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PLUMBING.!NSPECTOR RECORD <br />APPROVALS DATE !D/SIG COMMENTS OWNER AUILDCR DELCARATION <br />I hcrchy affim undcr JEElty of pcrjury that I m excmpt fmm the Coilracto6' Liccnse Law for the following rcesn (Se.70]1.5 <br />Business and Pofcasion Codc): Any City or County which rcquires a fmil to conffruct, alt6, improvc, dcmolish or rt?air any <br />struc{ure, prbr to its issumcc, also requird th€ applicant for such pcmil to filc a signed statcmenl that hc or she is liccnsd pumant <br />to th. pmvisio[s of thc Contractor's Licen*d Law (Chapter 9, Commcrcing wilh Seclion 70fi] of Division 3 of thc Business and <br />PrefcssionsCodc)orthathcorsheiscxcmptthcrefiomandthebasisfortheallegedexemplion. Anyviolationofscction?03l.5byany <br />applicant for I pemit sbjsts thc applicanl Io a civilpcmltyof mt mrc than five hundred dollars ($500). <br />_1, as owncr of thc pmtErty, or my cmploycca with wagcs a! thcir mlc cotrrpcrstion, will do thc work and thc struc{w is mt <br />intcndcd or offercd for olc (Sc.7O44, Buircss md Prcfcssioro Code: 'l-hc Coilractor's Liccmc Law dos mt apply to m owrcr of <br />rhc pmperty wtn buildq or imprcs ttsoq ard who doe sch wo* himBclf or hcrself or thrcugh his or her own cmployecs. <br />provided that such imprcwils N mt intmdcd or oflircd for sle. If, lnwwn, th€ building or impmvcmnt is sld wilhin one )er <br />of @rphhr\ Ihc Chrns Buildcr will have thc burdm of pmving ttul h€ or she did ml huiH or irprcE the pmIEry for thc purJ[r of <br />sle). <br />_1, asowrcr of thc popcrty, am cxclusivcly contmclinE with liccnsd conlmctom to m[ctruct th€ pmjst (S(. 7044, Busircss <br />ard Poh3irnCodc:'lheCont(actor'sLicenreLawdocsnotapplytoanowncrofpmpcnywhobuildsorimprovesthersn, <br />and who mntmctsforsuchprcjcctswithaCoilmcto(s)liccnscdpursuntlotheContractor'sLicenseLas). <br />I am exempt under Setion-, B. & P.C. for this reason. <br />I )rle Owncr: <br />EASSEB!.:CA!4IjISAIIQN <br />DECLARATION <br />I hcrcby aflirm undcr lEmltyof psjuryore of thc following &clmtions: <br />I havc aml rvill n)rinlaii n (-crlilicalc of(i)nscnt to SclFlnsurc li)r sorkers' conrpensalion, ls prrvtdcd lirr hy Stction 37(ll) ol thc <br />Lahor Corlc. li)r thc pcrlbrnnnce ofth( ql)rk lirr lr'hich lhe pcfitril is issuc(l <br />_l have and will maintoin wo*ers' compeN8tion inwrance. as required by Smtion 3700 of the Labor Codc, for the pefomme of <br />thc work for which this pcmit is isocd, Myworken' compostion insuBnce mriq ard tnlicy number re: <br />Policlr Nunrher: Expires: <br />- <br />_l cedify lhat in thc pcrforrorcc of the work for which this p.rmit is isrued. I shall mr cmploy any pemn in any manncr <br />s 0s to besmc subjct to thc workcrs' compensation laws of Califomia, and agrc lhat if I should become ruhjcct to thc <br />worls' compenslion previsions of 36rion 3700 of thc Labor Code, I shall, fodhwilh mmply with lhos pmvisions.. <br />WARNINC| l;ailurc to *curc workeB'compcnsation covemSe is unlawful, and shall subject an employcr to oiminal pemltis and <br />civil fincs up to orc hundrcd rhousnd dollaN ($100,000), in addition to the cost of compcnslior\ damges as providcd for thc <br />Scclion 3076 of thc LatDr Codc, inlcrcst and attonEy's fe. <br />I I hcrcblaflimundqpcmltyofp.rjury .l <br />of the Bu3iness and Prcfessions Codc, and my licensc is in full force and efTect. <br />Liccnse <br />Drtc: <br />Class:-Liccnsc Numbcr: <br />- <br />( 0nlrxtl0I <br />CONST'RUC'I'ION LI'NDINC A(;ENC}' <br />I hereby amrm undcr penally o t perjury thal lhere is a conflruct ioil lending a8ency fi)r the perfornrance of lhc work fi)r which I his pertnil is <br />issued (Sec. 109?, ('iv. C.). <br />Lender's Name: <br />Lender's Address: <br />AfIIJCANLIIECTAEAITQN <br />I tmby allinn undt'r penalty ofperjury one of the follou'ing declarations: <br />Demrlition I'ermits-Asbestos Notificalion l;edcral Regulations ( l itle 40. Pan6) <br />_Required l-etter oINolifi crlion <br />-l <br />cen ily that the lederal rcgulati<tns regarding ashestos relnoval are nol applicable tr lhis projecl. <br />_l cenify rhil I t!1ve ref,d this applic.lion aftl state thnt the ah)ve inform.tion is corect. I agrE k) comply wilh all Cily and (-ounty <br />orclinances and State l-nws relating to building construclion, and herehy authorize representalives ofthis City rnd Counly to enter upon lhe <br />ahove mentirued prepeny for insprc(hn purJmses. <br />Appll(ant or Apent Slgnsture:_ <br />Permltee nsme (prlnl) _ <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <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 />Sanitarv Sewer/Cap <br />Back Flow Device <br />I <br />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release rl .zlt <br />F!NAL n 7 '71)E <br />Notes, Remarks, Etc v <br />/ <br />b-11,-lV <br />tMl-r I