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PLUMB!NG.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OIVNI,IR lltJll,l)llR lrLl,CARA'l'l( )N <br />Ilusinc.s an(l Prolc\\ir)n (i)dc): Any City or Counlv rvhi(h rcquircs n lErilril lo cot\lnr(l. rllry. iirprorc. dcnmlirh or rt-pair nnl <br />upplicantlbrrpcrilritsuhlcctsthc applicrnlk)rcivilpcnaltyoln([nx)rclhrill-ivchur(lrc(ldollar\(S5{x)). <br />l. x\ owncr ()l thc ptol{rty. or nly cnrphyccs rvilh wrgcs r\ lhcir \olo conpcnsation. sill (l(, lhc work r,il llt slnrlurc i\ In{ <br />srlc ). <br />_1. as owrer of lhc proIEny. .m cxclusively contraclinS wilh licensd contr.clore lo onslrucI thc pmjcct (S€. 7(X4. Busincss <br />and Prof6sbnCodc:ThcContraclor'sLicenseLawdmsnotapplyloanowncrofpmFErtywhobuildsorimproveslheron. <br />and who conlmctr for such tmjccls with I ContBctor{s) liccnsd pursuanl to thc Contraclor's Liccns Law). <br />I xnr cxcilrDl urilcr Sce tion-. ll & P.C. li)r lhis rcason. <br />lhlc: ()w[er: <br />\YOItKI{tS' CONlPliNSAll()N <br />t)t,rcL,\ti^'il(-)N <br />I hcrchy al l'ir nr rrrrler lrnrllv ol l)crilrry ()nc of thu lolkrs irg rI:chr rt ionr: <br />_l havcaftlwill nuintainaCenilicillcofColscnltoSclflnsucli)rNorkcrs'conrpcn{rtirnl.rs providcdforbyScclionlT{x)oflhe <br />Lahor Code. for lhc lcrli)rilrilncc ol-lhc work frrr *'hich thc pernrit i\ issucd. <br />-l <br />have and will mintain workcrs' compcnsalion insu,ame, as rcquircd by S6tion 3700 of the kbol Code. for the performrcc of <br />thc work for which this pmit is isnrcd. My workos' comJnnsation insurance @ier ald Jnlicy number m: <br />T pS rt*-r^rcrsr o t tt+€ tJcsf 7 <br />o <br />2Lr ccnify that in thc pcrlbrnuncc ofthe work for which lhis pcnnil is issucd. I shsll nol cmploy any pcrson in any mrnncr <br />s Bs to bccore subj$l lo lhc workcrs' comlEnsatior lsws of California. and agrcc lhal if I should 'e|*om subFct to tl& <br />workss'compcnsalionpmvisionsofSclion3T00otthctitnrCodc. lshall.forthwilhcomplywilhlhorcpmvisbns.. <br />WARNING: Failurc to surc workers'comfrcnsation covcmge is unlawful. and shall subject an cmploycr to fiiminal Fmllics and <br />civil fincs up to onc hundrcd thousand dollss ($100.0t0), in addition lo the cost of comfEnsation, drmges rs pmvided for the <br />Scclion J076 inlcrcst and altormy's fccs. <br />.q /(f €LAppli$nl: <br />7o ugso1 ICIiNSID CON'I'RACTOR <br />l)ltcLARr\1'loN Ll-O.Y o <br />ol lhc llu\inc\\ nnd I',r)lc\sir)ns Co(lc. {ild nty liccnsc ir iil lirll li)rcc rnd clli'cl. <br />C-7 c '77f771 <br />Nunrber:n /,+t kf alect* <br />CONSTRUCIIoN I F:NDINC ACENCY <br />Ihcrchyal'lirnrrndcrpcnnltyofpcrjurylhalthcrci\{co0struclionlcndingagcncyforthcpcrfr,rnrilnccoflheworkforahichlhilltrmilis <br />issucd (Scc. 3{}97. Civ. C.). <br />l-eildcr's Naillc: <br />lrndcr's Addrcss: <br />APPLICiINT I)ECLARATION <br />I hcrcby allirnr undcr pnrlty of pcrjury onc of thc folkrs'iIg dcclarat ions: <br />[)cnnlilion l'crmits-A\lE\to\ Notillcation Fcdcrrl RcSuhtions {1 ilIc.10. Pan6) <br />_Rcquircd [-cltcr r)l Nrililicilliur <br />_l ccrtily thnl thc li\lcrrl re Inlxliotrs rcgil(|iil8 ashcsl(,s rcrnoval arc nol rpl)licrhlc lo lhi\ proir'(1. <br />-l <br />ccrlify that I hrvc rcad lhis af,plicalbn aftl slalc lhal lhc sh)vc is corccl. I agre to comply wilh all City afrl County <br />ordinances and Stste [jws rclating lo huilding conslruclion.rcprcscnlali\rs oflhis City and Counly lo cnlcr lFn llrc <br />abovc mntiorcd pmlEny for inslEction purlnscs. <br />Toteqt <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouoh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill LineiBack Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitarv SeweriCap <br />Back Flow Device <br />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release <br />FINAL 7-2*'zaa J).5tf '@ <br />Notes, Remarks, Etc. <br />(*",-I <br />Conlre(krr <br />*,,/r/,