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Home My Public Portal About9663-9665 LAS TUNAS DR_Plumbing__ '7ei(557 n 5-50 ® 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 I ZONE PERMIT NO. PLUMBER RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS BUILDING CITY TEL. NO. ADDRESS COUNTY LOCALITY LICENSE NO. EXPIRES NEAREST PERMIT FEES CROSS ST. NUMBER I TYPE OF FIXTURE OR ITEM FEE OWNER � � MAIL WATER CLOSET (TOILET) @ 0.50I SI ADDRESS - 1 BATH TUB @ 0.501 I CITY TEL. NO. 1 SHOWER @ 0.50 1 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 STATE LAWS REGULATING PLUMBING. KITCHEN SINK @ 0.50 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 I ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM =OUTLETS @ O.50 1 WATER HEATER @ 0.501 1 SIGNATURE OF PERMITTEE J SLOP SINK @ 0.50 1 F INSPECTION RECORD FLOOR SINK @ 0.501 FLOOR DRAIN @ 0.50'1 1. DISHWASHER @ 0.501 DRINKING FOUNTAIN @ 0.50 1 1- URINAL @ 0.501 1 „I __1 HOUSE SEWER @ 0.501 1 Q _Z MISCELLANEOUS 1 U' 1� O 1 1 APPROVALS 1 DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING 1 GAS VENT CESSPOOL @ 1.00 1 _ CESSPOOL SEPTIC TANK: I SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT . . I 1.00 GAS TEST _ UTILITY CO. NOTIFIED TOTAL FEE $ , FINAL APPLICATION FOR PERMIT IDEPARTnIEIv'i' OF BUILDING AND SAFETY PLUMBING COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICTNO. GROUP ZONE P RMI N)O. ROUGH FIXTURES COMPLETE HEATER CESSPOOL I SEPTIC TANK R. RIVED BY READY FOR , ATB ISSUED FIRST INSPECTION Y GAS- MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB a, NAME /� - ADDRESS W CC. /. } III ADDRESS ZZT-31 (� �� ..R�� LOCALITY D D "' � � NEAREST . A. _CITY TEL.No. CR069 ST. COUNTY _ -- - CERT.No. - EXPIRESNAME m LOCATION OF SEPTIC TANK, OR CESSPOOL = MAIL 3 ADDRESS NORTH 0 CITY 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. 3 OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK a z_ BATH TUB FURNACE L7 a SHOWER DISHWASHER p LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK BAND 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 I I CESSPOOL TOTAL NUMBER OF FIXTURESSEPTIC TANK CE96POOL SEPTIC TANK SEWER $ 1 G-- UTILITY CO.NOTIFIED TOTAL FEE FINAL 7eAG67 17 9-49 ® APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING 1 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE I PERMIT NO. PLUMBER RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS ADDRESSl' 1_. .- r i W CITY TEL. NO. / _ - LICENSE NO. EXPIRES COUNTY LOCALITY 1 -(' n,-1 ,� �t .4., r PERMIT FEES cRCAsss s. �' NUMBER I TYPE OF FIXTURE OR ITEM FEE OWNER a F:Ve d MAIL �' r WATER CLOSET (TOILET) @ 0.50 I$ I ADDRESS2. BATH TUB @ 0.501 I CITY TEL. NO. ISHOWER @ 0.501 I 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 I APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ 0.501 STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ O.50 I ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PRO ERTY DESCRIBED BOVE. �I GAS SYSTEM--OUTLETS @ 0.50 I SIGNATURE OF WATER HEATER @ 0.501 PERMITTEE- 1 SLOP SINK @ 0.501 I on INSP TION RECORD FLOOR SINK @ 0.50 �^ / /� _ ry I FLOOR DRAIN @ 0.501 (' 11 tl DISHWASHER @ 0.50I DRINKING FOUNTAIN @ 0.50 I `!/I"4/, rv- URINAL @ 0.so ,J HOUSESEWER @ 0.501 I Q Z 1 MISCELLANEOUS O � I APPROVALS 1 1 I DATE INSPECTOR'S NAME 1 I ROUGH PLUMBING GA3 PIPING GAS VENT CESSPOOL @ 1.001 I CESSPOOL SEPTIC TANK: 1 I SEPTIC TANK I DRAIN ( ) PIT ( ) @ 1.00 I SEWER PERMIT . . I 1.00 GAS TEST UTILITY CO. NOTIFIED TOTAL FEE FINAL TT D.B.S.17 25M SETS 12.44 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING i WM. J. FOX, CHIEF ENGINEER 9 NATURE OF INSTALLATION DISTRICT NO. GROUP I ZONE PERMIT NO. ROUGH _- XTURES COMPLETE I RECEIVED BY READY FOR DATE ISSUED HEATER __ CFIESSPOOL -I SEPTIC TANK FIRST INSPECTION _ GAS I MISCELLANEOUS � - APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB S J C NAME !f ADDRESS of .{ ;J /"'y7V �4`/r/S!% w m ADDRESS /J ��G� ILI,F e TLOCALITY J NEAREST JCITY --C TEL. No. CROSS ST. fA 1✓ a COUNTY / CERT.NO. - EXPIRES NAME b LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL t -..e3 ADDRESS •.J / NORTH O '-- I CITY / ?'" TEL.NO. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. R w (� � OWNER 1 CORRECTIONS SOUTH a DESCRIPTION OF WORD BATH TUB FURNACE SHOWER DISHWASHER LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR BINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN 11 DATE IN9PEGT0 R's NAME .�1.WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER GAS SODA FOUNTAIN OUTI GAS PIPING GAS VENT �/ / j• /� CESSPOOL TOTAL NUMBER OF FIXTURES _- �`" SEPTIC TANK CESSPOOL SEPTIC TANK SEWER I) s UTILITY CO.NOTIFIED TOTAL FEE I [,. _ FINAL____ _ D.B.S.-17 251'd SETS 12-45 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AD SAFETY ��'�� COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. F r_ ROUGH FIXTURES COMPLETE ..- / 7 y T HEATER CESSPOOL I-I SEPTIC TANKR EIVED FY READY FOR DATE ISSUED / FIRST INSPECTION / GAS MISCELLANEOUS -e- APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY C. NOTTIN'GHAM COjos K NAME ' ADDRE88 ADDRESS 123 �N o. Cioverly Ave. LOCALITYNEAREST IL CITY TEMPLE CITIIILAC161UR CROSS ST. COUNTY CERT.No. EXPIRES W NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL 3 ADDRESS NORTH 0 CITY TEL.NO. IAM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. j! PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. m � OWNER CORRECTIONS SOUTH "a d DESCRIPTION OF WORK c� BATH TUB FURNACE a SHOWER DISHWASHER 0 LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK _SAND TRAP gLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING II METER GAS SODA FOUNTAIN OUTL 6A8 PIPING GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK -CESSPOOL-------SEPTIC TANK SEWER II TOTAL FEE UTILITY CO.NOTIFIED I FINAL D.S. 17 25M SETS 12-43 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT PLUMBING 1 COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH FIXTURES COMPLETE _ READY FOR DATE ISSUED RECEIVED BY HEATER CESSPOOL SEPTIC TANK FIRST INSPECTION GAS MISCELLANEOUS APPLICANT FILL IN IIEAVILT OUTLINED PORTION ONLY NAME JOBADDRESS W m ADDRESS LOCALITY J NEAREST L CITY TEL.No. CROSS ST. COUNTY CERT.No. EXPIRESIr NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL NORTH O ADDRESS CITY 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 OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK _Z BATH TUB FURNACE C7 [Y 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 6A9 PIPING GAS VENT 1 CESSPOOL I I TOTAL NUMBER OF FIXTURES SEPTIC TANK CESSPOOL-SEPTIC TANK SEWER S TOTAL FEE UTILITY CO.NOTIFIED - FINAL 76A667-CE817.12/59 EWFIL CI 14 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY RIVISION BUILDING JOHN A. LAMBI ADDRESS COUNTY NGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST j CROSS ST. NUMBER FIXTURE OR ITEM OWNER j WATER CLOSET MAIL BATH TUB ADDRESS Q !4 CITY�� TEL. NO. SHOWER LAVATORY CONTRACTOR SINK ADDRESS DISHWASHER CITY TEL. NO CONTRAC 'S q STATE LAUNDRY TUB REGIST ION NO. / COUNTY ❑ CLOTHES WASHER DISTRICT N GROU GENE PRMSBY T,,, r WATER HEATERS GAS SYSTEM INDUSTRIAL WASTE APPROVAL q INSPECTION RECORD w VA ' h f U a 0 F U W A. N z $1.00 PER ITEM OR FDITURE $ 0 APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 7100 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP Y. UTILITY CO.NOTIFIED SIGNATURE ✓ OF PERMITTE !lL/�� d FINAL I E)F VALIDATIO ROBERT A. OC/D, CK. M.0. �.A.H' /SUPERVISING,MECHANICALENG'R i 4 1: D C 2 7 5 D !;-50- Z"/ Ir"l *-17 12.54 DAPPLICATION FOR PLUMBING PERMIT' t;�-t7 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles p WM. J. FOX, COUNTY ENGINEER BUILDING 4? G L ADDRESS ` .7 CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY ti1'+�✓ �t'' FOR APPLICANT TO FILL IN WNNEARESTCROSS S A ER ?Z' K.* DI T NO. GROUP ZONE READY FOR INSPECTION MAIL ADDRESS / ` _ � �LLtit�f4�i I c `,z- K'ZL INDUSTRIAL CITY LLL' L TEL. NO. WASTE APPROVAL PLUMBERINSlPECTION RECORD ADDRESS 2 J- �+ (f 2 . CITYTEL. N -qy J O L� - LICENSE NO.' _ NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) BATH TUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINK 'r DISHWASHER f Qg�mnvzr a_* LAUNDRY TUB OR TRAY CLOTHES WASHER I TOTAL NO. @ 0.60 APPROVALS DATE INSPECTOR'S SIGNATURE GAS SYSTEM OUTLETS @ 1.00 ��CV UNDER SLAB WORK WATER HEATER @ 1.00 i _ _ ROUGH PLUMBING _ PgRMIT S 1yy 00 _GAS PIPING TOTAL FEE I 11T•�L, _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. 1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO. NOTIFIED CALIFORNIA OR THA 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEN AL PROPERTT.Y SIGNATURE OFPERMTTE � '� - "�� -�' FINALWILLIAM J.J. FOX.COUNTY ENGINEER VALIDATION " C211W vt31 3 200 BY .