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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS (,l.. t:R RUll,t)ER l)1,]t,CARA'ilON <br />ilpflicilnlli)rnpctrnit\ulljcclslhc ilpflicilnlloacivillcnahyolnotnxircthilnlivchundrcddollxrs(55(X)). <br />-1. <br />as owrcr of lhe pmIErly. or my employees wilh wagcs as their sh cotrUEnsation. willdo tlt work and the stffitrc is mt <br />intcrdcd or offercd for slc (58.7044. Busircss snd Professions Codc: The ContrBctor's Licensc Lsw docs not apply to on owncr of <br />lhcprcIErty whobuildsorirTrrcvesther@n.mdwhodocssuchworkhimsclforhcrselforthroughhisorherownemployecs. <br />providcd that such imtmvercnts e mt inlcnded or offered for eh. If. lmwcrci thc boilding or itrpmrerent is sU within orc Fn <br />of corplclion. thc Owrer BuiHs will havc thc burden of pmving that hc or shc did mt huild or imprcvc thc pmfrcrty for thc purlns of <br />sle). <br />-1. <br />as owner of thc pmpelly. amexclusively contracting wilh liccnscd conlractos to consrruct lhe pmj$t (S(. 7044. Busincss <br />and PDfessbnCode:ThcContmctor'sLiccnscLrwdGsnolapplyloanowncrofproperlywhobuildsorimprovcsthcrcon. <br />snd who conlmclsforsuchprcjcclswilhaContEctor(s)licensdpursu8nltothcContmctor'sLicenscLaw). <br />-Iamcxemptundcrsfftion-'B.&P'c.forlhisE8on.Dsle:_Owner:_ <br />WORKERS' COIIIPFNSATION <br />DECI.ABAIIAN <br />I hercby aflirm undca [Enahy of pcrjury one of thc k)llowing dccluat ions: <br />-l <br />havc and will ntainlain a Ccrlifictrlc of Conscnt lo Sclf-lnsurc lbr workers' comFnsalion. as providcd for by Sstion 3700 of lhe <br />latxrr Code. for thc pcrforroncc of thc s'o* for whirh lhc pemit is issued. <br />_lhavcandwillnuintsinworkcrs'conrpcnsrlioninsurlncc.as rcquircdbySccthn-17fi)ofthet,oborCodc.forthcpcrformnceof <br />lhe work which pcrmit is issucd. My compcnsnlk)n insurancc can)t <br />Lo <br />and plicy numbcr rc: <br />,/a l3 <br />Policy N sTSb <br />_l ccnify that in lhc pcrfornuncc of the work for $'hich this lcrrlil is issucd. I shall not cilrpby lny pcrson in uny manncr <br />so x\ lo bccotrr suhjccl lo thc workcrs'conrpcn\rlion laws ofCnlifornid. rtrd agrcc lhrl if I should hccoillc suhjcct h lhc <br />workcrs corrwnsrtion provistrns ofScction 37(X) oflhc Latnr C(xlc. I shilll. lorthwith contply silh thos p()iisions.. <br />WARNING: Fnilurc b rccurc workcrs'compcnsalion covemgc is unlawful. and shsll subjsl an cmplo}tr to oiminal [rmltk$ and <br />civil fincs up to onc hundrcd thousand dollars (S|0O.UD). in addition to rhe cosr of dsmges 8s provided for thc <br />S&tion 3076 of Codc.and attorrcy's Iccs.2f <br />ol- thc Busincss rnd Proltssiurs Codc. arrl nrv liccnsc is in l'ull li)rcc ilnd clfccl <br />"L36Liccnsc <br />I hcrchy all'irrl undcr Jrnalty of pcrjury lhilt thcrc is a construclion <br />issucd (Scc.3097. Civ. C.l. <br />agcncy for thc Frformancc of the work tor which lhis Frmit is <br />Lrndcr'. Nunrc: <br />Lcndcr's Addrcss: <br />APPLICANT I)I'CLARAIl(IN <br />I hcrchyallirrrundcr pcnrlly ()l pcriury onc ol lhc li)lk)wilg dcclilrnti(,ns: <br />l)eilr)lilion ['crnrils-A\bcslos Nolilic{lk)n Fcderrl Rcgultlt)ns ( l itlc 40. Ptrl6) <br />_Rcquircd I-ctlcr ol N(ililicrli(nl <br />-l <br />ceflify that thc fedcral rcgul8tions rcguding asbc.tos rcmvalarc not applicabh to this pmj$r. <br />-l <br />cenify that I havc rcad this applicalion ed strle th6t thc rbovc infonmtion is corccl. I agr€ to comply with all City snd County <br />ordinances and Slatc llws rclaling to building drl oflhis Cily lnd Counly lo cnlcr ulnn rhc <br />D*- i1/2>l?atrrvc nrcntioncd propcny lbr <br />Applicont or Agent <br />Pemritee nrme <br />'n t^c <br />---7-l-L <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <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 />It/ain Drain/Pool Pipino <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 Plumbinq <br />Final Gas Test <br />Meter Release tl <br />FINAL 2 lot 7d D*v ot 1-kn <br />Noteg, Rgmarks, Etc.JI <br />Ittl nlfi- * clfl - l>ffn2,n-.*F,7 <br />I ,I 'U <br />Dsle: <br />Dster-