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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent \ <br />Water-Underfloor \ <br />Gas-Undeffiosr Q ro,**/) -E-a)/YR-\)-- <br />Building Sewer tt <br />Area/Storm Drain <br />lnterceptor/ Clarifler <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipeing <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />( <br />POOUSPA R.- <br />P-trap/Drain Line ^l -Eas V2/U <t-- <br />Main Drain/Pool Piping l)T4).LYk)* <br />Fill Line/Back Flow 7+7-6 <rqD <(>- <br />Pool Heater/Gas Line )et)b ),)fu-2L- <br />LV <br />Misc <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing t/ <br />Final Gas Test / b7/03 .h//lD (z- <br />Meter Release lt V <br />F!NAL 9-lo- 2o *hD)o> <br />Notes, Remarks, Etc. <br />Owncr-Buildcr Dalration <br />I hrcby aftim unda padty of pcdury thst I m cxmp fm thc Cmtrrctotr' Liccruc Law for thc following rcsotr (!cc.r0315 Buinas <br />sd Profc$ion Codc): Any City or Couty *hich rcquircs a pcmit to consruct, altcr, improve, dcmolish or rcpair my structw, prior ro it! <br />issuucc, also rcquire thc applicut fc such pmit to filc a rigf,cd statcmmt thEt hc or rhc is liccnscd pursuut to th€ proviliw of thc <br />Contractor's Licmcd Law (Chaptr 9, Comacing with Scction 7000 of Division 3 of thc Buincas ud Prof6siom Codc) or that hc or <br />shc is cxmpt thcrcfiom md thc bris fc thc allcgcd cxmptim .Any violation of Scction 7031.5 by ey applicilt fu a pmit subjccts thc <br />applicmt to a civil pa,alty ofnot morc the livc hmdrcd dollm ($500). <br />_I, u ownc of thc propcrty, o my mployc with wage u thcir iolc cmpmsedon, will do thc work md thc structre i! not intmdcd <br />or ofrmd fc salc ( Scc.7044, Buitres md Profasions Codc: Thc Contr@tor'! Licosc Law dm not apply to m owna of thc prcpcrty <br />who builds u impovs th@n, ud who dG such work hiruclf or hmclf u thrcugh his r hcr own mployce, providcd that such <br />improvmmts e not intodcd or offacd fq s8lc. If, hwcvq, thc building or improvmat is sold within onc ycu of complaion, thc <br />Owns-Builda will have tlrc budo ofprcving that hc or shc trot build or improvc for thc purposc ofsslc). <br />_I, s omc of thc propcrty, m cxcluivcly contrrcting with licorcd conrrcton to cwtruct thc prcjcct ( Scc 7044, Buine ud <br />Profasim Codc: Thc Cmrrctq's Limc Law dm not apply ro e oms of propcrty who builds r improvc thacon , md who <br />conracts for such proj€rs wilh a Cor&ro(s) licmscd pBuet to thc ConEactor's Lictrc Law.). <br />_l m cxcrnpt uada S@ti@ <br />-B. <br />& P.C. ftr thi! ttam. <br />Darc: Owra <br />WORKERS COMPENSATION DECLARATION <br />I hscby affim udr pcnalty of pajury onc of thc following delmtiou: <br />_I havc md will mintain a Catificarc of Coroat to Sclf-lNuc ftr wtrkm' compcnsstim, I providld fs by Sstion 3700 of thc <br />Labor Codc, for thc pcrfmcc of thc wort fm which thc pcrmit is issucd. <br />_lhavcadwillminuinwckm'cmpcasatimimmcc,c rcquircdbySction3T00ofthcLabqCodc,forthcpcrfomeccofthc <br />work for which this pcmit is isucd My workc' composation insuucc cmic md policy numbcr uc <br />Policy Numba, Expiro, <br />(This lcctim nccdnotb"-.pta"a ittnffioo) o t$) <br />1, ^u <br />rn <br />^c <br />pcfmcc of thc wok fu <br />bemc subjcr to thc wor*s ' comps[atim lawg <br />which this is issucd, I <br />agrcc that <br />shall not cmploy uy pcnon <br />ifl should bccomc subjcct to <br />in my mmncr so r to <br />theof <br />3700 ofthc Labor Codc,forthwith comply with thosc provisions.. <br />Datc: <br />WARNING: Failuc to sccurc workm' compmsation covcragc is unlawful, md shall s cmploycr to criminal pcnaltics md civil <br />fincs up to onc hundrcd thouod dollm (t100,000),in addition to the cost ofcompcnsation, damagcs u providcd for thc Scction 30?6 of <br />thc Labor Codc, inrcrcst ud attomcy's fc6. <br />Ihgcby8mmundcrpmaltyofpcdurythaffincingwithScction7000)ofDivision3of <br />thc BBin6s ud Profcssions Codc, ild my licensc is in full forcc md cffcct <br />Licme ClmsJ i - Li-n..[r-b., t,",QwYbw <br />CoNSTRUCTIoN LENDIT{G AGEN6I/ <br />I hmby aftim udcr pcnalty of pqjury that th6c b a consmcdon lcnding ag6cy for thc pcrfommcc of thc work for which ttris pcrmit is <br />issued (Scc. 3097, Civ. C.). <br />Lodr's Nmc: <br />Lodq's Addres: <br />APPLICANT'S DECLARATION <br />Doolition PmiB-Albqts NotifiBtion Fcds8l RcSulations (Titlc 40, Part 6) <br />_ Rcquircd Lmd of Notification <br />_l ccrtiry that thc fcdml rcSulalions rcSdding sb6t6 rmoval dc not applicablc to this trojcct. <br />lft ccrtiry ttat t lavc rcad this appliation md statc that tic abovc infomation is concct. I agrcc to comply pith all City ed county <br />ordinsce md Sdc kws to building consmction, md hcrcby <br />abovc motioncd <br />Applic\g^dmt sis. <br />Prmffrzrffie@1nt) <br />purposcs. <br />rcprccntstivca of this City to mt6 upon thc