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PLUMB!NG.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS owNltR BUt t,t)uR t)t;l,cARA'iloN <br />I herehy aflirm under penilly ofperiury thrt I nrn exempt from the Cr)ntrick)r\' l-iccnse [.aw frrr thc lirltrwirrg r!'nq)n lSc.7(l-11.5 <br />Bu\ines$ aDd Pfi)fes\ion Code): Any City or County which requires a perni( lo construct. illter. inr[r]!c. rlcnDlish rrr rtprir any <br />\lnrcture.l)rlrtoits isruance.rlsorequiresllEnpplicrnth,rsuchFrolillofileisiSncd\lolerpnl lhilrr)r\hcirlicenscrl purruant <br />h the prolisioo( of lhe Conlractr)r's l-icensed [-aw (Chnpter 9. Crrmnrncing wi(h Secli(xr 7(XX) ')f l)ivi\ir'n .] of rhe l}r\itre\s flnd <br />rlplicdntli)rrpcnnit\uhiect{th€ applicrntnracirilpenaltyrrfnotnr:rethanfilehundrcrldolLirs($5{x}). <br />_1, ar owrcr of lhc J,mlEny. o. my cmphy.es with wages as thcir s)lc comp.nuhr, willdo th. wo* afil rh. stuiurc h iltr <br />iilcfibd ororlcrcdforsalc(SE.T044,Bu3ircssedProfcasionsCodc:TltGrntmor'sLiccnslnsducsnotapplyhmowrcrof <br />thc lmltHy whr huiHs or impmrcs thcmn. arxl wlh dc such s)rk himsclf or hcrsclf or through his or hcr own cmphyces, <br />pmvided thd such imJrmwrcnts rc ret in(cfiled or olreEd for slc. lf. h)wercr. th. hoikling ol intr'mv.mnt ir rlld wlhin orc Fe <br />of mrrpLti)n. th. Owrcr Buil'lcr pill haE th. tilrdm of tmving thd he r shc dil nx huiu o. impn)E thc pn)lEdy for th. fu.F r of <br />sle). <br />-1. <br />as owmr of tha paolEny. om arclurivcly contracting with licankd contrack)m to congru(l tha prri(t (Se. 7(H.1. Business <br />and PnrftssirnCrx.lc:ThcContrrck)a'sLiccnscLawdocsnotaplly(ornowncrofl(rpaatywlxrhuillsorirnpruvesthcrcon. <br />and who NilEctsfilrsuchFmrjcctiwithaConlmckr(s)licen*dpu6u{ntkrtheConrsck)i'sl,icenskw). <br />I m.xcmDt undcr Setion-, B. & P.C. for this rcason. <br />WORI(FRS' COMI'UNSATION <br />DECLARA'I'ION <br />I herehy affirm under pcnalty of perjury onc of thc folbwing declaratir)ns: <br />l-ahrr Crxle. frr the perfornmnce ilfthe work for which lhe pcrillit is issled. <br />Ihiverndwillmrinlninworkers comnensi(i(ininsur0nce,rs requiredbySection.lT(nlofrlrl.ilhrr(ixlc.lirrtheflerlornlimceof <br />tlE work f()r which this pennit is i\sued. My workers conrpensrtion insurance carrier antl policy truDlhcr rrel <br />Policy Numbei_ Expircsr _ <br />_l cc(ify thd in tlrc lErformdmc of thc work fo, which this Jrrmit is i$rued. I shall not employ any Jrrson in any manner <br />s 6s lo bcom shj.ct to thc workfir' mmFnstion laws of Califomia. nnd aSEe (hd if I stnuld h.com suhFct h the <br />work..r'omlEnstionpnrvhi)nsofsstion3Tmofthct tnrCfrle, lsh6ll.fonhwilhmmplywithtlh*nNvirh)ns.- <br />WARNING: Failurc h scure wr)rkcrs'compensithn coverage is unhwhil. and shnll suhiect an emphryer kr diminnl FEn.ltics and <br />civil finesuptoorchundrcdthousnddollors(Sl(X).(XX)).inaddiliontothccostofcomlEnsation,damrgescsp(rvidedforthc <br />Scction :io76 of th. tjtrrr C(xj.. irtercg and athmy's fees. <br />Drtc:- ,.pptro.^, {Q:!1? <br />DECLARA'I'ION <br />I hcrcby affirm undcr FEnalty of pcrjury that I am liccnscd under prrrvision ofChapter 9 (comnrncing with Scction 7u)()) of Divisi(rn 3 <br />of the Business snd hofessions Code, orxi my license is in full fr)rce and effect. <br />CONS'I'RUC'I'ION LENDIN(; AGL,NCY <br />I herehy afllrm under lrnillty of leriury thrt thcre is a construction lending agency for the ped{trilrrnc. of rhe *rrrk for which rhis fErrnit is <br />issued (Sec. .1{)97. Civ. C.). <br />Lendcr'. Nrnre: <br />Lendcr's Adrlrcss: <br />Afl 'LICAN'I' DL,CLARAI'ION <br />I hcrrby allrrnunder JEnaIy of pcrjury one of the folk)wi08 declaralions: <br />Dcm)liirn Permirs-A(hestos Notification Fcderal RcBulxtions (Title 4{). Pan6) <br />_Rcqu ired kttcr of N(trih*ati(,n <br />_l cdify thd th. f.dcralrcguldions Egarding asbcsnrs rcmvalare not applicahlc m thk pmjet. <br />_l cenify thd I havc rcad this application anl sralc thrt Ihc ahrvc inforrmtion is corcct. I ugrE kr cotrlply wilh lll Ciry tnd County <br />ordinanccs and SIata kws this City and County to cntcr ulntrthc <br />Dsac:- <br />above runtioncd prolEny <br />Appllcant or A8ctrt <br />Pemrltee nome <br />hcrcby aulnrizp rcrr.scntativcs of <br />UNDER GROUND I <br />Waste & Vent 'l lttt <br />Water-Under floor I <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptori 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{rap/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 />Sanitary Sewer/Cap <br />Back Flow Device <br />t)I <br />Bouqh Plumbinq Vt , <br />Final Gas Test ri <br />Meter Release I W NIlU <br />F!NAL E-M./ltJ <br />INotes, Remarks, Etc. <br />^, <br />7-t 7-/7 , <br />7/7) <br />Liccnsc Class:-Liccnsc Numh.r: _ <br />DstG:- coot t*ofr-u' L-17_, <br />4-- <br />Mtlryt <br />lt <br />>.fr <br />I