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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/S!G.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildino Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />lVain 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 Plumbinq <br />Final Gas Test <br />Meter Release <br />FINAL 2-1-9. %?J),.h @ <br />Notes, Remarks, Etc <br />\lructurc.pri(rrloil\ i\surncc.rlsorcquircsthcapplicanlli)r\uchncnnitlolilctsigicdslrlcnrnl lhrthcorsheisliccn\c(l pnl\uit| <br />xpplicanllorat^-nnit\uhjcct\thc ilpplicnnlk)acivilpcnaltyol'nrlilmrclhantlvchundrcd(lollrrs(S5(n). <br />-1. <br />rs ou'ncr of thc p()Jrnv. or my cnrpk)yccs wilh w{8cs n\ lhcir srrlc cornpcnsation. willdo Ihc work and llrc stndurc i\ rxil <br />irilcrdcd orollircdli)rsalc(S(.7(}l4. IlusirrcssandPrrlissionsCodc: JhcContractor's[,iccnschw&)csnolapplykrnlowocro[ <br />lhc pmrcdy who builds or iillprolcs lhcB)n. and uho doc( such sr)* himsclfor hcrsclfor lhrough his or hcr own cmpkryccs. <br />providcd that such improvcilrnls arc nol intcndcd orollcrc(l for silh. lf. howcvcr. lhe huikling or iilrprovcnEnt is sold wilhiil (nrc }(ilr <br />o[conrdction. thc owncr Brildcr will have thc hurdcn of provir]g lhdt hc or shc did nrrt buikl or improvc thc propcrty tbr thc purF)sc o[ <br />srlc). <br />-1. <br />Bs owner of lhc pmpcaly. am exclusively contractin8 wilh liccnscd conlracloN to construct lhe pDject (Ss. ?044, Busincss <br />and Ptoftsskrn Codc: Thc Contractor's Licensc Law docs not apply lo an owrer of properly who builds or improvcs lhercon. <br />and who contracls for ruch tmjccts wilh I Contmclo(s) liccnsd puBuant to the Contrador's License [rw). <br />_l nnl excmPl .C. for <br />al firnr un(lcr pcnrlty ol'pcrjury onc <br />' DECI"AEAIIQN <br />folkrwing dcclaralions: <br />_l have ud will mintain a kr Sclf-lnsurc for workcrs' comlrcnsalbn. as providcd for by Scctkil 3700 oflhc <br />ktDr Code, for lhc pcrformancc of for which thc pcrmit is issucd. <br />for the pcrfommc of <br />r <br />_l ccnily thal in thc pcrfbilmncc of thc work for which lhis pcrnlil is issucd. I shall not nny in nnv ntxnncr <br />w as to trccomc suhjccl to lhc workcm' compcnsation laws ofCalifornia. and agrcc lh0l if I should hccom subjcct lo thc <br />workc6' compcnsation provisions ofScction 3700 ofthc Lilh,r Codc. I shall. fonhwilh comply with lhos provisions.. <br />WARNING: Failurc lo rccurc workcrs'compcnsnlion covcragc is unlxwful. and shlll subjcl an cmpk)ycr to siminal lEnallics and <br />civil fines up to orc thousand dolla.s tr&lil lo Ihc cosl as provilcd for thc <br />Smtion 1076 of intcrcsl ed attomy'sL <br />DECI ARATION <br />undcr provision of <br />,WA <br />I hcrchy aflirm uuder l)cnalty of pcrjlry that I mr with 7fin) ot Division.1 <br />()l' lhc Busiilcss and llrol'('\\ir)n\ (ixlc. ilnd rny is in lirll li:rcc and cfltct. <br />Liccnsc r <br />? <br />l- <br />I hcrchy alfirm undcr Jrnrlty of pcrjury lhirt thcrc lcnding agcrrcy for the pcrfomncc of the work for which this frrmit is <br />issucd (Scc. 1097. Civ. C:.). <br />hndcr's Namc: <br />kndcr's Addrcrs: <br />APPI ICANT DECLARATION <br />I lm$y aflinn undcr pcnahy oI pcrjury onc of lhc following dcrlarations: <br />Dcmlilion Pcrmils'Asbcsros Norification Fedcral Rcgulstions (Titlc 40. Pan6) <br />-Required <br />[.ttcr of Notificatk)n <br />_l ccflily lhdt lhc tcdcral rcgulnlions rcguding ashcslos rcnx)vfllurc not applicahlc h lhis nroject. <br />_l ccilily lhal luvc rcrd lhis rpplicalioI lhc ahrve with all City rnd Counly <br />ordin:rnccs and Stale liws rchling <br />abovc mntiorcd pmperty for <br />or Agrnl <br />lo <br />and slnlc lhrl <br />aftl <br />inlornnlion is co16l. <br />and County thc <br />,,t ", *"^*,, /,€f,/ 6'itz Vf 29 / fZ / 7 r^rt ""