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PLUMBING.INSPECTOR RECORD <br />I hcrcby aflim undcr pcnalty of pcrjury that I m cxempt frcm thc ConlractoN' Liccns Law for thc ftrlowing r.en (se.7031.5 <br />Busin6s and Pmfesion Codc): Any City or County which rcquircs a pmit lo conrtrucl, altc, impmve, dermlish or refat tfo/ <br />structure, prior to its issuance, alm rcquircs the applicant lor ruch permit io file a signed statement thal hc or she is licenscd purruIz'l <br />to lhc pmvisions oflhc Contractor's Licensed Law (Chapter 9, Commcncing with Section 7000 ofDivision I ofthe Business and <br />PmfcsionsCode)orthathcorsh€isexcmpttherefromandthebasisforlhcallegedexcmption. AnyviolationofscthnT03l.5byany <br />applicant for a pcmit shjels the applicant (o a civil pcnalty of mt more than fivc hundrcd dollars (3500). <br />-[, <br />as owr of thc prcpcny, or my cmplolces with wagcs as thcir sl. mmpenstion, will do the woft a.d tlE stnrc{w ir mt <br />intcrdcd oroffcrcdforslc(Ss.?044,BusiressmdPmfcssionsCode: lhcCorfractor'sLiccnrcL6wdocsnotaF,plytoanomcrof <br />thc popcrty sho tilil& or ftpmB thomG and wtn doe sch mrt himsclf or hffilf or thrcu8h his or hcr om employces, <br />prcvidcd thst sch impmvmds m mt intcrdcd or olltrtd for slc. lf, howd6, th. tililding or itrpmrcmnt ii sld within orc ,€r <br />of mrplctkl]l, thc Oryrcr Euikler will haw ttE bordcn of pmving tlEt hc or slE dil mt build or impmrc thc pm]Ety br thc purfrs of <br />sh). <br />-1, <br />&rowr of lhc pmp.rty, am cxclusivelyconbacting with licenscd contmctoB to coNtruct the prcject (S*. 7044, Busine*s <br />and Pm&sbn Codc: Thc Contrrctor's Liccnse Law docs mt opply lo an owrcr ofpmpcrty who builds or improvcs thson, <br />and who @ntracti for sch prcjcrts with a Codmcto(s) licm€d puEuanl to thc Coniractor's Licenr lrw). <br />-l <br />mcxcmpt undcr Srction-, B. & P.C. for this rcasn. <br />Date:()$tr(r: <br />\1 ()R|l t-RS' ( O]\t t't.NS,1 I t()N <br />l)l.cl.,\lt,\ I loN <br />I hercby affim under p€mlty of p(juryorc of thc following delaations: <br />_l havc and will minlain a Cenificate of Conrent to SclfJnsre for workffi' compensation, as pmvided for by Setion 3700 of the <br />lrtnr Code, for thc pofomrcc of thc work for which thc pmit is issucd. <br />-l <br />havc and will maintain workers' compensation inrurancc, as required hy S(tion 3700 of lhe Labor Code, for the perfomnce of <br />the work for which this pemil is issed. My workqs compenslion insurarce carier Ix)licy number are: <br />o 2-OvPolicy <br />-l <br />cenify that in thc performance of the work for which this permit is issued, I shall not employ any person in any manner <br />w as to bccome subjecl to the workers' sntpensation laws of Cal ifornia, and agrce that i f I stnuld bccomc subject to thc <br />workerC mmpe[stionpmvisionsofSeclion3T00ofthcl.atnrCode.lshall.forthwilhcomplywirhrlmsepmvisions.. <br />WARNING: l'ailurc to *cre workcm'compenstion @vemlre is unlawful. and shall rubjat an mplolcr to Gimiml JEmltid nnd <br />civil fines up to ore hundred thoumnd dollars ($in addition to the cost of comp€nstion, damges as provided for thc <br />Seclion 3076 Code, interest and <br />r0 \ <br />I hereby aflirm under pcnoltyof pcrjury lhat I am <br />NFCLARA'I]ON <br />under pmvision ofChaptq 9 (commencing with Sstion 7000) ofDivision 3 <br />of lhe Business and Prefessions Code. and my license is in full force and effect. <br />Licc[3e ^,.*,, f8t{1lf <br />1 <br />CONSTRUCTION LFNDING AGENCY <br />I tmby allim under pemhy of pcrjury that thqc is a cordructbn lending agcrcy for thc pcrfom€ of th. mrk for which thk lrmit is <br />i8scd (Se. 3097, Civ. C.). <br />Lcnder's Name: <br />Lender's Address: <br />APT'I ICANI' DI.'CI.ARA'I'ION <br />I heruby allinn under penahy ofperjury onc of the Ii)lhwiilg decloratt)ns: <br />Dctrx)lition Permils-Asbcslos Notification l:ederal Rcgulati()ns ('l itle 40, l'an6) <br />-l(crluired <br />Lercr of Noti,ication <br />-l <br />cerlify that lhe fedcral regulatbns reguding asbestos removal nre not applicablc h lhis pmject. <br />-l <br />cerlify that I lurve read this applicatbn ard stalc lhal lhe ah)ve informalion is corecl. I agre to comply with all City aml County <br />ordimrcd ard Statc lrws ElatirE cpr*ntalivd of this Cityand Countyto otcr upon thc <br />above rentioned pmpcrty for <br />Applirililt or Agcill <br />Pernrltec n{me <br />APPROVALS DATE ID/SIG COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOUSPA <br />Ptrap/Drain Line <br />Main Drain/Pool Pipinq <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 Plumbing <br />Final Gas Test <br />Meter Release <br />FINAL 7*7"70 trMiv) <br />Rema Etc. <br />/\\ <br />l)ilr <br />,J,/.of'1