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PLUMBI NG.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS ( )\l', N t.:tt tltr I l,l) litt l) 1,. l.('..\ ll,\'l l( ) N <br />I hcreby aflirm undo poalty of perjury lhat I dn exempt from (he ConlradoE' Licosc Larv for the follou'ing re3en (Ss.?01 1.5 <br />Businss and Profsion Code): Any City or Coonty \r'hich requirc a pmir to construct. altq. improvq dcmiish or rqhil any <br />shlctulq pdor to its isuance. also requirs the applicanl for such FEnnit lo file a signed statement that he or shc is licenscd ptmuant <br />te thc Fovisions of lhc Contractor's l-icenrd Law (Chapts 9, ('omnencing N'ith S(tion 7000 of Dif ision I of lhe Busincs and <br />Pmfesions('odc)orlhatheorsheiscremptthrcfromandlheb6sisforthcallegcdexonJ,tion. AtryviolationofsectionT0Sl.tby8ny <br />applicantforapmitsubjctslhc applicanttoacivilpcnahyofnotmorcthanfir'e hundeldollus($500) <br />A. *, osne of lhe popeny. or my employm sith $s!6 as their $lc cornpqstion. rvilldo thc trcrk od lhc slrucim is not' intmdql or offqcd for sle (S(.7044. Businss and Pref6sions Code: I hc (bntraclor's l-icms lalv do6 nol apply lo an orvf,s of <br />thc trolEty s.ho huilds or inrJrevs thmn. and rvho do6 srrch rmrt hinself or herslf or th.ough his or hs own employed. <br />prcvidedlh0tsuch imlnovqlmtsrcnotintadqlorofllrqlformlc. lf.horvqs.thebuiHingorimprovemcnlismldrvithinone)ry{ <br />ofcompletion. thc o$'no Builds rvilt have the burdm ofpo|ing that hc or shc did not birild or impro\r thc Impoty for thc puryxrr of <br />sle). <br />_ _l.asoNn6oflhetmpoty.anexclusivelyconlrscting\rithliceilsdconlracloNloconslrucllhcprojEt(Sc.7M4. lltrsins <br />and hrrltssirnCode:'l'he(bntraclor'sl,icenscLarvdosnotapplytoano\r'nqofpropertyrvhobuildsorimprovGlhdeon. <br />and $ho conlracls for such ltrojsls \r'ith a Contracto(s) licffil puBuail lo lhe Contraclor's Licse krv). <br />- I arn e.\ctnpt undcr Scction . ll. & l'.('. lirr <br />Drr". .C- X- l7 <br />I hereby affirm under pmalty of perjury one of the follorving <br />_ I haye ancl rvill rnaintain a ('ertificate of Consent to Self-tnsure for \\'orku's'compeflsation. as provided for by Section .1700 of the <br />labor ('ode. for the perfonnance of the \\'ork for rvhich tlre pcnnit Ls issued. <br />t havc antl s'ill maintain \\'orkers' conlpensation insurance. as required b),Section .1700 of the l.abor Code. for the perftrnnance of <br />the rvork for rvhich this perrnit is issued. My s'orkets' conrpensation insurance can'ier and gxrlicy number are: <br />( 'rrr r icr <br />Policy l:rl'itt's <br />|Ar*iS that in the performance of the work for which this pennir is issued. t shall not employ any person in any manner <br />so as to become subject to the u'orkers' compensation laws of California. and agree that if I should become subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code. I shall. forthrvith comply with those provisions.. <br />WARNING: Failure to secure workers' <br />civil fines up to one hundred thousand <br />and <br />the <br />Section 3076 of the Labor Code. interel and attorncy's fecs. <br />orr", (- r0-T- l7 o <br />I hcreby aflirm under penalty of perjury that I arn licenscd of Chapter 9 (cornmencing with Section 7000) of Division .1 <br />of the Business and Professions Code. and my license is in full force and effect. <br />\, <br />II.iccrtst' Ntnttt'ct:I . iccrrsc ('lirss: <br />('orrlractor:I <br />('0NS'l'Rl,lc'l l0N l,ENplN(; AGEN('\' <br />I hcby a{Iim undo penslty of psjury that lh6e is I construction lmding agmcy for thc pcfommcc of the work f(,r shich this ]Elnit is <br />isstrctl (Scc. 1()()7. ('it. ('. ). <br />l.crrrlcr 's Nittttc: <br />Lender's Address: <br />AfIIICANLDECI.ABAIION <br />I hqlty afm unda poahy of pctjury onc of thc follot'ing dclratioro: <br />Dcmolition Pmils-Asb6tos Notification Fcd6al RcEul.iioN (Thlc 40. Pill6) <br />-Rcquircd <br />lrtto of Nolificatioo <br />-l <br />cqtify lhal thc fedaal rcgulstioN tl?Eding cbetos rmoval rc not @plicablc to this pmjcr. <br />Pl& "otiry <br />tf,a I havc red this application and statc that thc above infonnation is corcl. I agr@ to comply withall City and County <br />ordimnc6 8d Statc t s alatirg to building cordruc{ion. od h6cby authorirc rcpt6snativ6 of this City ud County to mtq upon fir <br />above mentioned property for <br />Applicnnt or Agent <br />Permilee nanle <br />orr", '6-ZY tr <br />UNDER GROUND <br />Waste & Vent o lzt 1,">FS t*l /a? <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />ArealStorm Drain <br />I nterceptor/ CIa rifier <br />TOP OUT <br />Waste & Vent Llr- /ra ,V< t>tt ,arA, <br />Water Pipinq <br />Gas Piping glnlrt Drkdloi <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/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 />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing ilu ltr,,wP lo9 <br />Final Gas Test <br />Meter Release I -^, <br />FINAL <br />Etc.Notes Remarks <br />( <br />( )rl ner: <br />Z <br />ftz^n,ria.^tkzry