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PLUMBING.!NSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS owN!:R uutLI)ER Dttt.cARAl ruN <br />afplicnrillorxpcrnrilsuhicctsthc nlplicnnlk)rcivilpcnrltyofloltrr)rclhxnflvchun(lrc(ldollars($5(x)). <br />I.ns owncrol'thcpropcrly.ornlycnrl)k)yccswithwagcsaslhcirsolccornpcnsrti(nl.willdolhcworkandthcstruclurci{trol <br />thc p(,ncrly who huilds or itrrprovcs lhcrmr. rnd who docs such w(n'k hinrscll'()r hcrscll or thr(rgh his or hcr own crnployccs. <br />salc). <br />-1. <br />as owncr ofthe propcrty. am cxclusively contracting wilh liccnsed contrscto$ to construct the project (Scc. 7044. Busincss <br />tnd ProfcssbnCode:TheConlraclor'sLiccnscLawdocsnotapplyloanownerofpropertywhobuildsorimprovcslhercon. <br />and who contracts for such projccts with a Conlmctor(s) licenscd pursuant to thc Contraclor's License law). <br />lutrlcxclnDlundcrSccliotr-.B,&P'C,li)lthisIeason. <br />Date:_()wncr: <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hcreby affirm under penalty ofperjury one ofthc following dcclealbns: <br />_l havc md will mrintain fl Ccrtificatc of Conscnt b Se If lnsurc li,r workers' conrpcnsation. rs nrovidcd tbr by Sectk)tr -37U) of lhc <br />hh(n (i,dc. frtr thc ficrlirrNancc ol thc work lin which lhc pcflrit is i\\uc(I. <br />%{l"v""nawitt trriiiltainworkcrs'conrpcnsrlioninsurancc.ils rcqtirc(lbyScclion.lT00oflhcl-aborCodc.forthcpcrfonnanccol <br />lhc work for which is issucd. My workers'insurance canier and policy number arc: <br />')^ s,t/6 lz(/znoPolicy <br />_l ccrtify lhal in thc pcrformancc of the work lbr which this pcrmit is issucd. I shall not crnploy any pcrson in any manncr <br />so as lo become subjcct h thc workcrs' conlpcnsation laws of C{lifornifl. and agrcc lhal if I should bccorrc subject to thc <br />workcrs' compcnsation provisions of Scclbn 3700 ofthc Ltrhor Codc. I shall. tirnhwith comply with thosc provisions.. <br />WARNINGi Failure k, scure workers'compcnsation coveragc is tnlawfirl. and shall subjcct M cnrployq h fiiminal penaltics and <br />civil fincs up to onc hundrcd thousand dollars ($100.0m). <br />Scction -3076 of thc tibor Code. interest and allorncy's fces. <br />in addilion to lhc cost of compcnsation. damages as providcd{or thc <br />A <br />Dltcl,ARAll()N T <br />ol thc lJusinc\s nnd l'(rl'cssions Co(lc. rnd nty liccnsc is in lirll firrcc antl cllcct. <br />oLiccnscNunrhcr: <br />n L o <br />CONS'I'RUCTION T,ENDINC AGENCY <br />I hcrcby rflirtr! undcr pcnrlty of pcrjury lhat therc is d construclior lcndinS il8cncy lbr thc pcrtbrnnncc ol-thc work lbr which lhis fErnril is <br />issucd (Scc. 3097. Civ. C.). <br />Lcndcr's Namc: <br />Lcnder's Addrcss: <br />ATIIJSANLDECI.ABAIIQN <br />I lrcrcby allirm undcr pcnalty of pcrjury onc of I hc follow ing dcclarat ions: <br />Dcnmlilioil Pcrmits-Asbcsbs Notilication Fcdcral Rcgulations ('l'itle 40. Pdrt6) <br />-Rcquircd <br />Letlcr of Nolification <br />_l ccftily thrl thc fadcral rcSulalions rcgr(ling asbcslos rcrn(,r'al ilrc rxil rpplicahlc lo this projccl. <br />nbovc ilrcntioncd propcfly for inspection <br />Applicanl or Agent <br />l'rrnrilcc nxnre <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />It/ain Drain/Pool Pipino <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 Release tt l I /^ <br />FINAL Ar5fult)I WrAu ttbil <br />Notes Remarks Etc. <br />4 <br />,^*, QlLLllT.o <br />t <br />*,"rLfzlftaza <br />I