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APPROVALS DATE rD/srG.COMMENTS Owna-Builda Dcclantiq <br />I hmby aftim uds pqBlty of pcrjury thar I m omp fm rhc CorEroa' Li@!c Lr* ftr thc followint Bm (16.7031.5 BBin* <br />md Prcf6ri6 Codc)r Any City or Couty which rcquis a pcmit to cdrtrucl, rlt6, improvc, dmolich c Epoir uy 3tuctuc, ptriq to itt <br />issue, also requie the rpplimt fq ruch pcmit io {ilc r tigncd ttatanot thal hc d lhc is limcd pG@t !o thc Foyilim of rhc <br />Cdrrdff's Licmcd ls (Chaflq q Comadng with Sctim 7000 of Divirim 3 of thc Buins od Prcfaim Codc) ff thst hc tr <br />shc is ampt thmfrom ed dlc bBtu fc thc allcgcd smptid .Any riolatim of Scaion 7031.5 by uy applimr fn s pemit subjccts thc <br />applimt !o a civil pcnrlty of nor mm thu fivc huM dollm (t500). <br />_I, o omc of thc Fopcrty, 6 my mploya with wagc u thcir solc mpcrouim, will do thc wort md thc ttrustuc is not intodcd <br />u offmd fc sale ( Sc.7044, Bain6s md Prcfsim Codc: Thc Contrrct6'r Licruc Llw dm nor aprply to u m6 of thc propcrty <br />who buildr n irprovc thm, ud who dm tuch wtrk hiruclf tr tmclf c thrcugh hir r hs om mployd, provi&d that ruch <br />improvmmi! rc not intmdcd ff offmd fc sdc, If, howw6, thc building c improvmmt is rold within mc ycr of complction, thc <br />Ownq-Buildc will hav€ thc buda ofproving that he r rhc not build o improvr for $c purposc of sslc). <br />_I, a om6 of thc Fopqty, m cxcluivcly cmtrrctir8 with lic@cd @$etm to mtruct thc projcct ( S4. 70/14, BEinqs ed <br />Profosim Codq Thc Cmtractor's Limc L{q dG not oprly to I omo of propcrty who builds r improvs thmn , ud who <br />cotracts fc such prcjcctt with 8 CoEetor(r) limcd puuur to thr Conr&tor's Licosc Law.). <br />_I m ampt unda S6ti@ <br />-B. <br />& P.C. for this rcson. <br />Datcl <br />t hmby afiim uda -r, or*,u' -ffi <br />_Ihavcmdwillmint8insCatificlt ofcmat!oSdf-Ituwftrwortm'cmpcnsstiq,r povidcdfcbyScction3T00ofthc <br />kbd Codc, ftr rhc pcrfme of thc work for which thc pomit it isucd. <br />K*a*itt*;nrainrqlo'ffipcot8ti6iilwe,s requircdbysetion3TooofrhcLsbacode,ftrthcpcfmeofthc <br />work fc which thir pqrnit ii i!$cd My wott6' mpcmtim ime cui6 ud polisy numb6 uc: <br />Policy Nmbcr: Expiru: <br />(Thtu setid n@d no, u".or4t*a ir,l@1 . t*y <br />rn ey tmnq ro a to <br />thc work6' <br />o,(- <br />WARiIING: Fsilre to i@rc workc' cornpquariil covaagc is unlswful, <br />fin6 up to onc hu&rd thoued dolln (t I 00,000),in 8ddition to thc cGt of <br />thc Labor Codc, iilct md anmcr's fq. <br />and civil <br />1076 of <br />LICENSED CONTRACTORII DECLANATION <br />I hacby affim u&t podty of psjury thrl I m limcd u&r prcvisim of Chapta 9 (cmmacitrg with Setio ?000) of Divisim 3 of <br />thc Buinc md Prcfsi@ Cod., &d my licmc i! in full fre ed clfd. <br />Licosc Clu:_ Licmlc Numba _ <br />I hmby affim uda pcndty of pcrjury thst thqc agilcy pcrfomucc of 0rc w6k for which this pcmit ig <br />Civ. C.). <br />Lmdo's Ad&es: <br />ATPUCANT'S DECLARATION <br />Dcmolitio Pmit!-Albet6 Notificrtim Fodlnl Rc8ulrtiN (Titlc 40, Prt 5) <br />_ Rcquircd Lcn6 ofNotificrtion <br />I ccttify that thc fedml rc8ul8timr rcssdin8 abstd moyd ac not eplicabl. to thi! projcl <br />..2ffi-ty tn"ttt "c Ed thit spplicstim ed rbrr 0rrt thc sbovc infmtion i! cmet. I lgre !o cffiply yifi .ll City md Countyr ordinms md Sotc km rclrting to buildinS cdrtructim, ed hffiby suthorirc rcprGatdivca of thir City md CMty to atcr upo6 th. <br />abovc mmtioncd propmy for inspcction purposa. <br />Applicet <br />Pcmittcc nmc <br />UNDER GROUND <br />Waste & Vent <br />Water-Underfloor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipeing <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOUSPA <br />P-trap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Misc <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing //. 0.; t'/h//- <br />Final Gas Test <br />Meter Release <br />FINAL rJ.//.atf //)ulnr <br />Notes, Remarks, Etc. <br />PLUMB!NG-I NSPECTOR RECORD <br />)-