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PLUMBING.INSPECTOR RECORD APPROVALS DATE !D/SIG COMMENTS OWNER BUTLDER DELCARATION I hcrcby aflirm undcr penalty of pcrjury that I en cxcmpl frcm the Contractos' Licens Law for thc following rcaen (Ss.7031,5 Business arl Profession Codc): Any City or County which rcquircs a lvmit to construct. alto, imprcve. demlish or rcpair my structurc, lrhr to its issuancc. also rcquircs thc spplicsnt for such Frmil lo filc r signcd slalcmnt that he or slrc is liccnrd pursuul to thc pmvisions of thc Controclor's Liensed law (Ch!ptc. 9. Commrcing with Setion 7000 of Division 3 of the Busitttss and Prcfcssions Codc) or that he or shc ir cxctrlpl thercfmm snd th€ hssis for thc rllcgcd excmption. Any violalion of S6thn 703 1.5 by any rpDlicant for a pcmil ruhjccts lhc rpplicanl lo 8 civil pcnalty of nol mrc thu fivc hundrcd dollrs ($Sfi)). _1. as owncr of the proF,erty. or nly employees wilh wagcs as their sole comFrcnsalion. will do the work and the strudure is not intcndcd or offcred for salc (Scr.7O44. Busincss and hofcssions Codc: Thc Contraclor's License [:w does not apply to an owncr of thc property who builds or improvcs thcrcon. and who docs such wo* himself or hcrself or through his or hcr own employees. providcd that such improvcnrnts src not intended or offered for salc. lf. howcver. the building or improvetrEnt is sold within one ),car of conqrhtkrn. lhc Owner Buildcr will have thc burdcn of proving that hc or she dkl rml build or impove the property for the purpose of srth). W, as owncr of the propcrty. am exclusivcly contracting with licensed contraclors to construct the project (Sec. TK,Busincss and nofcssion Codc: Thc Contractor's License Law dcrcs nol apply lo en owner of property who builds or improves thcreon. and who contracts for such projccts with a Contractorls) liccnsed pursusnt lo lhe Contractor's License taw). -l am cxcnrpl undcr B. & P.C. for aDate:_2lrllzot-o O*n.rrts I hcrchy alljrnr undcr ;rcnalty ol'1^-rjury onc o[ thc lirllowing tlcclarnliotts: _lhavcandwill rrnirrtainaCcrtiticatcot'ConscrrttoScll'-lrrsurcfrlru'orkcrs'contpcnsalion.as providctllilrbyScctiotl3T(Dofthc l.atxrr C<xlc. lorthc J^-rfrrnrurncc of thc rvork l'or which thc;^-ntrit is issuctl. _t h:rvc altd rvitl rnairrtain rvorkcrs'cornlrcnsatiorr irrsurancc. as rcquircd by Scclion l7(X) of thc L^abor Codc. for ltrc pcrltrrmance tlfl thc work tirr u'hich this pcrrnit is issucd. My workcrs' conrpcnsnlion insurancc carricr and Jnlicy nunrbcr iuc: Policy Numbcr: ExPires: lilrcenify that in thc pcrformancc of the work for which this prmit is issucd. I shall not employ any person in any manner so as to bccomc subjcct to the workcrs' com;rnsation laws of California. and agrec lhat if I should becomc subject to the workcrs' compensation provisions of Scction 37fi) of thc Labor Codc. I shall. forthwith comply with thosc provisions.. WARNING: Failure to sccurc workcrs' cornpcnsalion covcrugc is unlawful. and shall suhjcct an cnrploycr to criminal Jrcnaltics and civil fincs up lo onc hundrctl lhousan<l Scction J076 of lhc l-ahrr Codc. inlcrcst dollars ($lm.(XX)). in atlclitiott to lhc cosl as providcd for the und altorncy's fces. ,)a,,: ?)fl-lzpzo Applicant: I hcrcby affirrrt undcr pcnulty ol'perjury lhat I artt liccnsc<l 9 (comrnencing with Section 70i,0) of Division 3 of thc Business und Prol'cssions Codc. and nty licensc is in tbll force aud effbct.I License Class: Liccnse Numbcr: Date: Contractor:- ('()NS'|'Rt r("t't()N l,t;NDING,\(; I,.NCl' I herchy affirm undcr Fnalty of [rcrjury thsl thcre is I constructk r hnding rgcncy for lhc pcrformme of thc uork for which this pcrmit is issued (Sec. 3097. Civ. C.). Lcndcr's Atklrcss: APPI ICANT IIF'CI ARA'TION I hrchy alfirnt undcr pcnalty of pcrjury onc of thc frrllowing dcclarations: Dclrxrlition Pcrnrits-Ashcstos Nolification Fcdcral Rcgulations ('I'itlc .10. Part6) -Rcquircd Lctlcr of Notification ,fJ:";:fedcralrcgulations rcgarding asbcslos rcmoval&re nol applicablc to this project. rcad this application arrd slatc thal lhc atnve inl'orrrutiort is corrccl. I ordinanccs and Statc [:ws rclating to building construction. and hercby lhc atxrvc nrcnlioncd propcrty for insJrc'clion purF)scs. Applicanl or Agenl I'ernrilre nnnte *I o,,",2h?. lzow UNDER GROUND Waste & Vent 11 -26*a L (t,attztt*Y, g+o Water-Under floor Gas-Underf loor Buildinq Sewer ArealStorm Drain I nterceptor/ Clarif ier TOP OUT Waste & Vent \It ^2-r^17 2 t-^ f ^s ,r-voLo b Water Pipinq ,/'Ja r)I - t_-t )t -eJ--. ?-< Gas Pipinq Roof Drain Tub/Shower Test Rouqh Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Pipinq Fill Line/Back Flow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary SewerlCao Back Flow Device Rouqh Plumbinq // -c/-(4 /t-c T -zr7 Final Gas Test Meter Release l-t FINAL Notes, Remarks, Etc. -+ Carricr:- ?harln