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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/S!G.COMMENTS OWNEN BUII,I)ER DET.CARATION <br />I hacby affm uadc poulty of pcrjury thd I m qmpt from thc ContrrtoB' Licge Lrw for thc following mn (Soc.7031.5 <br />Buins ard Proftssion Codc): Any City or Cou[ty which rcquiro a pomir to @rdrucl. altc, imprcvg &rnolish or rpat uy' <br />struclurc prior to its i!ffic slso rcquic thc sppli(rut for such pcrmit to filc 8 signcd nd6ot tha hc or rlp b licqsed pmant <br />to thc prcvisios of thc Contretor's Licascd L:w (ChsP6 9. Comocing with Sctiotr 7000 of Division 3 of thc Buiae md <br />Prcf6ioB Codc) tr thst hc or shc is ampt th@from ud thc bdis for thc sllcgcd umpaion. Any violation of Setiotr 7031.5 by my <br />applicmt for s pcmit suqiers thc 8pplicut to a civil p€nrlty of not mrc tha fivc huorH dollm ($500). <br />_1. a om6 of thc pmpary. or my mplolc with wag6 a thcir $lc @mpcnsstion, will & thc work ad thc stnrctw b rct <br />intandod or ofircd for sslc (Se.7044. Buitrs md Profciom Codq Thc Contractor's Lic@ law do6 mt apply to m omc of <br />thc propqry who builds or inTos tlEEc ad wlE d6 srch wrl himrclf or hqslf or thmugh his fi hq om cmploycq, <br />providcd that sch impromts m mt htardcd or oftrod for slo I[ hoM, tlE building tr inprcHmt is sU wfuhin onc ]a <br />of conplabo thc Ovma Builda wil hlw thc brd6 of povirg 0u hc u shc dil mt build or in4rcrc thc propsty 61 0E Brpoe of <br />sb). <br />_1. a owM of thc Fopsty. m acluivcly contractitrg with licqEcd contrac-toF to oruilrud tlE projct (S6. 7044. B6in6 <br />ard Prcftssbn Codr: Thc Contrctor's Liccffi kw doB ml spply to s om6 of propqty who builtls or imprcvB th6@n, <br />md who ontmcls for such lrojcts with 8 Contrrcto(r) lknlcd pumnt lo thc Crntrrlor's Licre L:w). <br />-l <br />m cxcmpt udg Satioo-. B. & P.C. for thb ra$n. <br />f lo lo' <br />EOBTEBSSOMfTNSAIIAN <br />DECIdBAITON <br />I hcrcby affrm unda poaltyof pcrjuryonc of thc following d6lu8tioE: <br />[i[-l havc md will miilain a Cqrificarc of Conmt to SclfJmurc for rcrkss' compcosation. u prcvidcd for by Sction 3?00 of thc <br />tabor Codc. for thc pqfommcc of thc wort for which lhc pqmit b isucd. <br />€.5r <br />the <br />have and will maintain 3700 of the Labor Code, for the performance of <br />\\'ork [0r u'hich this and policy number are: <br />3 tl - l t4'/4?-l <br />fut certi$/ that in the performance of the work for which this p,ermit is issued, I shall not employ any pcrson in any manner <br />so as to become subject to thc workers'compe$dion laws of California, and agree that if I should become subjcct to the <br />worters' compc.nsation provisions of Sec'tion 3700 of the L^abor Code, I shall. forthwilh comply with thosc provisions.. <br />WARNING: Failure to sc'cure workcrs'an anploycr to oiminal penalties and <br />civil fines up to one hundred thousand damages as provided for the <br />Scction 3076 of the Labor Code. interest and attorney's fees. <br />erru, l\-?5'24?A <br />I hercby affirm under pcnalty of perjury that I am licensed (commencing with Section 7000) of Division 3 <br />of the Business and Professions Code, and my license is in full force and effect. <br />Number: \0 St rF o <br />r jkz,cALicense <br />W <br />I hcrcby affum unds p€nalty of pcrjury tha thrc ir a coNiruc{bn knding ag6cy for th€ pGfomilcc of thc rcrt for which thb p6mit b <br />issued (Ss. 3097, Civ. C.). <br />Lcndq's Nmc: <br />Lcndcr's Addrcss: <br />APPLTCANT DECLARATION <br />I hereb)/ aflirm under penalty of pcrjury one of the following declarations: <br />Dernolition Permits-Asbcstos Notification Fcderal Regulations (Title 40, Parr6) <br />-Required <br />Letter of Notification <br />_l ccrti$ that the federal regulations regarding asbestos removal are not applicable to this project. <br />_l ccrti0 that I have read this application and state thal the <br />ordinances and State Laws relating to building construction. <br />above mentioned propcrty for inspection purposes. <br />Applicent or Agenl ^,"i-L\-?L{L 0 <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarifier <br />TOP OUT ,tl <br />Waste & Vent rZlr u1 D4417 <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 Piping <br />Fill Line/Back Flow <br />Poo! Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCao <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release <br />FINAL <br />Notes, Remarks, Etc. <br />, <br />Dr.". l\-Lr -?-0?O ConlrRctor:_ <br />Permiteenrme tprtnO, h1 F.'tl L-O,l'f 2 <br />)r