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PLUMBING-INSPECTOR RECORD <br />COMMENTSAPPROVALSDATEID/SIG. <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf Ioor <br />Buildinq Sewer <br />ArealStorm Drain <br />I nterceptor/ Clarif ier <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 />Itlain Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool HeaterlGas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitarv SewerlCao <br />Back Flow Device <br />Rouqh Plumbinq <br />Final Gas Test <br />)-Meter Release <br />FINAL /24'Za 2-Cg/J21@6ryry <br />Notes, Remarks, Etc.,bd h =id-e- lvli*L V <br />.. .a <br />II -fr^-Lil @ 9e lEr -o/2-6 t*L ry Dzsa /ze'z' <br />T <br />\l <br />0I1'N I.]R II I.I I I,I)ER <br />I hercby offirm undcr pcnslty of ttrjury thrt I m cxctrrpt frcm thc Contracton' Liccnr Lrw for thc following rcs$n (56.7031.5 <br />Busincss snd hofcssion C(de): Any City or County whhh rcquircs a ;rcrmit to construd. sltfi. imorovc. demlish or rcprh my <br />structure, prior to its isruamc, alo rcauircs the applicsnt for such lEmit lo tilc I sigm{ statemnt lhst hc or slE h licmsd pwut <br />to thc |rovisiom of thc Contractor'r Liccnscd Law (Ch8pter 9. Commcrcing with Setion 7000 of Division 3 of the Busircss 8nd <br />PmftssionsCodc)orthathcorshciscxemptthseftomandthcbssisforlherlhgcdcxemp(ion. AnyviolationofsctbnT03l.5byany <br />applicont for r lrcmit subjNls thc opplicsnt to a civil Fnolty of nol mrc th.n fivc hundrcd dollrs ($50O). <br />_1. as owner of thc propcrty. or my cmployces with wages ss their sole compcnsation. will do the work and the slnlcture is not <br />intcrdcd or offered for sate (Ser.7044. Business and Professions Codc: The Contractor's License [.aw does not apply lo an owner of <br />thc property who builds or improves thcreon. and who does such work himself or hersclf or through his or her own employces. <br />providcd that such improvcnrnts are not intended or offered for sale. lf. however. thc building or inprovcrrcnt is sold wilhin one )aflr <br />of conphtion. thc Owncr Buildcr will have the burdcn of proving that hc or she did not build or improve thc propoly for thc purynsc of <br />sah). <br />_t. as owncr of thc propct-ly. aln cxclusivcty corrlractirrg u'ith liccnserl contrilclors lo cotlslruct thc prtrjcct (Scc. 7(114. Busincss <br />and ltofbssiolrCode: 'l'heConlractor'sLiccnscLawdocsrrolapplyloiurowncrofpropertywhobuildsorintprtlvcslhcrcon. <br />and who contracts for such projccts with a Contraclor(s) liccnscd pursuanl lo thc Conlraclor's Liccnsc l-aw). <br />-lattlcxclllptundcrSectitttt-.B.&P.C.lirrthisrcastltt.l)nlr: ()u'ltt'r: <br />WORKERS' CONI PF'NS {'TION <br />DFCLARATION <br />I hcrcby affirm undcr penalty of pcrjury onc of lhe following dcclaralions: <br />_t havc antl rvill nmintain aClcrtificateof Conscnt to Sclf-lnsurc f<rr workcrs'compcnsation. as providcd for bySection.3T0Oof the <br />Labor Codc. for thc pcrlbrnuncc of thc work for which the pcrrnit is issucd. <br />-t <br />havc and will nraintain workcrs'conrpcnsation irrsurancc. as requircd by Scclion 37fi) of thc Labor Codc. for the p*rfnr*un.".lf <br />thc work lbr which this permit is issucd. My workcrs' compensation insurancc carricr and policy numhcr urc: <br />Policy <br />_l ccrtify that in thc perlbrmance of the work for which this prmit is issucd. I shall not employ any pcrson in any manner <br />so as to bccorne subjcct to thc workcrs' comgrcnsation laws of California. and agrce that if I should beconrc subjcct to thc <br />wrlrkcrs' cornpensation provisions o[ Section 3700 of thc Lahlr Code. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failurc to sccurc w<lrkcrs' compensaliot't covcragc <br />civil fincs up to onc hundrcd thousand dollars ($lm.fin). in <br />is unlawful. and shall an cmployer to criminal pcnaltics and <br />to lhc cost damagcs as provided ftrr the <br />Scction 3076 of the l.abor Code, intcrest and attorney's fecy <br />,r,", 1-) '%2 Applrcanr: K <br />I hercby alfirm undcr pnalty of prjury that I am licensctl undcr <br />of the Busincss and Professions Code. and my liccnsc is in full <br />9 (commcncing with Section 7m0) of Division 3 <br />cfl'cct. <br />Liccnse e <br />o"", 1-f -'ZO <br />I hcrcby afTirm undcr penalty of grerjury that there is a <br />issucd (Scc. 3097, Civ. C.). <br />agcncy for thc performancc of the work for which this J:crmit is <br />APPLICANT DECLARATION <br />I hcrcby aflirm undcr penalty of perjury one of the following declarations: <br />Dcmolition Permits-Asbestos Notification Federal Rcgulations (Title 40. Part6) <br />lrttcr of Notification <br />that the federalrcgulations rcgarding asbcstos rcmovalarc nol applicablc to this projcct. <br />ccrtify thirl havc rcad this applicltiott and I hlt thc alxlvc irr lirrrttal iort ls corrccl,agrcc Io colnJrly with all City :ttttl Courrty <br />lttrl Statc [.aws rclating County lo enlcr ulx)rt thc <br />abovc mcntioned propcrty for <br />Applicant or Agenl <br />Pernrilee nonle <br />to building <br />sliltc <br />c) <br />hcreby aulhorizc rcprescntativcs of this City and <br />8-D <br />7 <br />Contractor:_ <br />P