� DEPUTY ® R 76A667A ICE 8178)- 1 1/76 APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUIDRESS 63LDING J• I V�r � NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET LOCALITY p L>M 0� 4 CNEAREST y BATH TUB CROSS ST. SHOWER OWNER LAVATORY MAIL ADDRESS SINK S/J,(-)MC-C) CITY TEL.NO. DISHWASHER CONTRACTOR L CA O l j� /*94 /h 6 i N G CLOTHES WASHER ADDRESS j�o �, /y j(J[j Q A 1L. SWIMMING POOL RECEPTOR n ^ CITY C`'Y 0 i - TEL.NO.j4[,j(0 7'j?V STATELAWN SPRINKLER SYSTEM --7 WATER HEATER LICENSE NO. � Z S7, CLASS � _� DISTRICT N GROUP ZONE1,�CES4SEB::, GAS SYSTEM OUTLETS r OUTLETS OVER C- � ` } 5 PER SYSTEM INDUSTRIAL 4. WASTE APPROVAL U INSPECTION RECORD OC 0 0 U W d N Z Plan check fee PLUMBING PERMIT ISSUING FEE$ v �L TOTAL FEE •D Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name _ . UNDER SLAB WORK Address ROUGH PLUMBING r City Tel.No. GAS PIPING IF I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OFPERMITTEE FINAL -L •? PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH i 0 9 4't+a`dl 10 5 11 0.5 0 Its 7f COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer PLUMBING DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer DISTRICT ND. GROUP ZON . FOR APPLICANT TO FILL IN 5. I I PLUMBER READY FOR T._ . VE13`BY FIRST INSPECTION S IED' ADDRESS / 1� �- BUILDING CITY - TEL No. ADDRESS r ' COUNTY^ LOCALITY LICENSE NO. EXPIRES NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) 0.50 s ADDRESS BATH TUB @ 0.50 CITY TEL. NO. SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) EES 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. I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY 0.50 ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SY5TE M—_OLIT LETS 0.50 SIGNATURE OF '- WATER HEATER @ 0.50 PERMITTEE SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK Q 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 "I Q HOUSE SEWER @ 0.50 _Z MISCELLANEOUS Q' O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL 1.130 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) Q 1.00 SEWER PERMIT . . 1.00 GAS TEST TOTAL FEE Is 2UTILITY CO.NOTIFIED - FINAL - 76AG67 DBS#17 10/52 COMPENSATION DECLARATION I APPLICATION FOR PLUMBING PERMIT I ereby, affir.m 20-0026 DPW 4/87 that I have a certificate of consent to self in- sure,ora certificate of Workers'Compensation Insurance,ora CE 817(REV.8/86) 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 ,� Certified copy is filed with the ` •county building inspection ADDRESS } department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER sw. (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS �jQ ,fe I certify that in the performance of the work for which this perol - mSINKit is issued, I shall not employ any person in any manner so CITY f TEL. NO. � as to become subject to the Workers'Compensation Laws. DISHWASHER Date-/Z2,01' Applicant r/ .f ::! CLOTHES WASHER CONTRACTOR ✓ J ADDRESS NOTICE TO APPLICANT: If, after making this Certifi ate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY �j p TEL. NO. ,�' �P cation provisions of the Labor Code,you must forthwith comp= LAWN SPRINKLER SYSTEM v'� l ly with such provisions or this permit shall be deemed revok- STAT /� /per LIC. ed. WATER HEATER LICENSE NO.%�7J CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. P CESSE BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS O � 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER v(J and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL _ fect. _ DATE V (DATION / _ f 4 License Number G G' Lic. Class �` J .� V ✓ c � FINAL Contractor ,, f Date ~7 B,Y G�iG� O 1— I am exempt under Sec. B.&P.C. for this reason -8528A- Plan check fee Date' PLUMBING PERMIT ISSUING FEE$ I ,o 0 0 0 0 5 Signature TOTAL FEE 10 0 1 b 5 0 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name 0 0 0 1 6,505 Law for the following reason (Section 7031.5, Business and Professions Code): Address 2 b ...87 I, as owner of the property, will do the work and the City Tel. No. 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 authorize represe fives of this County to enter upon the above-me I* property r inspection purposes. 17_� SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Pe mittee Date