY- TEL.NO. s �'� CROSS ST. COUNTY / f dYl G� ,,y CERT.No. EXPIRESL! 101 C NAME file / - LOCATION OF SEPTIC TANK, OR CESSPOOL! 3. MAIL ADDRESS NORTH O CITY-. TEL.NO. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. . 7 PLOMBER� I AM THE LEGAL OWNER OFTHE PROPERTY DESCRIBED ABOVE. v OWNER CORRECTIONS 1 SOUTH .J DESCRIPTION OF WORD " Z BATH TUB FURNACE SHOWER DISHWASHER ; Q ^.f LAVATORY REFRIGERATOR . KITCHEN SINK WATER SOFTENER, FLOOR SINK SAND TRAP E .SLOP SINK FLOOR_DRAIN { 1 " WASH TRAY URINAL ;{• APPROVALS WATER CLOSET - DRINKING FOUNTAIN DATE' INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY J ROUGH.PLUMBING METER—GAS -------SODA FOUNTAIN �I GAS PIPING ) L ' GAS VENT'.. CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK w CESBPOOI SEPTICTANKSEWER UTILITY CO.NOTIFIED If TOTAL. FEE a ¢C i. FINAL D.B.S.-17 25M SETS 12-45 'DEPARTMENT FOR PERMIT •DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH FIXTURES i COMPLETE HEATER CESSPOOL !) SEPTICTANK REE6VE�D/yB�Y READY FOR DATEISSUED FIRST INSPECTION /• GAS MISCELLANEOUS APPLICANT , L IN HEAVILY OUTLINED PORTION ONLY JOB CG NAME _.. .. . . .ADDRESS f �.✓ Y'IIYIa� �....M ._ m ADDRESS LOCALITY �d O • NEAREST a CITY �, TEL.No. - CROSS ST. COUNTY r- -- .-CERT.No. EXPIRES � W• NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL 3 ADDRESS NORTH O CITY TEL.NO. I AM THE LEGAL POSSESSOR OF THErABOVE LOS ' - ANGELES COUNTY CERTIF .E. F�q,U4 LIFfdATION. I, • - �+�` PLUMBER ' I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. i OWNER CORRECTIONS SOUTH Q DESCRIPTION OF WORK, BATH TUB FURNACE ~ SHOWER DISHWASHER LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTfiNER FLOOR SINK SAND TRAP. SLOP SINK FLOOR DRAIN WASH TRAY URINAL I APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER-- GAS •-SODA.FOUNTAW" - OUTL GAS PIPING GAS VENT .. CESSPOOL ' TOTAL NUMBER OF,FIXTUREB SEPTIC TANK' M_M CESSPOOr SEPTIC TANK SEWER $ UTILITY CO.NOTIFIED + , TOTAL FEE G 1 FINAL D.B.S.-17 25nz SETS 12-45 APPLICATION FOR PERMIT DEPARTMENT- OF BUILDING AND SAFET� COUNTY OF LOS ANGELES PLUMBING 'Wm. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH FIXTURES COMPLETE HEATER CESSPOOL —I SEPTICTANK RECEIVED BY READY FOR DATE ISSUED' �: a/CA"��. FIRST INSPECTION GAS MISCELLANEOUS V4 APPLICANT FILL IN�1 HEAVILY OUTLINED. PORTION ONLY JOBT E Fe NAME /� (�/�'] 1 J�/2t ADDRESS "! (J • S /{.I�f�•- ADDRESS 2 :1—' ��_C fi11�1,C� LOCALITY- P A J J� / NEAREST n� L CITY /[/�. r ( `� TEL.-No. CROSS ST. /V• COUNTY CERT.No. ® EXPIRES '^�0^.r m NAME LOCATION OF SEPTIC TANK, OR CESSPOOL 2 MAIL 3 ADDRESS NORTH - O - CITY TEL.No. 1 AM THE -LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE F QUALIwFICATIO, N�—� • �LU 6QR/R 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. - M> a a OWNER i CORRECTIONS SOUTH a DESCRIPTION OF.WORE yp� PATH TUB FURNACE V� M SHOWER DISHWASHER, 0 LAVATORY REFRIGERATOR, KITCHEN SINK WATER SOFTENER —FLOOR SINK RAND TRAP LOP SINK FLOOR DRAIN ,O WASH TRAY URINAL APPROVALS WATER CLOSET _ DRINKING FOUNTAIN - - - DATE INSPECTOR'S NAIVE WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I :7i' '�t�-• METER _ GAS _ SODA FOUNTAIN OUTL GAS PIPING GAS VENT ` TCESSPO /�.../� OL TOTAL NUMBER OFFIXTURES `�+ SEPTIC TANK. CESSPOOI- SEPTIC TAN / . SEWER{ Q UTILITY CO.NOTIFIED ITOTAL FEE I FINAL x WORKERS COMPENSATION DECLARATION; •hereb ,affirm 'that L have.a certificate,of. cor sent to>self t APPLICATION FOR:PLUMING PERMIT,; Y'' ._ 76A'667A 17 p. .. nsure or,a certificate of;Workers';Com erisation.ln'surance;,,. CE 817(REV 10%81) or.a,certified'copy thereof{Sec: 3800,:Lab. C ) „,,: <s COUNTY OF=LOS APIGELES BUILDING AND SAFETY:• ,. ",Policy No: Company _ '1 _ Certrfied•copy is`.hereby furnished = FNI OR APPLICANT T% &FILL OR TYPE).. Certified copy is.filed;with The.county,buildingsnspe¢;,. ti DDRISS ' tion department, `; C - - - 'i'@ ,. NUMBER 7 FIXTURE OR ITEM FEE , SET , A E LO CALI TY •: D a tec, Applicant ",.� .. _ ,., Q OO' NEAREST ORKERS:' B, OSS'ST CESS l4{^(D�Lq ja ' W ATH TUB-. CERTIFICATEOF EXEMPTION'FRO NCE"' -� '` -' - CR COMPENSATION.INSURA r-- 'SHOWER`' OWNER L'CU�� S."v ' (This'section need."not be compieted if the.vrork involved by' ° A MAIL]: r the permit is for°one hurid'red'dolldrs.(5100)or.less:) LAVATORY ADDRESS 1 L I V 6 V C J certify that in,the perfo'rmance,of'the'work for which this ; ermit is'issued,A shall not em to nn erson in on manner ',SINK CITY, PLet TEL. NO' 'p P Y.:aYP_ Y. -1c12 s6-ds to'become`sublect to;'the Workers'Compensation Laws: DISHWASHER C ONTRACTOR Date Applicant CLOTHES WASHER y NOTICE TO APPL'ICANT:,If; after making,this Certificate of, Exemption, you should become subject^.to they Workers',' 'SWIMMING.POOL RECEPTOR ADDRESS Compensation,provisions.;of-the-Labor Code, you must forth', LAWN SPRINKLER SYSTEM TEL with ;comply with such'provisions' or: this;permit:,shall be, STATE LIC. N deemed,revoked: WATER HEATER LICENSE'NO.' CLASS O - LI CEN SED.CONTRACTORS DECLARATION DISTRLCT N "'PROLE ED BY' ' I hereby;bffirm thaf.l am;licensed under provisions of C5`apter 9 °°•GAS SYSTEM OUTLETS s ✓'.V {commenc`mg.with'Section'7000);::of;bivision;3.of the_Business. _ '- ^: _ OGUTLETS"OVER `. ,- , and Professions Code,and my,license is in{full force and effect., S PER SYSTEM FINALd! VALIDAT License;Number Lic Class %- DATE FINAL Contractor Date • _ / ) " BY I,am exempt under Sec. LU B.&P C• for this reason Plan check fee` Date r (�''PLUMBING PERMITrISSUING FEE$ 1 'Q Signature } 8 6 2A TOTAL FEE D #:o. Plan check appa licnt' n SINGLE FAMILY HOME OWNER-BUILDER.DECLARATION Name I.hereby,offirm that I am exempt from.the ContractoYs L'icens'e d.' P. • Q= :Address, Low-for.-the following reason (Section' ,B 7031.6, usiness an 0 Rrofessions Code):_ City' Tel 1 8 No. 5 I,`as owner'of,the property,;will do.t work and the , ry structure is; not' intended or offered far sale,'(Section_ j 7044Business and Professions Code), k : CONSTRUCTION"LENDING AGENCY I hereby affirm that.thereis.a construction lending agency for the- erformance of the work for"vihich`this perm f,-is issued. (Sec' 3097 Gv'C.) , Lender's Name Y n' , .Lender's Xdclress I 'certifytha -" t I have reod'this,application,:and state`that the'. above"information is correct I agree to comply with all County ordinances and Stateaaws regulating Plumbing, and:hereby. ® ' authorize,:representatives ,of this,.Countyto,enter,upon the _ dbove-ment' ed' ro 'ert"for inspection, ur poses. P P Y, p., s , SEE',REVERSE FOR,EXPLAN'ATORY LANGUAGE lift Signature Lo PermitteeDate ` :, i