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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor Tt(-?A fL sc Lr7 <br />Gas-Underf loor <br />Buildinq Sewer <br />ArealStorm 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 />Main Drain/Pool Pipinq <br />Fill Line/Back FIow <br />Pool HeaterlGas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back FIow Device <br />Rough Plumbinq <br />Final Gas Test <br />Meter Release <br />FINAL /28'?4)f2 Ct1 Pilrr< %r/ <br />Notes, Remarks, EIc.rlA ,lI, <br />t <br />?II /r 'L, r-*2-r-7 <br />I hcrctry amrm undcr pcmlty of perjury that I m exernpt fmm th6coiaracloB: Licrcnrc tlw for the folloeing rcapn Ga.'tO3l.5 <br />Busincss ord Profcssion Codc): Any City or County which rcauim a pmit to snstfft. altcn imprcrc. dcmlish or rcpoir uy <br />structurc, ]rhr to ils issurec. alm rcquircs thc applicant for such Fmil to file a sigrcd strlcmnt thst he or slE b liensd pusut <br />to the lmvisions of thc Contrctq's Lbenrcd lru (Chsptc] 9, Commrcing with Sation 7000 of Division 3 of thc Busiress and <br />PrcfcssionsCode)othatheorshcisexemptthqcfromandtheb&sisforthcsllcgcdcxcmption. AnyviolationofscctionT03l.Sbyany <br />applicant for I pcrmit subjsts the applicsnt to I civil pcmlty of not mrc than five hundrcd dollars ($500). <br />_1. as owner of the propcrty. or my employc-es with wagcs as their sole comprcnsalion. will do the work and the strucrure is rrot <br />interdcd or offercd for salc (Scrc.7044. Busincss and hofessions Code: T'hc Contractor's Licensc law does not apply to an owncr of <br />thc prcperty who builds or improvcs thcreon. and who does such work himself or hersclf or through his or hcr own employces. <br />provided that such impmvenrcnts are not intendcd or offcrcd for sah. lf. howcvcr. the building or inqrrorrcrmnt is sold within one )asr <br />of completion. the Orvncr Buildcr will harr thc burden of proving lhal hc or shc dkl rrot build or imFnovc thc profrcrty for thc purgnsc of <br />salc). <br />-1. <br />as owner of the proFrcrty. am exclusively contracting with liccnsed conlraclors lo construct the projcct (Sec. 7W. Business <br />and Prrofcssbn Codc: Thc Contractor's Licensc Law does nol apply lo an owner of property who builds or improves thercon. <br />and who contracts for such propcts with a Contracto(s) licensed pursuant to thc Contractor's Liccnse Law). <br />-l <br />am exemrrt under Section-. B. & P.C. for this reason. <br />I)ale: ( )r+ ner: <br />lV()R Kt,' RS' C0t\l PtiNSA'l'l( tN <br />I)IiCI ARA'I'I()N <br />I hcrclly'ull-intt urttlcr pcltullY ol'pcrjurv onc ol'thc lirllou'irtrr tlccllrltions: <br />_l have and will maintain u Ccrtificate of Conscnt to Self-lnsurc for workcrs' conrpensation. as provided for by Scction 37fi) of the <br />I-abor Codc. for thc Jrcrformance of the work for which the permit is issucd. <br />-l <br />have and will maintain workcrs' conrpcnsation insurancc. as requircd by Scct ion 37fi) of thc Labor Codc. for the pcrformance of <br />thc work for which this pcrmit is issucd. My workcrs' cornpcnsation insurancc carricr and policy numbcr arc: <br />Policv Numbcr: Exnires: <br />-l <br />certify that in thc performance of thc work for which this Jrcrrnit is issued. I shall not cmploy any person in any manncr <br />so as lo become subjcct to thc workers' compcnsation laws of California. and agrcc that if I strould becomc subject to thc <br />workcrs' comJrcnsation provisions of Scction 3700 of thc l-ahor Codc. I shall. t'orthwith conrply with thosc provisions.. <br />WARNING: Failure to sccurc workcrs'corrrpensation covcragc is unlawful. and shall subjcct an cnrploycr to crirninal pcnaltics and <br />civil fines up to onc hundred thousand dollars ($l in addition to lhc cosl of compensation, damagcs as provided for thc <br />Section 3076 of the [:tnr Ccxlc. intercst and <br />I <br />I hcrcby alfirrn under Jrcnalty of Jrcrjury that liccn:rd of Chupter 9 3 <br />of the Busincss and Profcssions Code. and my liccnse is in full forcc anl <br />Liccnsc Nunrbcr: <br />Dnte:_)(\ <br />I hcrcby allirm uNlcr Fnally of pcrjury thdt thcrc is a s)nslruction lending agcrcy for thc ptfmrcc of thc work for which this Jrcrmh is <br />issued (Sa. 3097. Civ. C.). <br />lrndcr's Namc: <br />lcndcr's Addrcss: <br />APPI ICANT DECLARATTON <br />I Mry atlirm undcr pnalty of prjury one of thc following dc.clarations: <br />Dcmolition Pcrmits-Asbcstos Notification Federal Rcgulations (Titlc 40. Part6) <br />$"q""cd Lerter of Notilicarion <br />_t regulations rcgarding ashc'slos rcmoval itrc lx)l applicahh this projccl. <br />&"n this application and slillc l hul the utxlvc ilrlorrtntiott is conecl. I agrcc to comply <br />rcpresentativcs of this City <br />with all City lntl County <br />ordinances and rclating to building construclion. <br />for inspction purynses. <br />hereby aulhorizc and County lo cnlcr upon thc <br />abovc nrcntioncd <br />/t>Applicnnt or <br />Pernrilee name <br />arxl <br />tq <br />Carricr: <br />il1Dale: