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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS o\\'Nl:R RUIl,l)llR l)F:1,( ARAI loN <br />Busincss and l,rol'tssiur (irclc): Any ( it) or (o[nl\.\\hich rcquircs a lxnnil lo c(\ilslnrcl. allcl'. inrflo!c. dernolish or rqrair anv <br />applicailt for a pcflilil subjccls lhc al)plicilnl lo a civil pcilallY ol trol nxrrc lhan fltc hln(hcd &rllars ($500). <br />salr). <br />ail(l who (onlracls fo'such proiccts N'itll i (i)rnmckn(s) li(cnscd pursuanl lo lhc (innrnclor's l,icense l.nw). <br />I arn cxcnlpl uDdct Scclirln . ll. & P ( . Irrr lhis rcason. <br />Ownrrilhlc: <br />\\Olikl'lllS'( ONtl'lrNS,\ l l()N <br />t)t,,( t.Att^ IloN <br />I hereby allirnr unclcr pcnally ofpsiutJ one ofthc folloN'in!. dcclnralions: <br />lhaverurrlrvillnraintainn('ellificalcof(irnscnlloscll:lnsurclirr\llrrkqs compeilsalion..s plt\idedforbySeclionlT00ofthe <br />l-atx\r (ixle. for lhe ptlforntance oflhe \\'ork for \\'l]ich lhe petnil is issucd. <br />@*\haveantllill rilainlair!$lt'kcrs conrsrsationinsuran( requiredbySdionlT00ofthel-abor('ocie.forlhepofomlanceof <br />lhc \r(nk for \\'hich lhis pcnnit is issue{. My $okos' conlfensalion instrrance caricr and fxrlicy nuntber oe: <br />c",,i., , gt\< (otlQ[$\ gF <br />P"li"yNrrbo, ' rJSD S63l +lL 6 <br />{ce-I UET <br />li\l) D1 <br />_l ccnify thsl in thc pcrfomancc of thc uork for which this psmit is issued. I shall not mploy any pq$n in a[y manncr <br />$ I to bccomc subjct to lhc sork6' compdsation laws of Califomia. and 88rc thar if I should bccome subjcr to thc <br />rvod<m' compqration prcvisiom of Sation 3700 of thc Labor Code I shall. fonhuith comply wilh thor prcvisiom.. <br />and <br />lhc <br />I hreby aflinn unds psahy of pqjury thal I an licenrd unds [ror ision of Chaptr 9 (commmcing Nilh Seclion 7000) of Diviriotr 3 <br />of thc Busine md Profsioro Codc. and my licmsc is in full force and effet. <br />I-i".*.t'tu*', ' !-9- l-icmse Number: ' 3O9Bb3 <br />( ()\\ I Rl ( I t()\ l.l \l)l\(; \(;1.\( \ <br />I hocby affm unda Jrnaltyof pcjurythat th6c is a consruction lmding agocy forthcpafommcc ofthcwort for which thispsmh b <br />issuctl (Scc 1097. ( iv. ( .). <br />[-en(ler's Nnn)c: <br />Lodo's Addrs: <br />APPLICANT DECLARAIION <br />I hoeby amnn unds penalty of pcrjury one of the f()lloNing declarations: <br />Dernolition Permits-Asbeslos Nolification lreddal Regulatioils (-fille 40. Parl6) <br />Rcquired l-etler of Nolifi cation <br />0{', <br />-l ccniry thal ihc fcdsal rcgul8tions rcguding cbctos ranoval are not spplicablc to this projcct. <br />cstify thst I havc rcad thb applicalion ild slatethat lhc abovc corect. I agrE lo comply with all City and County <br />ordinancs and Slatc I-aNs relaling to building construclion.of this Ciry md County lo ml( upon lhe <br />.1D2D <br />\\.rt <br />o",", t t'l5 <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ Cla rifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler ,A <br />Sanitary Sewer/Cap 2-E"7ro V.llJ/ltJ\lprl€ AdX <br />Back Flow Device \-/ <br />Rouqh Plumbing <br />Final Gas Test <br />Meter Release /r\ <br />FINAL 2-\fi,24 rru <br />subjat <br />,",", '-la,$.152rY2D <br />I <br />Appllcrnt or Agent Signature:y' <br />Pemitenlme(prltru, DC Ffan ci 9co