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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS owNER IttJtLDUR l)l,LCARA IT0N <br />I hcrchy rllirnt undcr pcnully of fcr.iury thul I dtrr cxcnrpl tionr lhc C(nilrack)rs l-icc,l\c l-rw li)r thc li)lk)wilg rcrron (Scc.70]l 5 <br />lo lhc p()vi\iurs ol-llrc Cont.ackrr'\ Licco\c(l Lat! (('hrflcr 9. CoDnncncing !rilh Scction 7(X)0 ol I)ivisi<rn J ol thc Bu\incss atd <br />rpplicrrilli)rilpcrillil\uhjccl\lhc upplicrnll(,acivilpcnnltyofDolnn)rcthrnl'ivchun(lrcddollars($5(X)). <br />-1. <br />rs owrcr of lhc Jmpeny. or my employes sith eagcs as lheir sole mmlrnsalion. will do the wod( and the stn$rc is mt <br />intcndcrl or offered for sle (SN.7044. Busincss and Pmfcssions Codc: The Contrrctor's Liccnrc hw docs not apply lo an owncr of <br />lhepmFny whobuildsorimprcvcsthemn.srdwhodftssuchworkhimselforhcrselforthrcughhisorherowncmployecs. <br />providcd lhst such imlmvmnls rc rct intended or offcrcd for sle. If, howew, the buiHing or itrprcwmnt is eH within orc )rry <br />of comphlion. the Owmr Buildcr will harc lhc h[den of Fovirg tlut hc or shc dil mr buiH or irfrcre the pmpcrty for the purtD$ of <br />sh). <br />-1. <br />tr\ owncr ol thc lropcny. am cxchsivcly conlrncting wilh liccnscd conlrack)rs lo con\trucl thc pn)jccl (Scc. 70J.1. Busincss <br />artd Pnrfsshn Codcr Thc Contrrctor's [-iccnsc [,aw docs not apply to an owncr ofpropcrty who builds or improvcs thcrcon. <br />dnd who conlracls for such trojccts wilh a Corilracbr(s) liccnscd pursudflt kr thc Contrtck)r's Liccnsc hw). <br />I ail! cxcnrDl uildcr Sccti()il . ts. & P.C. li)r this rea(on. <br />()rtrcrl <br />W0RKERS' CO[IPENSA'T'ION <br />DECLARATION <br />I hcrchy affirnr undcr pcnally of pcrjrry onc of lhe fi)lk)whrg dcclnralion{: <br />-l <br />hrvc and will illainlain a Ccrtilicalc ol ConscDt lo Scll:lnsurc for workcrs' cotrrlcnsation. ns providcd tbr by Scction 37(n ofthc <br />hbor Cixlc, for lhc pcrfornuncc oflhc work lbr which lhc pcrmil is issucd. <br />-l <br />havc und will trtninlain workcrs' conrpcnsulion insurancc. as rcquircd by Scction J7fi) ol thc Lnhor Codc. for lhc pcrformancc of <br />lhc w(trk li)r whig[lhi\ pcrrpil is is\ucd. My wor!9!!' cotrrpcnqati(nl i[surancc carricr rnd Jxrlicy nurnhcr xrc: <br />,^n,",, \ X!91\wr4rk ')rJaran(c trln^{)ony.c tr3e z T :1l'rrlicy <br />WARNING: Failurc to surc workcrc'compcnsation covemge is unlawful. and shall suhjcct an cmploycr to oiminal IrcMltics snd <br />civil fincs up lo onc hundred lhousand m.om), in addition to the cost ion. dnrnagcs us providcd for thc <br />Section of l.ahrr iiltcrc\t rtr(l <br />I <br />I hercby affrm under penalty ofFrjury lhal I am provision of Chapto 9 (comrrcrcing wilh Setion 7000) of Division 3 <br />of lhc Business and Professions Codc. ard my liccnse is in full forcc and cflcct <br />Liccnsc <br />,ts{6 <br />c( <br />I herchy {l llrm u[dcr lEnally oI pcrjury lhnl lhcrc is a consldrction lcnding ngcncy Ior thc pcrlirrnunce of lhc wr)rk for which this lErnrit is <br />issucd (St'c. 3097. ('iv. C.). <br />Lcndcr's Nunrc: <br />1-cndcr's Addrcss: <br />APPI,ICANT T)ECLARA'IION <br />I hcnby aflirm under pcnillty oI pcrjury onc of thc tblk)wing dccldrat i(ns: <br />Dcnn)lilion Permils-Asbcstos Nolillc{tion Fcdcral Regulxttrns ('l'illc 40. Pun6} <br />-Rcquircd <br />Lcttcr (,f Notillcati)n <br />_l ccdify that the fcdcralrcgulations rcgoding asbeslos removalarc not spplictble lo this frojcct. <br />_l ccnify that I havc rcad lhis opplication ard statc that thc atnve inforrolion is corcct- I aBrc lo comply with all City and County <br />ordinanccs and St0tc Laws rehting to authorizc rcpresenlativcs oflhis Cily {nd Counly to enter upon the <br />above nEnlioncd pmpcrly for <br />Applicsnl or Agent <br />l'rmrilm Dxtrrc <br />ion. <br />t-z- <br />*," l(>n/r( <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building 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 />Main Drain/Pool Pipino <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 />Rough Plumbing <br />Fina! Gas Test <br />Meter Release <br />FINAL 7 Al1/)D& ocf -*gc( <br />Notes, Relrlarks, Etc. <br />t7 ,t1 \h- f 0 7 L- *"fl <br />I t, <br />l)otei <br />-l <br />ccnify lhat in lhe pcrformtncc of Ihc work fo. which this JErmit is issucd. I shall not cmploy sny Jrcrson in any manner <br />s as lo bccorc subjccl lo thc workcrs' compensation laws of Calilornia. and trgrcc that if I should bccom subict to lhc <br />workers'compcnsalionprovisionsofScclion3?0OoflhctiborCodc.lshall.lbrthwithcomplywithlhoseptovisions.. <br />l)alel