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I <br />PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hrcb alfm undo pcnahy of pcrjury thst I m cxcmpt from thc ContractoE' Licrue law for $c following rcn (5€.7031.5 <br />Busincs ud hofsion Codc): Any City or County shich requirB s pcrrnit to construct. alta. improvq dmolish or rcpair my <br />slructurq prior to its isuocc. also rcqutG lhc applicilt for such permit to file 8 sigocd ststm@t thar lE or shc is licos€d plmut <br />to thc provisions of lhc Contractor's Liccnscd taw (Chapt6 9. Comencing with S$tion 7000 of Divisioo 3 of the Buincs! md <br />PrcfesiomCode)orthathcorshciscxemptthrcfromedthebasisforthcallcgadcxmption. AnyviolationofsectionT03l.5byany <br />#*#;ilJ;;fi *,d;*;***;ilffiffi :r#nn'.L, <br />the Fopqty who builds or impovc ths@n, atd who dc such rcr'k himsclf or hmlf or thrcugh his or hq om mployea. <br />providcd thal such improvqmls e not intoded or offocd for sle. lf, howd(. thc buildilg or implovclmt is sld within onc yw <br />ofcomplaion. thc Owna Buildq will havc thc bttrdo ofptoving thd he or shc did not build or imprcvc thc prcpqty for thc purpos of <br />slcl.// <br />ll. s omc of thc popaty. m exclusively cootractirg $ith licsed conradoEto construct thc Foj(l (Se. 7044. B6in6 <br />od Ptofrsion Codc: Thc Contractor's Liccme Law doc not apply to m osns ofpropdty who builds or imprcvB thq@n. <br />End who contmc{s for such projccts with a Contraclo(s) licmcd puBuant to ihc Contractor's Licmc Law). <br />_l m cxmpt undr S6t B. & P.C. for lhis r6on. <br />n^,", d/.=rl2O <br />DECLARATION <br />I hocby aflim undo penalty ofpojury one ofthc follorving dcluatiore: <br />-l <br />havc and will mintain I Cgtificatc of CoMt to SdfjGurc for workm' ompcrudion. c povidcd for by S(tioo 3700 of thc <br />Labor Codc, for thc pqfomucc of thc worl for s,hich thc pqmit b issucd. <br />thesrrrkforrhichthispcrntitisissud.M1rvotkcrs cornpcnsalirrninsurancccarricranrlpolicynunrbcrarc: <br />Policy Erpire: <br />-l <br />cstify that in thc pqfomancc of thc \rork for which this p6mit is issued. I shell not mploy uy pcrrcn in any mmnc <br />m ro to becornc subjat lo thc rvorkm' compasation laws of Califomia. and agre that if I should bccomc subjet to thc <br />wo*m' comperoation prcvisions of Scction 3700 of lhc Llbor Code. I shall. forthwilh comply with thos prcvisions.. <br />IVARNING: Failurc to sure rvorkqs'compmation col'qagc is unlarvful. md shall subjet an onployo to siminal pqraltie and <br />civil finc up to onc hundrcd Ihoumd dollm ($100.000). <br />S(tion -i076 of the t bor Codc. inl66t md ator.m's f6. <br />in addition to the cost of compmstion.dmago o provided for thc <br />I )s le:-z /t /<o7-7--7 <br />I hereby affirm undcr penally ofpqjury that I am licensed 9 (comnrencing $ ilh 7000) ofDivision 3 <br />of thc Businm and Profesions Code. ed mv license is in full force ud effet. <br />I iccnsc ( hss: l.iccflsc Nunlltt <br />l)alc: <br />CONSTRUC'IION LENDINC ACENCY <br />I hmby allim undr penalty of psjury that th6e is a construclion lmding agmcy for the pqfomancc <br />issued (Sr. 3097. Civ. C.). <br />Lcnds's Name: <br />of lhc sork for s'hich this fnrnit is <br />Lsrds's Ad&e: <br />APPI,I('AN'I' DECLARA'I ION <br />I hcrthy affirrr under pcnally of pcr jury one of the folkrrving dcclarations: <br />l)errrlition ,'errnits-Aslxstos Nolificalion [ederal Retlulations ( I ille 40. Pan6) <br />Rcquired [-etler of Nolifi catiur <br />with all City and County <br />md County to fit6 upon the <br />Pemile name <br />3 F <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Cla rifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Piping <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 />Rough Plumbinq <br />Fina! Gas Test <br />Meter Release I ,,1 I tl <br />FINAL <br />Notes Remarks Etc. <br />4h-----v <br />_ Cotranclor <br />Roof Drain <br />D