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ID/SIG.COMMENTSDATEAPPROVALS <br />UNDER GROUND <br />/2w r )Waste & Vent <br />//'UWater-Underfloor <br />Gas-Underfloor <br />Building Sewer <br />IArea/Storm Drain <br />T YTYY,/l?lnterceptor/ Clarifier <br />tt <br />ltTOP OUT .Mql )Waste & Vent C <br />Water Piping Z <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 />'f lut '/1.;wHbRough Plumbing <br />/a Ml{/\/Final Gas Test <br />Meter Release ,l\."lll ,z <br />lp L <br />^) <br />FINAL <br />Notes, Remarks, Etc. <br />I hacby affum unde pcmlty of pojury that I u acmpt fom thc CoilndoB' Lie8e hw for thc followilg rmn (re.7031.5 Buiaer <br />rnd Profasioo Codc): Any City or Couty which rc4uiro a pcrmit to @Etrud" rltq, imEorc, dcmolirh or rcprir my rtrucfuq Fior 1! G <br />irsuncr, alro rcquira thc appliesr for ruch pcrmit o filc a signcd ltrtmcot dtt hc or lhc it li@Ecd punut to thc provirioro of thc <br />Contrsctor'r Li€Ead hw (ChEptcr 9, Commcncing with Setion 70O0 of Division 3 of dE Buinil rod Profdrior Codc) or dnt hc or <br />shc ir ucmpr thocfrom and thc bcsis for thc rllcgcd qcmption .Any viohtion of Setion 7031.5 by uy EPpliont for r p<mit rubjrcts thc <br />spplient to I civil pcmhy ofnot morc dun Iivc hundrcd dollan ($500). <br />-I, <br />a om6 of tbc prop6ty, or my cmploye with mgc u thcir rclc ompcmtio4 will do thc work ud tho rtructuc is nor intcndcdl <br />mfrsod for slc ( Sc.7044, Buircc rnd Profc$ioro Codc: Thc Contactor's Li*N kw do6 not apply to u ow of thc propsty <br />who buil& or improvo thqort ud who dos ruch work hirelf or hmclf or tlrough hir or ha om employa, providcd thst luch <br />imProvcmcntsucmtintandcdoroffcrcdforsle.I{howwc'thcbuiIdingorimprorcmcntigroldwithhorcyaofomplaioqrhe <br />Omq-Buildq will havc thc budcn of proving th8l hc or shc not build or improvc for tlE purpos of slc). t <br />_I, r omo of thc propcny, am aclurivcly @otnctinS with liccEcd @ntncloB !o aNrua thc projat ( Se. 7044, Buin6! md <br />Profacion Codc: Thc Cotrt[dor'r Liere lrw doc mt rpply to m oma of propoty who buildr or improva thoon , ud who <br />@ntrrct' for iuch prcjcats with s Cootrs6or(s) lic$cd PWWI o thc Contnctor'a Liere hw.). <br />& P.C. for this <br />I hcrcby unda pcmlry ofpcrjury onc d6la0tio6: <br />_t hsvc md yill mintlin r Cdtifiotc of CotHt to Sclf-IN[c for rcrkm' ompcutiort B providcd for by S6tion 3700 of thc <br />labor Codg for drc paformm of rhc work for which tbc pcrmit ir irsuod. <br />I hEvc ud will roiotlin workss' @mpcmtiotr irour8ne, 6 <br />iorh for which this psmit is icaucd. My workm' ompcuation <br />rc4uircd by Scction 3700 of tbc hbor Codg for thc perfotrrua of thc <br />irulme 6ris md policy numbe rc: <br />Poticy Numbc Eryircr: <br />(rhi! r€rion nccd m, r" *.pr.n a co*fri rE6Ilo,.a,Eiun-iloo) or h$) <br />_l cgtiry dEt in thc pcrformne of t}lc work for which this pcrmit <br />b€smc rubjdt to thc rcrko ' ompcution lews of Califoruis, ud <br />i! isuc4 I lhrll rct mploy rny in 8ny tms co a to <br />the workm'agre that ifl should bcomc <br />with thosc <br />u mploys to simiEl pcmltio ard civil <br />provbios ofSEtion 3700 ofthc Lrbor Codc, I <br />(\ <br />Failuc to seurc wortqs' <br />finc hundred thousnd dollan <br />covmgc is ulawful, ud <br />Eddition to thc @rt of damrga u providcd for thc Setion 3076 of <br />ompcution <br />(c100,000),itr <br />the llbor ud rtromey's f6. <br />LICENSED CONTRACTORS DECLTRATION <br />I hqcby rffum unds polty of pajury thtt I u lierocd undc provision of Chapta 9 (omcncing with Scrion 7000) of Divirion 3 of <br />thc BuiH rod Profodou Codc, rnd my liccre fu h full for@ srd cffcet. <br />Lieroc Clas:- Lieroc Nu.bs <br />- <br />Drtc: CoDir8clor <br />W <br />I hacby affm unda pcElty of perjury thst thqc is a ortruction lcnding agacy for thc pqhme of the work for which this p<mit ir <br />issucd (S@. 3097, <br />lrnds's Nlmcl <br />Civ. C.). <br />Ipnder's Ad&s: <br />A8ILICANT:S.DECLABAIIQN <br />Pqmitr-Asb.stos NotifiCtion Fcdml RcgulslioB (Titlc 40, Psn 6) <br />cstiry dBt thc fedml rcgulatioro rcgarding ubqtos rmonl sc not Epplieblc to thir prcj@i. <br />_ I @ni& tlst I havc rod thir applietion ed statc OBt the Ebovc hforution i! @r6t I lgrc to 6mply with lll City snd County <br />ordimocG rnd SEtc IrB rclsting to building mrotructioq md ruthoriz repr*ntativo of this City md Couty to 6tq upoo tlE <br />mcntioncd prop€rty for iNpcction <br />or agmt sig. <br />Eme (print): <br />PLUMBING.INSPECTOR RECORD <br />z./// <br />I <br />y/ <br />ftc.W'<*tttff- <br />/\,/ l"rl t rt <br />\ q*\\r l' luv