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PLUMB!NG.!NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />(rq )Water-Under floor z/ztl t7 *ut ? <br />Gas-Underfloor I <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />Ptrap/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 />Sanitarv Sewer/Cap <br />Back Flow Device <br />, <br />Rouqh Plumbinq \/st / rz _aML znL)a / <br />Final Gas Test <br />Meter Release I Ir I r. I .l <br />FINAL 'illl ntry)t}l.tl'd0 'SNotes, Remarks, Etc. <br />OWNER BUILDER DELCARATION <br />I hacby affm undc pcaalty of perjury thal I m cxcmpt from the ContractoF' Licms l.aw for the following ravrn (S9c.7031..! <br />Buine and Profsion Codc): Any City or County which rcquire a pcmil lo consiruct. alto, irnprolt. fonolish gr rcpair my <br />structuc. prior to its isswcc. aho rcquirB the applicet for such pemit to filc a signed statmot that he or shc is licmsed puBu{n <br />to thc provisioN of thc Contractor's Liccnsed hw (Chaptcr 9, Commencing with Setion 7000 of Division I of the BNinB md <br />Prcfsions Codc) or that hc or shc is crcmpt thqcfrom ed thc bsis for thc allcgcd exonplion. Any violation of Sction 70-l1.5 by any <br />applicmt for a pcrmit subjcts thc applicml to a civil pcnshy of not more thm fivc hundrcd dolles ($500). <br />_1, u oma of thc popcny. or my employG with wag6 6 their sle compo$tion. rvilldo the $ork dd the stnrluc is rct <br />intqdcd or offocd for slc (58.7044. Buinos and hofqsions Codc: Thc Contractor's Licorc Law doa not apply to an osno of <br />thc prcpcty who buil& or improvc tluo( md who do6 such wrt himsclf or hrelf or thmugh his or ho orvn cmployeo. <br />providcd that such imFovmts e rct intqrdcd or o&cd for slc. lf. horvrc, thc building or imprcvmt is mld rvilhin onc yw <br />ofconpl:tion, thc Owns Buildq will havc thc burdcn ofpoving tha hc or shc did not tuikl or imptove thc pmpo'ty for lhc purpos of <br />$h). <br />_1. 6om6 of thc tropqly, m exclusivcly codracting wilh liceNcd contraclo6 lo coNlruct lhe pmject (56. 7044. 86ins <br />and PrcftssionCodc:ThcContrrtor'sLiccnscLawdocnotapplyloanownoofpropcnywhobuildsorirnprovsther@n. <br />md who contmcts for such projets with a Contracto(s) licqsed pureusnt lo lhe Contraclor's Licose Lsw). <br />ll. & l'.('. for lhis <br />I h6cby sffirm unds psulty ofpqjury delarations: <br />I have md $,ill nuintain a Cerlificale ofConsenl to Self-lnsurc for workas conrFnsllion. as pror iricd for br Satiur 1700 ofthe <br />l-abor Code. for the psfonmnce ofthe rvork for Nhich the lErnit is issucd. <br />_l haveandwill rnainlain\vorkcrs compcnsaltminsurance.as retpirelblS*ritrn jT00oflhel.alu(ode.forlhepelornranceof <br />the work for $hich lhis pennit is isuerJ. My sorkm conrpensation insurance carlier and fxrlic:- rurnbu are: <br />Policy <br />-t <br />cgtiry that in the pqformancc of thc work for which this psrnit is issued, I shall not onploy any peEon in any mmos <br />s 6lobccomcsubj€ttothcworlm'compmsationlawsofCalifomia.andag@lhatiflshouldbecomcsuhjcllolhc <br />workm' compqrsation prcvisiore ofScaion -1700 ofthc tabor Codq I shall. forthwith comply wilh tho* provisions.. <br />WARNING: Failure lo seuc workm'composation covmgc is unlawful. and shall subjcd an onplo)q lo aitninal pcrEhk3 ed <br />civil fincs up to onc hundrcd thousand dollaB ($100.000). in addition to thc cost of compcmtion. darnag* u povidcd for thc <br />Section 3076 of int66l and fc. <br />I hereby aflim undo penalty ofp€rjury that I an prcvision of Chapto 9 (commcing with SNtion 7fi)O) of Division 3 <br />of thc Buitrs ud Profsioro Code, ud my full forre fril effcct. <br />l)rtr ( r)[lrrcl{rr <br />W <br />I hrcby allim undo pcnalty of pcrjury tha thoc is a conslruction lcnding agmcy for lhc pqfommcc of thc worl for s'hich this psoh b <br />issucd (s(. .1097. civ. C.). <br />lEnder's Narnc: <br />Lads's Ad&ss: <br />AfII.TCASLDECI.AMIION <br />I hatby aftm unda pctrahy of pcjury onc of thc following delarations: <br />Demolition Pmit3-Asb6to3 Notification Fcdaal Rcgulatiom (Titlc 40. P8n6) <br />-Rcquircd <br />Lrtts of Notificdb! <br />-l <br />cdiry that thc fcddal rcgulatioro rcguding obetos rqrroval arc not applicable to lhis prcjecr. <br />_l cqtify that I havc r@d this application ed statc that the abovc infonnation is co[c.1. I agrc (o comply with 8ll City 6nd County <br />ordinecq ed State Laws rclsting to building construclion. md hscby authorize rcprBentativs of this Cily md County lo st6 upon th€ <br />abovc mmtioncd propeny for <br />Appllcint or Agent <br />Permite mme (print):r/u< <br />-l <br />m cxcmpt/uqdq SFcrion- <br />""n!gf/,6 <br />Cuiq:- <br />Liccnse Clas:- l,icense Nurnhs: _ <br />l)tfe:uf); s