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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS olvN[:R l]tIt,t)ER t)Et_( ARATl()N <br />I hcrchy rlliur undcr pcnahy of rcrjury lhut | ilrn cxcnrpl liotrr lhc Conlraclor\' l-iccnsc l;rw lirr thc lblh:wing rcason (Scc.70.ll.5 <br />Rusincss ilr(l P()ltssion Codc)r Any City or Counly which rcquircs a pcrnril to cotrstnrct, rhcr. itnnrovc. dcm)lish or rcpair nny <br />slnrclurc. rior lo ils i\{uancc. olso rcquircs lhc'rpplicnnl lirr such l[rnlil lo lilc r signcd statcnrnt thit hc or shc is liccn{cd lursnrnt <br />lo lhc frovisions ol lhc Conlrrct)r's l-iccnscd [-rw (('huplq 9. Coi]nrcncinA with Secli(,n 7(XX) ol Divisi(,n .l ol thc Busincss xnd <br />Prolcsst)0sCodc)orlhutlrcorshciscxcmpllhcrclionlilndlhchasislorthcallcgcdcxcnlption. ADyviolati(,nofSccrion70.ll.5hyilny <br />npplicanlforafcrnrit\uhjcclsthc applicrDltoocivilpcorltvofnotilx)rcthxilllrchnndrcddollars(S5(x)). <br />-1. <br />as owrcr of lhe prcFrty. or my cmployes wilh wages as thcir slc @mpenstion. will do the wmk ard thc stnr'tre Ls mt <br />inlended oroffcredforsh(S4.7(X4.BusincssandhofessionsCode: TheConlrsclor'sLiccn$kwd@snotapplyloanowncrof <br />thcpmpny whobuildsorinprcrcsthcmn.ardwhodcs$chwo*himsclforherslforlhmughhisorhcrownemployccs. <br />providcd thal such impmremnls m mt intcndcd orolTcrcd for slc. lf. howcwr, the tuihing or ingrrovcmnt is sH within onc }ee <br />of cotr{rhlion. lhe Owrcr Buildcr will hsvc the burdcn of proving that hc or shc did not build or ir[,rovc thc pmfrcny for th€ purlb$ of <br />slc). <br />-1. <br />as opM oIlhc [mIEny. am crclusivcly contmctinB wilh liccnicd conlEclos to construct llt prcirt (Sec. 7044. Busirc$s <br />lnd Profission Codc: Thc Contractor's Liccnse Law does nol apply to an owncr of propcrty who builds or improves thercon. <br />ond who contractsforsuchpmjcclswilhaConlEclo(s)licenscdrursuonltothcContractor'sLiccnsekw). <br />-l <br />trm cxempt undcr B. & 1'.(1. for this rcason. <br />I )rlc: <br />1I'(IRKI.]RS' CONI PI:NSA'I'ION <br />IIt,'CI 4,RITTION <br />I hcrcby allirm undcr pcntrhy ofpcrjury onc ofthe following delartrtions: <br />l-ak)r (ixlc. Iitr thc pcrlirrnuurc ol lhc {r)rk lor sltich thc pcrmit i\ i\\ucd. <br />-l <br />havc <br />lhc work <br />and will nuintain Section .l7U) of thc kbor Code. for thc pc'formrce of <br />canicr ard Jxrlicy numbcr m: <br />Policy <br />g 6) <br />-l <br />ccnify lhal in lhc tf,rformrce of lhc work for which lhis pcrmit is issucd. I shall nol cmpk)y 8ny pcmon in any manner <br />so ss to hcconrc subjecl to thc workcrs'comlcnsalion laws ofcalifornia. snd agrcc th.t ifl should becorc subjet to the <br />workcrs'compcnsalionpmvisionsofScction3T0OofthctihrCr'dc. lshall.fonhwithcomplywilhthospmvisions.. <br />WARNING: Failurc to scurc workcrs'compcnsalion covcrage is unlawlul. ud shall suhjcct an enploycr lo oiminal lEElties and <br />civil fincs up to ore hundrcd thoussnd dolles ($l tn l() thc of compcnsation. dam{gcs as provided for thc <br />Sccli(n 3076LI of latxrr intcrcsl andq <br />I hcrcby allrm undcr pcn{lty ofpcrjury thal I am ofChoptcr 9 (comrmncing with Scction 7000) ofDivision 3 <br />of lhc Busincss trnd Prefessions Code. ud mv license is in full forcc and cffect. <br />Liccnsc 36 <br />Ir 4, <br />I hcrcby alfirrn undcr Fnalty of pcrjury lhat lhcrc is a construction lcnding agcncy for thc Jrcdormancc of thc work for which lhis Frnlit is <br />issucd (Scc. 3097. Civ. C.). <br />Lcndcr's Nanlc: <br />[rntlcr's Addrcss: <br />i\PPLICANT DECI ARA'TI(IN <br />I hrchy allirut undcr pcnrlly of pc{ury rrrc r)l lhc folkrwinE dcclilratt)trs: <br />l)cn()lition Pcrnrils Ashcstos Norillcotion Fcdcrtl RctUlati(ns ( l irlc 41). Part6) <br />_Rcquirc(l [-cltcr ol' Noliliciltiul <br />_l ccnify th8t thc fedcral rcgulations rcgffding asbcstos rcmvd ec nol applicable to this pmjcTl. <br />_l ccnify thd I have read this application atx| slatc that the atnvc infornution is corcct. I with all City and County <br />ond County to cnler upon lheordinanccs and Statc l,aws rclating <br />above mntioncd pm;rcny for <br />Appli(rnl or AgeDt <br />Pemrite€ <br />c()nslrncli()n. nnrl <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 Pipino <br />Gas Piping <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 />Rouqh Plumbinq <br />Final Gas Test <br />Meter Helease tl <br />FINAL 4n"lz:'l>kttl,L tt-w <br />Notes. Rerparks, Etc. I <br />tt <br />lt ltvltq - -n cl (l - > */r)<rL +\-7III <br />s/t b-a <br />4r' <br />l)illr <br />*,", l/(>4q <br />!L"