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PLUMBING.INSPECTOR RECORD ? <br />APPROVALS DATE ID/SIG.COMMENTS <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 It lrt ,/,LA <br />FinalGas Test <br />Meter Release <br />FINAL <br />Notes, Remarks, Etc. <br />I hrcby af6m uda pcrs.lty of pGjury thlt I u uopt fom thc ColtrrtoB' Lirc Law for thc following rmD (s.7031.5 <br />md Profxioo Codc): Any City or Couty which rcquiro a po'mit to oElnrct, alta, iEprovc, dootish or rcpat uy structEc, Fior to ils <br />issurce also rcquiu ttc appliot for such pqait to filc r signrd stat@t that hc or shc b lic@scd prut ro thc prcvisiou of thc <br />CoDtrrctor's LiccBad taw (Chaptq 9, Comocirg wirh Sction 7000 of Division 3 of thc Bwioq ud Proftssiou Co&) ortba hc or <br />shc is aopt thacioo and thc bssis for thc allqcd a@pio! .A!y violstio! of Satiotr 7031.5 by uy applimt for a pcmh subjets thc <br />applicagda civil paahy of aot morc tha fivc huodrcd dollm ($500). <br />!{s o*oofthcpropqty,orEy@ptoycwithwag6sthcir$lccomp@sstioD,willdothcwotk&dthcstuctebrotirtodcd <br />or offccd for salc ( Se.7044, Buircs ud Profsiou Codc Thc Conrctor's Licre kw doc oot rpSrly to u ow of thc popaty <br />who builds or improvc throq ud wbo do6 such work hirclf or bmlf or through his or ha om oploye, providcd thar sch <br />iD[rcv666 qc trot iatadcd or offqpd for salc. I[ bowws, thc buildilg or inprcvaot is sld withi! orc yE of @Eplaio!, thc <br />Omq-Buildq will havc thc burdm ofproving thar hc or shc trot build or improvc for thc purfrcs ofsalc), <br />_I, u omo of thc propaty, u acluivcly @ltrsctiDg with liccascd oalEctoc to @lstruct thc Fojet ( Se. 7O44, Buias ud <br />Pm&sioa Co&: Thc Coatrattor's Liry Iaw dG rct apply to e ow of propaty wbo builds or improvc t!ao! , ed who <br />coilrets for such projcB with a CooEacto(s) licascd putMr to thc Cofiraclor'c Li@ kw.). <br />_lu Sstiotr &for ihis 160g. <br />Datc:I <br />I hacby affm unda pculty ofpojury oac <br />_I havc ud will minaio 8 Cstificltc of Cot$t !o Sclf-IM for w*c' oupastion, r prcvitod for by Scctio! 3700 of thc <br />hbor Codq for thc pqforc of thc wo* 6r which tbc pamit is iscd. <br />_l havc ud will EaiDtsin wotl6' ompoation isumcq r rcquircd by Scction 3700 of thc Labor Codg for thc pafomcc of thc <br />worL for wbich this pmit is isucd. My wortm' compcsstio! islrurc wicr ud lrclicy aubo uc: <br />Policy Nuba: Expircr: <br />qfhir sgri6iimea mt bc complctcd if thc pmit is for Orc hu<bcd do[6 {Sl0O} or l*) <br />v-l cstiry &ar ia tbr pqforw of tbc wort for whi:b this pamit is isc4 I sbEll mt qby uy parca ir uy ma rc u to <br />bcec $bjct to th. mrtc ' oupostba laws of Califonia, ud agc &at if I sbould bcorc subjEt to tbs wqr(6' <br />of Setiotr 3700 of thc hbor Codc, I sb8ll, fonhwith comply with tho* provisiou..I /z 6 <br />Failuc to suc wortc' omposatiol is udawful, md shall subj@t e @ptoF to md civil <br />fi!6 up to orc hu&cd thouynd dola$ ($100,000),iD <br />thc Labor Codc, iDt66r ed ammry's f6. <br />addiriotr to thc cost ofcomp@sarioo, daoagc s providrd for Setion 3076 of <br />LICENSED CONTRACTORII DBCI.ARATION <br />I barby afm uda paaty of pcjury that I u licelcd uDdq prcvisior of Chapc 9 (orccing with Sctioa 7000) of Divisior 3 of <br />thc Buiw ud hofcsios Cod., &d Ey licry is ia full fore ud cffcr. <br />Licruc Clas:_ Liw Nuobq _ <br />Datq Coatr*tor: <br />CONSTRUCTION LENDING AGENCY <br />I hacby affm udc pcorlty of pcjury that th@ b a coutnrslio! lcodiag agocy for thc Isfomc of rhc work for which this pqnit ir <br />issucd (56. 3097, Civ. C.). <br />lad6's Nmc: <br />[:ods's Addrs: <br />APPLICANT'S DECLARATION <br />Dcmolitioa PmiB-Asbcstos Notificatioo Fcdral RcgulatioE (Titlc 40, Part 6) <br />_ Rcquircd tato ofNotificrtion <br />,A**dffi ffi ffi I**#i#,il***Hsry.a?,*:v.* <br />abovc 06tioncd propqty for <br />Applicut or agot <br />Pmitte lmc (priot): <br />,-4't 4 <br />Alx-ri Artnli 1) <br />vovtt Yrl L .l)