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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE lD/stG COMMENTS OWNER BUTLDER DELCARATION <br />I hseby affim unds pmalty of pojury that I m crmpt from thc Contractore' Licruc tarv for thc following rc&n (Sa.7031.5 <br />Busin6s ud Profsion Codc): Any City or County which rcquira a psrnit to construct, alt6. improvc. dmolish or rcpsir ey <br />struc:luq prior to its isswcq also rcquirB thc applicut for such pcfinit to filc a signed ststment that hc or shc i5 licmcd puBuml <br />to th€ provisiore of thc Contractor's Licoscd trw (Chapta 9. Comcnchg with Sectiotr 7000 of Division 3 of thc Busin6 and <br />hofc$iomCodc)orthath€orsheiscxemptthqcfrommdthcbdisforthcallegedcxmption. AlyviolationofSwtionT03l.5byay <br />applicantforapermitsubjatsthc applicettoacivilpaaltyofnotmorcthefivehundreddollos(3500). <br />-1. <br />r omq ofthc Fop6ty, or my @plo1c with wagc u thcb rlc compasdiorL will do thc wok od ttrc srudw b rct <br />intodcd or offqcd for salc (Sc.7044, BEinB sd Profsiorc Codc: Thc Contractor's Liccrc taw do6 not apply to m omq of <br />thcFopqty whobuildsorirryrcvcttuouadwho&€uhwrthimclforhmlfortlrcughhisoluommploye. <br />providcd that such improwmts rc mt intqdcd or otrqcd for sb. lf. howm, thc building or impro!€Erl is sH within onc yq <br />ofconrplaion thc Ovma Builds wil tErc thc hrdo ofFoviru tl|rn hc or $c did not buiH or inprovc thc tropqty for thc pttrpos of <br />slc). <br />_1, 6 om6 ofthc propqty. m cxclNivcly contracting with licscd cor(racloE to corslruct thc projccr (Se. 7044, B6itrs <br />ud Proftsbn Codc: The ContBctor's Lic€nsc Law doB nol apply to e owns ofprop€aty who builds or improvG th6on. <br />md who contncts for such projets with s ContEclo(s) licccd pus@l to the Contractor's Licme Law). <br />--l m crempt undo Section-.re60n, <br />o",",1lzt-ll1 <br />I hscby amrm undd pcnalty ofpajury one ofthc following <br />_t havc and will mintain a Cqtificale of CotMt to Self-lnsure for workG' compc[sation. c provided for by Setion 3700 of thc <br />tabor Codq for thc pqfommcc of the work for which thc pqmit b isucd. <br />-l <br />havc and will maintaitr work6' compcNation iNurance. 6 rcquircd by S€tiotr 1700 of thc Lsbor Codc, for thc pgfomacc of <br />thc work for which rhis p6mit is iscd. My workc' compauation iBurece cuitr ad policy numb6 {c: <br />c*;,,Lvere!l r&h,uv,l *rlc,<e C o <br />_l cdiry that in thc pqfommcc of the work for which this pcmit is issued. I shall not mploy any pcrson in my muno <br />m r to bccomc subjet to the work6' compo$lion laws of Califomia, md agG that if I should bcome subjet to thc <br />workm' compwtion prcvisiou of Sction 1700 of thc L€bor Codc. I shall. fonhwith comply with thos prcvisions.. <br />WARNINC: Failurc to suc workm' compquation covmgc is unlawful. ud shall subjet m oployo to qiminal pcrultis md <br />civil fincs up to otrc hun&cd thownd dollrc ($100.000), in addition to the cost of compwtion. darogcs u providcd for thc <br />S6tion 3076 of thc Labor Codc, intqGt ild attomey's fc6. <br />I hoeby affm uoda pcrulty ofperjury that I m licsscd 9 (comm6citrg with SEtion 7000) of Dilision 3 <br />of thc Bsbs md PrcfsioN Codc, ad my licw is in full force dd cff*1. <br />l.iceme Numbs: <br />I hcrcby affm undc pcaalty of pa'jury tha lhcc is 8 construction <br />issucd (Sc. 3097, Civ. C.). <br />agmcy for pofommcc of the wort for which this p6mit is <br />Lrod6's Nmc: <br />Lods's Ad&er <br />APPLICANT DECLARATTON <br />I ho*y affim undo penalty of pcrjury one of thc followiog delmlions: <br />Dmolhion Pmits-Asbetos Notification Fcdtral Rcgulalioru (Titlc 40. Pan6) <br />_Requircd Lcttq of Nolifrcation <br />*r^ify rnn rhc fedaal rcgulatiom regading Bbstos roo!€l oe nor qplicable to rhis prcjcrt. <br />-l <br />cdiry thd I havc rad this applicstion dd statc that thc abovc infonnation is coret. I agre to comply wilh all City ud County <br />ordimcs ud State law rchting to building coEtruction. ad hseby authorize reprGanlativ6 of this City md Countyto 6tq upon thc <br />abovc motioncd prcpeny for impction purposs. <br />Applicrnl or Agent o,t",'llZbl t1I <br />Permi(e nrme <br />UNDER GROUND <br />Waste & Vent 5-z- t1 rzc t)t{ ? tao{r- <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent g4-n Lc'u <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test 7-3'11 ,ll?zzZ <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <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 />Final Gas Test <br />Meter Release <br />FINAL 6-7-7a E crs,wf /b.s 2V <br />Notes, Remarks- ftc Airr'J.lL Fl f(^+*rnt Bt ,e /"!4 r 6/?h /kz'), <br />a <br />"",, 1 lz b.ll1 <br />I