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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE !D/S!G.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby affm under Jrcmlty of pcrjury that I m cxcmpt fmm the Conlractor3' Liccnsc Law for thc following rcamn (Sa.703 1.5 <br />Businds ard Profosion Codc): Any City or Couny which requirca a Jfmil lo omtruct, ahc, improvc, dcmlish or rct)air sy <br />structwe, prior to ils isNarce, de rcquirs thc applicilt for ruch ;rmit to filc a iiSned statmnr thd hc or shc ie licenscd pumant <br />to the prcvisions of thc Contmctor's Liccn$d tiw (Choplfi 9, Commcrcing with Scction 7000 of Division J of the Busincss and <br />PmfcssioNCodc)orthathcorsh€isexcmptthcrctomandthcbashforthcallcg€dcxcnption. AnyviolationofScdionT03l.5byany <br />applicantforapemitsbjatsthc applicsnttoacivilpcEhyofmtmorcthanlivchundrcddollam($500). <br />-1, <br />as os'rer of thc pmJt.ly, or my employes wilh sagcs e3 thcir slc mmpenstion, witldo th€ work and ttE stnf,tw is mt <br />interded or olfscd for mlc (Sa.7(X4, Busims and Pmfc$ioN Code: 'l'hc Contraclor's Liccns lrw dos mt apply to an owrer of <br />the pmJEny sho build3 or io{lDB th.@[ 8nd wlb &B $ch m* himsclf or hcmlf or thrcugh his or lE own cmploycci. <br />provided that och impmvmils e mt intddcd or ofM for $le. I I tnwryc, thc building or inqrmrcmnt is rcld within orc ]ra <br />of orpk{k Ir 0E Chrrcr Builds will harc tlE tDrden of pmving that h€ or shc did mt buiH or inqrmrc thc pmpcry for thc purFnr of <br />ele). <br />_1, as owrer of the preperty, m cxclusively coilmcting with liccnscd conlrocloN to conflruct th€ pmFct (Sft. 7M4, Busircs <br />ard Prcf,:rsionCode:'lheConlractor'sLicenscLawdocsmtapplyloanowncrofpropcrlywlnbuildsorimprcvcathermG <br />and wln @ntmcts for such prejets with I Contmcto(s) liccnsed pursanl to thc Conlrsclor's Licensc Law). <br />-l <br />m cxcmpt undcr Sction-, B. & P.C. for this rcarcn. <br />l)nlr ()rrnrr <br />E086E8SSj)!48jNSA1IQN <br />DES.ASAIIQN <br />I hereby allirm under penalty ofperjury one oflhe following dcclarations: <br />_l have and u,ill mainlain o ('criillcalc of Conscnl lo Sclf lnsurc frrr rvorkers' conrpcnsaliilr, as provided li)r by Section -1700 of the <br />Latxrr Code, for the perlbrnmnce oflhc work lirr which thc pernrit is issueri. <br />-lhaveandwillmaintainworkers'compensationinsurance,as <br />requircdbySection3T00oftheLoborCode,forthcperfomanceof <br />the work for this pennit is issed. Myworkers'insurance carior and Jxrl icy <br />c<( <br />Policy <br />-l <br />certify lhat in thc performnce of thc work for which this pcrmit is issucd, I shall not cmploy any pcrson in any manncr <br />m as to bemme subject to thc workers' mmpcnstion lf,wr of California, and ogrce that if I slnuld becomc suhjcct to the <br />worteN' compenstion pDvisions of Sfftion 3700 of lhe Latnr Codc, I shall. forthwith @mply with rhos previ3ions.. <br />WARNIN(;: l;ailure to scurc u'orkcN'compensation covcmge is unlau,ful. and shall subjecl an mploler to criminal Jrmltis and <br />civil fines up to one hundrcd thousand dollars ($100.000), <br />S6lion 3076 ofthe L6tnr Codc, interest and attorney'i fecs. <br />in addition lo the cost of compensatior\ daroges as providlC for the <br />I hcrcby affirm under pemhy ofperjury thal I am licenrd 9 (commncing with S6tion 7000) of Division 3 <br />of the Businm and Pmfcssions Codc, and my liccnse is in fu ll forcc aml cffcct. <br />Lice*eclass, 6 LiccnseNumbcr: <br />I hercby a{Iirm under pmhy of perjury thal lhsc is a mnvruction lcndingigcrcy for thc pcfororcc of thc work for shich this pcrmit is <br />iszucd (Sa. 3097, Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />APPLICAN'I' DT'CI ARA-I'ION <br />I horby aflim under penalty ofperjury one of the folkrwing delamtionsr <br />Demlition Permits-Asheslos Notificalion l;ederal Regulalions ('litle 40, Pan(, <br />-Required <br />Letter of Notifi cation <br />_l cffify that the federal relulations rcgrdin8 acheslos removal are mt spplicablc to this pmject. <br />-l <br />certify (hal I harr read this application srd state that lhe <br />ordinnnces and State Laws relating to huilding conslruction, <br />above mentioned propeny ft)r inspstion <br />Applicatrt or Agcnt <br />Pentrilee name \,o <br />UNDER GROUND <br />Waste & Vent )-l -J ^/ t,rt /ld\ <br />Water-Under floor > I 17r)/w1 I -v <br />Gas-Underfloor I <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent rsltdt4 ,.{,1/L{,/ <br />Water Pipinq I <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P{rap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Misce!!aneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />I / <br />Rough Plumbing 418 '/g rk4l 7277C7/,b <br />Final Gas Test I <br />Meter Release <br />FINAL I ?-1{-202A J/adt La> <br />Notes, Remarks, Etc. <br />o.,", ' 8t16-[Q. <br />. &S.Zgt q <br />I[t"^^-, <br />tA) <br />_ Data:j 8-lo'lt