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PLUMBING.!NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND I <br />Waste & Vent o <br />7r A./'/ALyp / <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouoh 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 />Sanitarv Sewer/Cap <br />Back Flow Device <br />lt <br />Rouqh Plumbinq t,-1 (.( t/|Afu ) <br />Final Gas Test I <br />Meter Belease I I -^AI <br />FINAL '/o )/rqtlh 'L+Y67 <br />INete5, Remarks, Etc. <br />,W Y- <br />a <br />OWNER BUILDER DELCARATION <br />I hercby lffrm undcr lrcnslty of JErjury that I m exempt fmm tlE ConlrBcloF' Licenrc [:w for rhe following rcason (Se.7031.5 <br />Business ard hofcssion Code): Any City or Counly whkh rcquircs a 1rctmh lo conslruct. alter. impmvc. dcnmlish or epuir uy <br />structure. prior ro its issusrce. aLrc rcquircs the applicsnt for such Frmit lo file a sigrcd statemnt that he or shc is liccnrcd plNel <br />to the pmvisioN of thc Conhctor's Licensd Law (Chaplcr 9. Commrcing with Section 7000 of Division 3 of thc Busincss and <br />Prcfcssions Codc) or that hc or she is cxcmpt tltcrcfrom and lhc bosis for the alhgcd excmption. Any violation of Setion 7O.l 1.5 by any <br />applic8nt for a pemit subjtrls the applicant to I civil penslty of nol mrc the five hundred dolles (5500). <br />-1. <br />ils orincr ol'lhc p(rpcrly. or rny cnlployccs rvilh ulgcs rs thcir- rolc corrpcnsrlion. will do thc rvork arl thc \lrlrclurc i\ rrrl <br />\xlc I <br />-1. <br />as owrcr of the pmtErly. am exclusively controcling wilh licenrcd conl.aclos lo conslruct thc Eoj$t (Ss. 7(N4. Eusincss <br />.rd Prof6sionCode:TheContmctor'sLicenseLawd@snolapplytoonowncrofpro[Enywhobuildsorinrprorcsthcrcotr. <br />and who contBcts for such pmFs with a Coilmcto(s) liccnsd purswt lo lhc ConlEclor's Licensc Lnw). <br />-l <br />mcxcmDl uoder SEIion-. B, & P.C. for this rc&son. <br />()* ner <br />WORKERS' COITIPF'NSATION <br />DECLARATI(IN <br />I hercby affirm undcr lEnahy ofpsjury one of the folk)wirg dcclnrations: <br />-l <br />havc and will roinlsin a Certificate of Conscnl b Sell:lnsurc ltrr workcrs'compensution. as providcd for hyScction -17()() of lhe <br />Labor Codc. for thc pcrfornunce ofthc work tbr which lhc pcrmit is issucd. <br />_l have ond will muintain workcrs' conrpensalbn insurancc. rs rcquircd hy Scction -3700 ofthc LJbor Codc. l(,r thc pcrlb.munce of <br />thc work for which lhis pcrmil is issucd. My workcrs' conrpcnsalion insuroncc canicr and Jxrlicy numbcr uc: <br />Canicr'- <br />Policv Nunrbcr. Exoires: <br />-l <br />ccrtify thst in thc [Erformrce of the work for whhh this Jrcrmit is issucd. I shall not employ any FErson in any murcr <br />m !s to bcclm subjst to the wortrs' comlEnstion laws of Colifomia. and sgN lhat if I slhuld bccom suhFct lo thc <br />workss' ompcnsation pmvisions of Sation 3700of thc Labr Codc. I slEll. forthwilh comply wilh lhos previsions.. <br />1{ARNING: Failurc to rccurc workcrs covcmgc is unltru'ful. rnd shall subtct an cnrpkryrr to crirninal JEmltics and <br />civil fincs up lo onc hundrcd thousand dollars in a(ldition t0 ds proeidcd for thc <br />Sccti{rtr 107() ol lhc [][I)r Codc- irilcrcst <br />t)t,r't.,\tr.\ il()\ <br />I hercby aftirn undcr pcnslly of pcrjury thal I anr licen*d under provision ofChaptcr 9 (comnrcncing with Scctiotr 7Ux)) of Division 3 <br />o[ the Business and Prcfcssions Code. urd my license is in full forcc erd effccl. <br />Liccnsc <br />I hercby affrm under pnahy of perhry thar th@ is I <br />issucd (Se.3097, Civ. C.). <br />hnding ogcncy for thc Jnrformrcc of thc work for which lhis lErmit is <br />[*ndcr's Namc: <br />[rndcr's Addrcss: <br />A.P]IJI;ANLDECJ.A.BAIIAN <br />I hcrchy trllinn undcr pcnnlty ol pcrjury o[c of thc Iollowing dccldriltiorls: <br />Dcnx)lilion ['crmits-Ashcstos Nolilicatiotr Fcdcral Rcgulrtions (l itlc {0, t'trr1(,} <br />-Rcquircd <br />[,ctlcr ol Nolilication <br />-l <br />cenify lhul thc l'cdcral rcgulations rcgarding ashcsms rcrmval arc not applicablc t, lhis projcct <br />ard stalc lhal lhc 0hlvc information <br />Perylfe <br />constructbtr. xfll <br />4 <br />a <br />Dste:_ <br />f OZcat <br />*,"7-(^/Q,