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PLUMBING.INSPECTOR RECORD <br />ID/SIG.COMMENTSAPPROVALSDATE <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ 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{raplDrain 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 />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release ,rl <br />FINAL - ) /zht , ,tw lrn <br />Notes Remarks <br />t/ <br />I hereby affirm undcr penalty of perjury that I m excmpt frem thc Conbacton' Liccnsc kw for thc following reasn (Scc.7(B 1.5 <br />Business and Profession Codc): Any Cily or Counly which rcquircs a Jmit to construct. alter improvc. demlish or rcp8ir my <br />structurc. lrior to ils issuarce. also requires the applic8nt for such [Emit to filc I sigrcd statemnl thsl he or she is licensd pmuant <br />to lhc lmvisions of thc Contractor'r Liensed llw (Chaptcr 9. Comrencing wilh Sslion 7m0 of Division 3 of the Busircss md <br />PmfcssionsCodc)orlhatheorshciscxcmptthcrefromsndthcbasisforthcsllcgcdcremption. AnyviolationofsstionTO3l.5byany <br />applicant for a pcrmit subjsts thc applicsnl lo a civil penslly of not mrc lhs fivc hundred dollils (3500). <br />_1. {s owncr ol'thc proFrly. or nry cnrpkryccs wilh rvilgcs ils thcir srrlc conll[nsrtion. will do thc work an(l lhc slruclurc is nol <br />lhelr)Fr1y uhohuiklsorirrprorc\lhorqnl.undwhodocssuchrvorkhinrscll-r)rhcrscll()rlhroughhisorhcro*ncnrpkrvccs. <br />slc). <br />nr(l who c(,nlrrcls li)r such pfi)iccl\ wilh r Cotilrrclor(s) li((n\c(l pilrsuilnl l() lhc (i)illrilcl(n's Li(ctrsc I-rw). <br />I ilm cxcnrot undcr B. & P.C. for lhis rcason. <br />l)ale:O*ner:_ <br />woRKEns' cotuPENsATloN <br />DECL{RATION <br />I hcrcby af[irm undcr pcnalty of pcrjury onc of the follow hrg dcclarnl bns: <br />Lutx)r C(tdc. liir lhc pcrl-ornHncc r)l'lhc rvork li)r $tich lhc pcrnlit ir irsucrl. <br />thc <br />havcsndwillmaintainworke6'comlEnsationinsurancc.as rcquircdbySklion.lTU)ofthctiborCodc.forlhc[rcrformnceof <br />work for which this [Ermit is isscd. My workcs' comJrcnsation insurance canier and;nlicy number ue: <br />Policy _ 3- 7- 4o <br />-t <br />ccrrify that in thc pcrformrcc of the work for which lhis lErmit is issucd. I shrll not cmploy any J**n in <br />"ny <br />*nnf,. <br />s as to becom subjct to th€ worts' omJEnsation laws of Califomia. and a8m lhat if I shouH becom rubtrt to the '. <br />workm' @mpcnstion prcvisions of Setion 3700of thc tibor fue. I shall. fonhsilh comply with thos prcvhions.. , <br />! <br />Scclion lO7(, (rl lhc l-ahrr (-rxlc. inlcrc\l iln(l rllorncv's Iccs. <br />D.le:_ApplioDt:- <br />ucnxseu coltx,lcroi <br />DIiCI.AEAIIQN <br />of lhc Ilusincss rnrl Proltssions ('rxlc. ud tny liccnsc i\ i[ Itll li)rcc rnd cllccl. <br />ILiccilsc <br />l)alel .{t-34z-tg-bzo <br />issucrl (Scc. 1097. ('iv. C.). <br />Lcndcr's Nlnrc: <br />lxndcr's Addrcss: <br />AfIIJCANI.DESABAI&N <br />l hcrtby allirnr undcr pcnalty of pcrjury otre (,f lhc ti)llowing (lcchrali([s: <br />Dcrnolitioil Pcflnits-Asbcstos Notificali('n l:cdcrrl Rcguhlions ( l'illc 40. Pafl6) <br />-Rcquirc(i <br />l-ctlcr of Notificsti(nl <br />_l ccnify rhar rhc fcderal rcgulations rcSuding ashcstos rcrreval arc not applicablc to this proFct. <br />ugr@ to comply with all Cily and County <br />ivcs ofthis Cily und County lo cnlcr lpon the <br />atovc Ncntioncd propcrty for <br />Appliconl or Agenl <br />Pemilee neme o <br />\lilc ahrvc is corect. I <br />Z <br />2 <br />Cuinclor /