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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE IDiS!G.COMMENTS 0WNI.:R BTIII,I)I]R I)I'T,CARA'TtoN <br />I hcrchy allirnr uil(lcr lrlnlty of pcrjury lhnl I arn cxcnrpl liom lhc Coillracl(x's' Liccnsc [:w lbr lhc lblk)wirg rcrson (Scc.7(lJl.5 <br />Busincss and Prollsstrn Corlc): Any City or County which rcquirc\ tr Frilril lo c()nslnrcl. altcr. inlprovc. dcrrrlish or rcpair any <br />to thc provi\ions ol'thc C('ntrictor'( l-iccnscrl ks' (Chaplcr 9. Connrcncing uilh Sccli(il 7(X)0 of Dilision -1 o[ lhc Bnsinc(\ nn(l <br />ilpplicanl lor a pctrnil \uhjccls lhc npplicrnl lo fl civil pcnally ol'nol nt)rc lhan {ivc hun(lrcd dollnrs ($5(X)). <br />_1. xs owncr ol-lhc propcfly. or nry cmf k)yccs wilh sxgcs ns lhcir solc c()rrlpcnsxli()n. willdo thc rvork and the slruclurc is il,1 <br />iticlxlcd orollcrc(llirr$lc(Scc.7()l.l.Businc\sand['i)lcssi(nl\Co(lc:'lhcContrrclor'\l.iccnscl;rwdocsnolapplytounowncrol' <br />thc pfirfrfly sho build\ or irnprovcs llrrcrn. ilnd who (l(rs such srrrk hintscll or hcrscll or through hi{ or hcr own cmpl()ycc\. <br />sillc I <br />ilil(l $ltrr coillrncl\ for \uch l)rojcels with a (i)rxrrcl(nIs] licctrsc(l pursuilnl lo lhc (inilrxcloas l-iccnsc l-rw). <br />-l <br />amcxcmpt under sstion-. B. & P.c. for lhis reason. <br />WORI(ERS' COilIPT:NSATTON <br />DECLARA'I'ION <br />I hcrchy affirm undcr lrnally of pcrjlry oilc of lhc following dcclaralhns: <br />Lrtxrr(ixlc.liirlhcpcrlirnilrnccolthc\Irkli)r$hichlltncrnili\i\\nc(!. <br />tlr s(trk li)r u'hich lhir pcrnrit is issucrl. My *orkcrs coillpcn\xli()n ir\urrncc.nflicr an(l Filicy nunrhcr ilrc: <br />Policy Nunrhcr: Expircs: <br />_l cenify that in thc Jrrformrcc of thc work for which lhis frrmil is issucd. I shall noi cmploy any person in any mnrer <br />s as lo becorrc suhjcct lo thc wo.kers' conrpcnsalion laws of California. flnd agrcc lhat if I should hccom subjcct to lhe <br />workcrs' compensation previsions of Scction 3700 of thc titnr Code. I shall. forthwith comply with lhorc provisions.. <br />ciril llncs up to {)nc hundrcd thousand dollars (Sl(X}.{XX)). in trddilion lo lhc cost of conrpcnsatirrn. danragcs as provitlctl for lht: <br />Scclion 1076 oflhc l.atxr Crxlc. irilcrc\l and xlk)rrcy \ lccs. <br />l)alci <br />LICENSFN C(IN'IR CT(TR <br />DECLARA'IION <br />I hcrchy allirnr undcr pcnalty of pcriury thnl I am licc0scd Indcr provi\ion of Chaptcr 9 (conrtrrncilg wilh Scclirn ?(XX)) of l)ivision .1 <br />ol' lhc Busincss iin(l Prolts\i(lns Codc. rnd mv liccnrc is in full forcc rnd cflcct. <br />l-iccnsc Numbcr: <br />I)sle: <br />CONSTRUCTION LENDING A.GENCY <br />I hercby affirm undcr Jrcnalty of lErjury that thcrc is a conslruclion lending agercy for thc [rrfomrce of the work for which this pcmil ir <br />issucd (Scc, 3097. Civ. C.). <br />[lndcr's Nanrc: <br />Lrndcr's A<ldrcss: <br />APPLICANT TIECLARATIOIN <br />I lrrt*ry allirm untlcr pcflahy r)l pcrjury onc r)f thc li)lk)wiilg dc(lxrrti{}n(: <br />[)cilr)litioil Pcrmits-Ashcsto\ Notillcati()n l;cdcrrl RcEUlrlion\ ( l illc.]{). I'da6) <br />-Rcquircd <br />[-cllcr of Nolilicali{)n <br />_l ccrlily lhat lhc ltdcrill rcgulalions fegdrding nshcslos rcilrrval arc nrl applicahlc Io lhis proiccl. <br />atxrvc illctrlioncd p()l^-ny f(rr inspccli{)n nurfxr\cs. <br />Applicnnl ',r Agcnl l)illr: <br />Pcmit@ mme (print):_.- <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />N/lain Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release , <br />F!NAL 7 / ztlrt -&,lt <br />Notes, Remarks, Etc.-vv