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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/S!G COMMENTS OWNER BUILDER Df,LCARATION
<br />I hcreby aflirm undc. p€nalty of p€rjury that I m exempl fmm the Conlraclors' License Law for thc following readrn (Sa.?01 Li
<br />Business ard Profession Codc): Any City or County which requircs a pemit lo conslrucl, altc, improvc, dcmolish or rcpail any
<br />structu.e, prior to its issuarce, al$ requires the applicant for such pemil lo file o signed statemcnl that he or shc ir liccnsed purNdnt
<br />lo the pmvisions of th€ Contractor'3 Licensed Law (Chapter 9. Commencing with Scclion 7000 of Division 3 of thc Business ond
<br />PmfessionsCode)orthathcorshcisexcmptthcrefmmandthchasisforthcallegcdexcmption. AnyviolationofsslionT0Sl.5bysn,
<br />applicanl for I pcmit subjcts the applicant lo a civil pcnaltyofmt more than five hundrcd dollars ($500).
<br />-1,
<br />as owrcr of thc pmperty, or my cmployes wilh wagei s their mle compc[qtion, will do thc work ud lhe strutw is mt
<br />intcndcd or offcrcd for slc (Sc.7044, Busincss and Pmfessionr Codcr 'l hc Contractor's License Law docs not apply to an owner of
<br />thc pmpny wln build.r or inpmvcs themn ard wln dos wch mrk himsclf or hcreclf or thmugh his or hcr own cmployces,
<br />provided that such impremnts m mt intsdcd oroflcd for slc. I[, tnwffi, the huiHing or itr{rmrcmnt is sld within orc }car
<br />of ar{,htior\ th€ Owrcr Buil&r will have Ihc hrden of pmring tha he or she did mt buiH or itrpmrc lhc pmlEty for thc purgre of
<br />olc).
<br />_1, os owncr of the prcperty, am cxclusively contmcting with licensed conlmctoB lo onstruct thc pmjst (S(. 7044, Busircs
<br />and PmftsionCodc: lhcContractor'sLicenseLawdocsmtapplytoanowncrofpmpcnywhobuildsorimproveslhcron,
<br />and wln conlmctsforsuchpmjetswithaContmclo(s)licensdpu.sontlotheContractor'sLiccnrclaw).
<br />-Iamexemptundersection-,B.&P.C'forthisreason'Ihac:_O$ner:
<br />lvl28tsEBg.Cg II!2B
<br />-D&C!A8AUO!
<br />I hercby afl'irm under pemltyof ptrjuryone of the following drclarations:
<br />_l have ard uill rointain I Ccdificatc of Conrenl lo Self-lnsure for workeB' @nrpcnsotion, as previdcd for by Section 3700 of thc
<br />kbor Code, forthe psfomncc of the work for which the prmit is issued.
<br />-l
<br />have and will maintain workers' compcnsation insurance, as rcquired hy Sction 1700 ofthe Lahor Code. for the performance of
<br />lhe work for which this permit is issed. My workrs' comlcnsation insrance canier ard Jnlicy numher re:
<br />c".*. 6v€l? rT Nzrlio^ a(
<br />-?--t -lcl
<br />-l
<br />cerlify lhat in the pcrformarcc of lhe work for which lhis permil is issued, I rhall not cmploy any pcnon in any manner
<br />m as to becomc nuhjct lo the workcN' compensation laws of Califomia, and agrc that if I stnuld b€corc sbj(t to the
<br />workm' ompenmtion pmvisiors of S(tion 3700 of the Latnr Code, I stull, forthwith mmlly wilh ttnr pmvisions..
<br />WARNING: failurc to s[e workcB'comp€nslion @vemge is unlawful, and shall subj({t an mployer to qiminal pcMllis and
<br />civil fincs up to orc hundrcd thousnd dollars ($100,000), in addition to the cosl ofcompcnmtion, damagcs as previded for thc
<br />Scction 3076 ofthe Labor Codc, interert and atto.ney'g fec8.
<br />I hercby allirm undcr pcnalty of ,erjury that I am licensed undcr pmvision of Chap(tr 9 (comrercing wilh Setion 7000) of Division 3
<br />of the Business and Pmfcssions Codc, and my licenre is in full force arxl efTect.
<br />D,t-, L3t-to_Conaraclor:hcJ
<br />CONSl'RUCI'ION LENDTNG AGf, NCY
<br />I hcrcby afirm umler penalty ofperjury lhfll lhqe is a conslruclion lending agency for the perlirrnmnce oflhe work fi)r whiclr this pcrmit is
<br />issued (Sec. 1097, Civ. C.).
<br />Lenrler's Nanre
<br />Lender's Addrcss:
<br />APPLICANl' DECLARAI'ION
<br />I herttry affim under penalty ofperjury ore of the following delarations:
<br />Demolition Permits-Ashes(os Notillcation l;ederal Regulalions ('l itle 40, Parl6)
<br />-Required
<br />[,etler of Notification
<br />-l
<br />certify that lhc fedeml rcgulations reguding astrslos rcmorrl are nol applicahle lo this projed.
<br />qfl cenrfy that I hrve read thrs applcf,lion orxl stale that lhe atnve infomation is cotrect. I agre lo comply wilh atl City and County
<br />orltinances and State Laws rlatrng to building consruction, aftl hereby autlsrize represenlf,tiles oflhis City nnd County to enlr ulnn lhe
<br />abovc rcntioned pmpeny for
<br />Appllcant or Agent Slgn.tu
<br />PerDllee trame Grrinl):5 an ol {,'rt
<br />l)xlr Y?I:Q
<br />UNDER GROUND
<br />Waste & Vent $-'r'- 19 )r.Vm
<br />Water-Under floor ttr:rf ttl^rg{r t 4-1 -t1 \.wn)
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent LltLc 9sttaz-
<br />Water Pipinq Uul n r.* lo'a
<br />Gas Piping Doi-crnr-cluln *ara9/o\
<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 />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
<br />FINAL l.7o.zo Ex.+t la3
<br />Notes, Remarks, Etc.
<br />,n,tr*u,*' I"\rt- oH?S t{2} o^rn",,
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