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lolto PLUMBING{NSPECTOR REGORD <br />APPROVALS DATE !D/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Underfloor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ 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 <br />Final Gas Test <br />Meter Release <br />FINAL 7 u-/? /-4-r./L 4'L( <br />Notes, Remarks, Etc. <br />owncr-Buildcr Dcclsation <br />* ,t*t mI hacby aftim undr psn8lty of pcrjury dl8t I m ampt fm thc Cotrcto6' Limsc Lav :^r thc following rcson (r <br />ud Prcfsion Codc): Any City o Couty which rcquirc 8 pcmit to mstruct, alt6, improvc, dmolish s rcpair qy snmrc pdr ro is <br />isswcc, also rcquic thc a;plicmt fo such pcmit to filc a signcd statmmt that hc or shc is liccnscd puEuut to the Foviiios oTrhc <br />Contrrctq's Licmscd Law (Chaptd 9, Comacing with Sction 7000 of Division 3 of thc Bwinss ud Profssions Codc) or th* hc or <br />shc is cxmp thacfrom md thc bsis fq thc sllcgcd qmption .Any violstion of Scction 7031.5 by ay applicet fo 8 pqmit subjccts thc <br />spplicot to a civil p@6lty ofrot morc ihd fivc hundrcd dollm ($500), <br />-I, <br />o omr of thc Fopslty, or my mployB with wags a tlcir solc compcnsation, will do thc work ed thc structwc is trot intmdrd <br />or offccd fc salc ( 5@.7044, Buir6 ed Profosions Codc: Thc Contrrcor's Licmsc Lsw dG not apply to u omr of thc propcrty <br />who builds q improvd thmn, md who dm such wsk hiroclf or hmclf c 0rough his or hr om mployu, povidcd thu such <br />imprcvcmotr 8c not intandcd or offqcd for salc. I( hovcvs, thc building or improvmot is sold within onc yco of complction, thc <br />Ownq-Builds will havc thc bwdm ofproving that hc or shc not build or improvc for thc purpoc of salc). <br />_[, u ownr of thc propcrty, m excluivcly @ntsrcting with lic€nscd contsrctos to construct thc projcct ( Scc. 7044, B6inss ud <br />Profcsio Codc: Thc Cmtretor's Li@sc Law dm not apply to u owlr of propcrty who buil& o impove thocon , ud who <br />cmrea ftr such projcca with 8 Cots&to(s) licmcd pmumt !o thc Contactq's Licffr Law. ). <br />_I m cxmpt uda S6tim <br />-B. <br />& P.C. for thb r6otr <br />Datcl Ownq: <br />WORKERS COMPENSATION DECLARATION <br />I hacby allim udr p€nalty of pcrjury onc of thc following debadons: <br />_IhavcodwillmintainaCcrtifietcofCmscnttoSqlf-InrwforworkG'comp@satim,c providcdfabySccrion3T00ofthc <br />Labor Codc, for thc psfmucc of thc wuk for which thc pamit is issucd. <br />_l havc od will maintain workcE' compmsation inswucc, o rcquircd by Sccrion 3700 of thc Labor Code, for thc pcrfomucc of thc <br />work for which this pamit is isucd. My work6' rcmFnsation insurucc wic ud policy numbcr ae: <br />Policy Nmbr Expire: <br />(This srction nccd no, u" .orpt"*d ir ttffi 0o) o t6s) <br />_t ccrtiry ftat in thc pqfommcc of thc work for which this pcrmit ir issucd I shall not cmploy uy pmon in 4y mun6 so 4 to <br />bccmc aubj*t to thc workm ' compcmatio lawe of Califmia, od sgrcc thd if I should bc{omc subj@t to thc workm' <br />of 3700 ofthc I shall, fothwith with thec provisim.. <br />WARNING: Failuc to sccurc workm' <br />fina up to onc hu&cd tlrowud dollm <br />compcnsati on <br />($100,000),in <br />is unlawful, od shall subjcct u mploya to oiminal poaltie md civil <br />addition to thc cost ofcompcnsation, damagcs a providcd fo the Scction 3076 of <br />thc Labor Codc, intmt ud Ettomsy's f6. <br />LICENSED CONTNACTORS DECLARATION <br />I hscby affim undq pcnalty of pcrjury thal I m licmscd ud6 provision of Chaptq 9 (@mmcing wit]r Scction 7000) of Dvbion 3 of <br />thc Buines ad Prcfasions Codc, ud my licasc is in full fqcc md cffcct. <br />Licosc Clcs:_ Licosc Nmbq <br />Datc: <br />I hscby aflim undq pcnslty ofpcrjury tiat <br />issucd (Scc. 3097, Civ. C.). <br />L@dq's Nmc: <br />a lading rgocy for thc pcrfomacc of $c work for which this pcrmit is <br />Lcndcr's Addr6s: <br />APPLICA.TYT'S DECLARATION <br />Dcmolition Pmits-Asb6tos Notificatioo Fcdaal Rcgulations (Titlc 40, Pan 6) <br />_ Rcquircd LctEr ofNotificcrion <br />_l cmify that thc fc&ral rcgulations rcguding sbctos rcmoval ac not applicablc to tlis projcct. <br />rhat I rcad this applicatim ud statc that thc abovc infomsdon is @rot. I agrcc ro comply with tll City md County <br />ordin0cs rclaing to building consmctim, ad hcby authorirc rsprecnrativq of this City md Counry to ql! upon thc <br />abovc <br />Applicut or <br />Pmtic5q( <br />for inspcction <br />OS