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APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent 5>?-t7 [Le z.tl ls Platz- <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent l&+q l7eq, <br />Water Pipinq 9-3 -t I '{Lu?') <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test 1-?-*(Lc t-1 <br />Rough Water Heater <br />POOL/SPA <br />Ptrap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous.Gar.Serrice- <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing g.3 -t7 I cz') <br />Final Gas Test <br />Meter Release <br />FINAL '*q-3 @ t /L Qsk€/ray?, <br />Notes, Rem4r[s, Etc I IIt(nJea I Lc Uat ; Ult t *8o <br />I hocby affm undo pemhy of pcrjury that I m cxmpt tom thc ContractoB' Licffi tjw for thc following llen (5€.7031 <br />Businas and hofsion Codc): Any City or County which rcquire a po-mh to coctruct. ahc. improvc, dsnolish or (pair <br />structue, prior to its isuace, also requirG the applicet for such pennil to filc a signed statmdt thsl hc or shc is licffcd <br />to thc provisioB of tlp Contmtor's Licoscd Law (Chaptq 9, Comocing with Scctioo 7000 of Division 3 of thc EBins <br />Prcfsions Codc) or that hc or shc is crmpt lhqcfrom md thc basis for thc allcged crmptioD. Any violstion of Sccrbn 7031.5 by <br />applicut for a pcmit subjats the applicant to a civil pmalty of not more thm five hundrcd dollus ($500), <br />_1. u omq of thc prcpcty, or my mplole with waga s thcir sle compcmation, will do tlE work Ed thc stnrlr b rct <br />intodcd or offscd for sslc (5€.7044. Bwine ud hofesiom Codc: Thc Conractor's LiccN tiw do6 not qply to u oM6 of <br />thc prcpCty who buil& or irprovc thon. md who doc such Mrt himsclf or hwclf or thrcugh his or ha om cmployc. <br />providcd that such improvqErts e rct intodcd o olkcd for sh. lf. howdq. thc buiHing or irnprovomrt is mld within one )s <br />of onplctiort thc O*nq Buildq will havc thc hrdan of poving tha hc or shc did rct hriH or inprovc rhe prcpcty 6r thc grpor of <br />ele). <br />-1. <br />6 ow6 ofthc Fopsty, m qclsivcly contracriog whh licoEcd contractoE to @nstrucl tlE pojet (Ss, 7044. BEin6 <br />and Prohsbn Codc: The Contractor's Licmsc Law do6 not apply to m ownq ofpropcrty who builds or improvB thr@n, <br />and who contncts for such projccts with a Contmclo(s) licmcd pm@t lo thc Contraclor's Licffi L6w). <br />_l meimpt ud6 forthis rwn. <br />"",,1lLalll <br />I hoeby allirm under pmalty ofyrjury one ofthe following <br />-lhaveudwillmintainaCqtificateofcomttoSclf-lmurcforwork6'compcnsation.r <br />prcvidcdforbySetion3T00oflhc <br />t bor Codc for the psfomocc of thc wo* for *trich thc pannit is isucd. <br />-l <br />havc md will maintah work6' compcMtioD isuanca s rcquircd by Sdion 3700 of thc tabor Codc. fot thc pafomcc of <br />thc wrk for which this pcrmit is iso<t My workm' compqB{dioo iremcc cmiq and policy numba rc: <br />Policy <br />-l <br />cediry thst in thc psfomcc of the work for which this pmit is issucd. I shall not mploy my pmn in ay mmo$ 6 to bccomc subjet to thc work6' compcnsation lam of Califomia od agrc that if I should bccomc subjGt to tlE <br />workm' compwlion prcvisions of Section 3700 of thc Labor Codc. I strall. forthwith comply with thor prcvisioro.. <br />IflARNlNG: Failuc to suc workc' <br />civil fins up to one hundrcd lhowd <br />Setion 30?6 of thc Labor Codc inlqGt md attomcy's fc6. <br />compcnsdion ovaage is unlawful, md shall subjct u oployq to qininal psuhics md <br />dollm ($100.000), in addition to thc cost of compemtion, dmag6 I providcd for thc <br />I hccby affm unda poralty ofpcrjury that I u ticemcd provision of Chsptq 9 (comocing with Setion 700O) of Division 3 <br />of thc Buine ud Prof6ios Code, md my licmc is in full force ed cffet. <br />".r", <br />'7 lzt-l11 <br />Licme <br />Drie:1 <br />ZJmlrv rrrat trrc fcdoal rcgulatiom rcgilding cbstos rqnoval tre not applicable ro this projcct. <br />Numbs: <br />I hwby aflim undo penahy of pcrjurythat th6c is a construction lmdiog agmcy for the pofonnilcc of thc work for which this lrrnit is <br />issucd (Se. 3097. Civ. C.). <br />lrndq's Namc: _ <br />tsdq'sAd&s: <br />APPLICANT DECLARATION <br />I hslby athrm unde pcf,slty ofpqjury onc oflhe following dsldations: <br />Dcmolition Pmits-Asb6tos Nolification Fcdqal Regulations (Tirle 40. Pan6) <br />___Requircd t,etts of Notification <br />-l <br />cqtiry that I havc rad this application erd state that thc abovc infomdion is cor6t. I 8grc to comply with all City snd Counly <br />ordimcG ud Slate law rclding to building construclion, and hqcby suthorizc rcprMtaliv6 of this City ild Couily to 6tq upon the <br />abovc mationcd pmpcrty for <br />Applicrnt or Agent <br />Pernrilee nsme (print): <br />PLUMBING.INSPECTOR RECORD <br />n",7lzuln