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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS otvNlitt lr t I I l.DI|R I)l,ll.('A RA'l'l( )N <br />t hercby sffum undcr Fnslty of pedury thal I m cxen?t from lhc ContrcloB' LLw Lrw for thc following mwn (Sc.7031.5 <br />Busin$s rrd Profcssion Codc): Any City or County which requircs s pcmil lo onstruct. 8116. itr{rrcrc, dcmlish or qdr my <br />structurc, prhr to its issure. sls rcquircs thc spplicmt for such ;rmit to lile 8 signed strtercnl lft8t hc or stE is liensd Pusant <br />ro the ,f,ovisiotrs of t|! Conlrctor's Lictnsd Lrw (C-haprcr 9, Commrcing vilh Sation 7000 of Divisbn 3 of lhc Busircss od <br />Pmfcssions Code) or thsi hE or shc fu crcmpt th@frcm rnd thc bosis for thc Ellcggd excmplion. Any violstion of Scclion 703 I .5 by 8ny <br />tDplic8nt for 8 permil subjlrts the applicant to s civil penslty of not mrc than live hundrcd dollrs ($500). <br />ffi u on* orrhc prcFny. or my emph)rcts with wagcs ss their rclc ompsrsslion, uill do the wt utd thc stndrc b Dt <br />l'ln-.tendcd or ofrcrcd for sle (Sc.7O44. Busincss md Professions Codc: The Conlraclor's Liccns lrw docs not spply ]o 8n owner of <br />tlE lrclraty who builds tr in$m6 thcpn. rnd wl[ dc sh rc* himsclf or herslf or lhrcugh his or hcr own cmplolrccs. <br />prcvkledrhrtsEh imFowGnlsNmtintqrdedffollcEdftrslc. lf.howcg.tlEhriHirgmitrTtrecnrissldwhhhorc)r <br />of @trpbliotr the Owrcr Builtcr will h8rc the burdcn of Foving thd hc or shc dil mt boiH or itrptoE thc trclqty for tlE PulIs of <br />sle). <br />_L as owns of the propcrty. am exclusiwly @ntlactiog wilh liensd contGlor to o[ttruct lhc prc]r-l (Sa. 7044. Busircss <br />rnd Ptofssi,n Code: The Contrrctor's License kw dos not apply to m owner of prcpcrty who buildr or imPrcvcs thqeoft <br />rnd who contmts fd iuch pmixts with s Contrscto(s) liensd puEut to thc Coilnctor's Lhcos [5w). <br />_l,am cxcrnpt B.& <br />()r'ner: * <br />I hcreby affirrn under Fnalty of Jrcrjury onc of the following <br />_l havc and will tnaintain u Ccrtillcatc of Consclrt to .Sclt-tnsurc li)r workcrs'conq)ensillion. as pn)vidcd lbr by Sccliott 37fi) ol'thc <br />t-abor Ctxlc. t'orthc pcrlirrrrurrrcc oIthc work for which thc pcntrit is issucd. <br />_l havc 1n<l witl nlaintain workcrs'cotnpcnsation insurancc. as rcquircd hy.sccliott -17(X) of thc l,ahor Codc. for thc pcrf'ortnancc of <br />thc work ltrr u,hich this pcrnrit is issucd. My workcrs' corlrpcnsution insurancc can'icr alxl policy nutnhcr iuc: <br />in thc pcrfr)rmanceo[thc work for which this pernrit is issucd. I shall not cmploy any person in any manncr <br />if I should bccomc subjcct to thc <br />conrply with thosc provisions.. <br />subject to thc workers'compensation laws of Califcrrnia. and agrcc that <br />workers' compensation provisions of Sc.ction 3700 of thc L.rrhr Codc. I shall. forthwith <br />WARNING: Faiturc to securc workcrs'corrrpcnsation covcragc is unlawful. and shall subject sn cmployer to criminu! Jrenalties and <br />civil fincs up to onc hundrcd thousand dollars ($l00.un). in addition to oI damages as provided for the <br />Scclion 1076 of Codc. intercst and attorney's fecs. <br />o 2{2o o <br />I <br />I hcreby affirm undcr pcnalty of perjury lhat I am licensed under provision Chaptcr 9 (cornmencing with.Scclion 7000t of Dlvision 3 <br />of thc Business and Professions Code. and my license is in full force and cffcct. <br />t, <br />l)lrlt'. ('tlltlritclttr. <br />CONSTRUCTION LENDTN(: AGENCY <br />I hcrchy nllirn undcr lrcnllly ot pcrjury rhar therc is a construcrion lcndirg a8cncy lbr lhc p(rfornuncc oflhc work for whhh lhis trcnnil is <br />issucd (Scc. 1097. Civ. C.). <br />Lcndcr's Addrcss: <br />APPLICA NT DIICLARATION <br />I h'rcby itflinrt undcr ;rcnalty of Jrcrjury onc of thc following dcclarations: <br />Dcmolition Pcrntits-Ashcstos Notification Fcdcral Rcgulations (Titlc 40. Part6) <br />-Rcquircd <br />Lrttcr of Notilication <br />_t ccrtify that thc fcdcralrcgulations rcgarding asbcslos rcrnoval urc nol applicablc to lhis project. <br />f?Accnify that I havc rcad this application arxl statc rhar thc atnve infirrmatiolt is correct. I agrcrc to comply <br />%rdinances ancl State l.aws rclating to builcling conslruction. and hcrcby aulhorizc rcprcscntatives of this City <br />with all City and County <br />antl <br />atxrvc rrrcnliorrcd propcrty for irrspcction <br />Applicanl or Agent <br />l)t nrrilee nirnre <br />t -- <br />cnlcr <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf !oor <br />Buildino Sewer <br />ArealStorm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipino <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Itlain Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heaterlcas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sorinkler <br />Sanitarv SewerlCao <br />Back Flow Device <br />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release rl D. <br />FINAL ll 11l-h)T*W,,"1 <br />Notes, Remarks, Etc.- I <br />ll 11 l'?,0 Fro %a L€Altrv t> L'K1r1r'69 , <br />ffiW\/61 I =-DI+J+W-L <br />\ <br />Date: J <br />t3 <br />a