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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/S!G.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildi Sewer <br />Area/Storm Drain <br />ClarifierI <br />TOP OUT <br />Waste & Vent <br />Water Pi n <br />Gas P <br />Roof Drain <br />Tub/Shower Test <br />Water HeaterRou <br />POOL/SPA <br />P-t Drain Line <br />Main Drain/Pool Pi <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />nklerLawn <br />Sewer <br />Back Flow Device <br />PI <br />Final Gas Test <br />Meter Release <br />FINAL <br />Etc.Notes Re <br />u <br />lrtrll.t)tiR 1t()N <br />I hcreby uffrm under pcnalty of IErjury that I m cxctrqtl frcm thc ConlracloB' Liccns Law for thc following rctrsn (5(.70.11.5 <br />Business snd Profcssion Code): Any Cily o. Counly which rcquircs a pmit lo construcl. sltcr. improve. demlish or rclair sny <br />structure. Itriq lo its issuarcc. al$ requires lhc spplicsnl for such Jrmit to filc 8 sigrcd slalemnt thal he or she is licenrcd pursut <br />lo thc Imvisions of the Conlraclor's Licensd bw (Chapler 9. Comncing wilh Seclion 7000 of Division 3 of lhc Busincss and <br />PmfcssionsCodc)orthathcorshciscxcmptlhcrefromsndlhcbasisforlhcalhgcdcrcmplion. Anyviolationofselion?0-3l.5byany <br />applicant for a pcrmir subjr-ls lhe applicanl lo a civil pcnslty of not more than fivc hundrcd dollars ($500). <br />_1. us owncr ol'lhc p(,Frty. or nry ctrrl)k)yccs wilh wngcs os llrcir solc conrlcilsali()n. will (lo lh! work ilnd lhc slrlrclurc i\ n(r <br />qb). <br />_1. as owncr of lhc propcny. anr exclusiwly conlracling wilh liccnscd conlrack)s lo .onslruct thc projccl (Scc. 7()14. Bu\iilcs\ <br />and hrrfcssim Codc: Thc Conlraclor's Liccnsc Lnw docs nol apply k) an owncr ofropcny who builds or improvcs lhcrcon. <br />and who contracts tirr such pr+cls with a Conlracto(s) liccnscd pursuanl lo lhc CoDlractrr's l-iccnsc kw). <br />I d[ crctrrnt undcr Sccti(rn-. B. & P.C. for lhis rcason. <br />Owner: <br />wonrrns' coupnns,rrrot <br />NECLARATION <br />I hcrcby affirm undcr pcnulty ofpcrjury one ofthc following dcclarations: <br />_l htrvc and will ruiilain a CenilKalc of Conrcnl t) Sclf-lnsurc lbr workcrs' con{rnsation, as l)rovidcd for by S6lio .l?(X) of lhc <br />lakrr Codc. for thc Jrcrformamc ofttrc work for which lhe lEnlit is issucd. <br />_l hilve and will mriflilin workers' compcnsation itrsu.ancc. ar rcquired by Scction 37U) otthc tihor Code, for lhc pcrtbnnancc of <br />thc work for which this pcrmit is issucd. My workcrs' compcf,sation insurancc caricr and fDlicy numbcr are: <br />f,.-i^,._ <br />Policv Number: Exoircs: <br />-l <br />certify thal in Ihe pcrforronce of lhc work for which this 6rmit is issued. I shall not employ any Frcrson in any manrcr <br />s 8s to becom subjst to lhe workeri' compcnsation hws of California. and agrcc that if I slnuU tmom subict to thc <br />work6s' compcn$lion pmvisions of Seclion 3?00 of thc tihor Code, I shall. forlhwith comply with tlbs provisions.. <br />WARNING: Failurc to surc workeff' conrlEnsalion covcraSc is unlawful. lnd shall subjecl an cmployer lo pmltics and <br />civil fincs up lo thousand dollsB ($100.m0).thc cost ()f providcd for thc <br />Scclion 1076 of interest and atrorrcy's fccs. <br />pcnillty of pcrjury that I provision oIChilllcr 9 {coilnilcncing with Scclion 7(XX)) ol t)i!'i\ion .] <br />of thc Busircss ard Profcssions Codc. and in full fore and elTat. <br />3 I <br />Licensc <br />I hcrchy rl'lirrn urxlcr lr[nhy ol rcriury lhiil <br />issucrl (Scc. .'1097. ( iv. ('.). <br />[-cntlcr's Narrrc: <br />lcnding agcncy for thc pcrfonnancc ofthe work for which this pcrrnit is <br />kndcr's Addrcssi <br />APPLICANT DECLAR,{TTON <br />I hcrchy amm undcr pcnalty of pcrjury one of lhc folk)wing dcclarations: <br />Dcmolition Pcrmits-Asbcsk)s Nolification Fcdcral Reguhlions ('l'ille 40. P{n6) <br />-Requirtd <br />I-cltcr of Nolifi calhD <br />__l rolily llhl lhc li\lcrirl rcgrrlnli{)ns rcgrkliDg r\hc\lo\ rcilrrval rrc nril applicrhlc lo lhis projccl. <br />_l ccrtify th[t I havc rcod this applicalion and stslc lhrl lhc stnve information is I agre b comply with all City and County <br />ordinances and State hws rclaling lo <br />abovc mntiored pmlrny for <br />Applicant or Agent <br />Pemitee Dsme <br />and r)l this Cily and thc <br />hls*z(7-2*.2OZO,tQ) <br />DAtel <br />Date:-