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PLUMBING.!NSPECTOR RECORD <br />APPROVALS DATE !D/SIG COMMENTS OWNER AUILDER DELCARATION <br />I hcrchy affirm undcr [Enalty of Frjury that I m erempl fmm the Conlraclors' Licens kw for the following rcason (Sr.70.31.5 <br />Business and hofcssion Code): Any Cily or County which rcquircs a Imit Io @nslruct, alter. imprcve. dcmlish or rcpair any <br />structurc, prirr to its issusnce. also rcquires lhe applicanl for such Frermit lo filc I sigred statemnt that hc or she is licenrcd pursuanl <br />lo the prcvisions of thc Contnctor's Licersd txw (Chapter 9. Commencing wilh Section 7000 of Division 3 of thc Eusincss and <br />PrcfcssionsCodc)orthathcorsheiscxemptlhercfromsndthcbasisforlhcallegcderemplion. AnyviolationofsrctionTO3l.5hyany <br />applicant for a pcmit subjects thc applicsnl k) a civil pen.lty of not mrc lhan fivc hundred dollss ($50O). <br />_1. as owrer of the prcperly. or my employees with wages as lheir slc conlEnsdion. will do the wot 8rd the stMtw is mt <br />interded or offercd for sle (Ss.?044. Business and Professions Codc: The Contmctor's Licens lxw d(Es not apply to an ownct of <br />the polErry who builds or irn{mve 0mn, and who des ruch wort himself or her*lf or lhmugh his or her own employees. <br />provided rhat such impmrcmnts m ret intended or offered for sb. lf, howcw. the boiHins or imptftmnt is sH withir ore )Ee <br />of corphtion, the Owrcr Buikhr will harc tlE burden of pmving that h€ or shc did mt buiH or impmrc the prcFmy for the puqrs of <br />sh). <br />_1. ts owncr ol'thc prcpcny. am cxclusively conlr&clilg wilh licenscd conlraclors lo con\lrucl lhc proFcl (Scc. 7()14. Busirrcrs <br />tlxl PNfcssinr C(xlc: 'l-he Contrnctor's l-iccnsc Law (krcs not apply b nn osner ofpropcrly who builds or inrprovcs fhcrcon. <br />and who conlracls li)r such projccts wilh fl Colilrack)r(s) liccnscd pursuxnl lo lhc Conlract)r's l.iccnsc hw). <br />liln|cxcD|DtUndcrsc.li(nl-.B.&P,C.li)rthisrclson, <br />ITQE6EBLI]QMfIN&IIIAN <br />DECIdBAIIAN <br />I hcrcby affirm undcr pcnalty of Jrrjury orc of lhc following declarations: <br />_l harcanrlwill maintninoCcnillcntcofConscnlk)Scl['llsurcli)r$1nkcr\'conllEn\ilion.as fovi(lcdli)rbySccti(tn.l7(X)oflhc <br />Lak)r (i)dc. f(tr thc pcrli)riluncc ol lhc work li)r which lhc pcilnil i\ is\uc(|. <br />_lhavcandwillmaintainworkcrs'compensalioninsurrncc.as requircdbySclion-17fi)ofthctiborCodc.forlhcperfomurccof <br />tlE work for which this permit ir issued. My workers' compcnsulion insurance carier &rd plicy numbcr m: <br />Policy <br />_l ccnily lhat in lhe pcrforronce of lhc work for which this lErmit is issued. I shall nol employ any FErson in any munner <br />$ as to bccom subjcct lo the workcrs' compensation laws ofCalifomis. and agre lhal if I stnuld tHom subjctl lo lhc <br />worktrs'comlEnsalionprcvisionsofScclion3T0OoftheLrborCodc.lshall.fonhwithcomplywiththosprcvisions.. <br />WARNIN(i: I;tilurc to *curc workcrs'compcn\dtion covcrrgc is unlawtirl. aml shall suh.icct an cnrploycr lo critninal Jtnnltics and <br />civil lincs ul to onc hundrc(l thorsund dollrrs ($l{X).(xX)). in addilion lo thc cost ofcompcnsalion. darnagcs as frovi(lcd lbr thc <br />Scclioil 3{)7(, of thc l-xh)r Codc. inlerc\l ond atkrrncy's fccs <br />I ICENSED CONTRAC'TOR <br />UECLABAIIAN <br />I hcrchy nflirm undcr pcnxlly of Frjury lhat I anr licenrd undcr provision of Chaplcr 9 (cotrnncncinS wilh Sccliotr 7(XX)) of Divisiil -i <br />of thc Busincss and Proltrsions (iilc. aml my Iicensc is in full lbrcc ud clfccl. <br />Liccnsc Chss:-Liccnsc Nunlhcr: <br />Contrsclor:__ <br />CONSTRUCTION LENI)ING ACENCY <br />I hcrcby rlllrnr undcr Frcil0lty of pcrjury that Ihcrc is d constructk)n lcnding {gcn(y li)r thc Jrrfonnancc of the work for s'hich lhis frcrmit is <br />issucd (Scc. .1097. Civ. C.). <br />Lxn(lcr's Namc: <br />- <br />lrndcr's Addrcss: <br />AfIIICANIIECI.AM.IION <br />I hscby affmundcr penally of perjury onc of the folhwing dGleetions: <br />Dcmlition Pcrmits-Asbestos Notification Fcdcral Rcgulations (Title 40. Part6) <br />-Rcquircd <br />kltcr of Notifrcatkrn <br />-l <br />cenify thal thc fcdcralrcgulalions rcBarding asbcslos rcnrvalarc not spplicablc lo lhis proFcl. <br />_l ccrtili thut I huvc rc[tl this application an(l slrtc thrt lhc ahrvc inlbrntrlion is coffccl. I aSrcc h conuly wilh all ('ily and Counly <br />()rdinnnccs nild Stalc Irws rcltling to building constrctbn. ind hcrchy rulhorizc rcprcscnlrlir'cs ol this City and Counly lo cntcr ufon lhc <br />atx)vc nr0ti()[cd propcny for inspccli()n purp(,scs. <br />ApplicHnl or Agent Signslure: <br />Pemiae nrme <br />l)nlc <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildino Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rouqh 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 />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release I <br />FINAL 7 /,2-T/llf 49.t t <br />Notes, Remarks, Etc /v <br />l)slr: ApplitnDl: