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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildino Sewer <br />Area/Storm Drain <br />lnterceptori Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />[t/ain 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 SeweriCap <br />Back Flow Device <br />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release <br />FINAL 2.??.?lu,Dd"b a) <br />Notes, Remarks, Etc. <br />()lVNUR UtJil,l)t;R t)tit,CARATt()N <br />rpflicrnlli)raFrnril\uhjccl\lhc rpplicxnlk)ilcivilfcnilhyol'noliil)rclhinllvehundrcJdollnr\(S5(X)). <br />_1. &s owrer of the prclErty. or my emplo)es with wagcs as lheir $le comlf,nstion. will do lhe worl ard thc smfurc is ml <br />interdcd oroffercd for sl€ (Sa.7O44. Busircss and Pmfessions Codc: Th. Conlmdor's Licens lrw dcs nol agply lo sn owrcr of <br />thc profEny who builds or irpmm 0E@tr Ed who d6 sh mrt himsclf ot hcNlf or thrcugh his or hcr own crnployccs. <br />prcviied that such imprcremnts m mt interded or offercd for sh. lf. howew, lhe building or inprcwmnt is sld within orc ,tu <br />of @r{,btion. 0E Owrcr BuiHc will harc thc burdcn of proving that hc or sh€ dU ml tuild or iqrcw thc Imfrrry for the purlns of <br />sle). <br />anrl $ho conlrncls li)r snch pfiiiccts qilh n ('()rilrilclo(\) liccilsc(l pnr\uilnl k) lhc Conlrircl(n r l-iccn\c l.irrv). <br />lilnlcxclnnlundcrScclb[-.t}'&P'C.lirrthisrcason. <br />WORKFRS' COIIIPFNSATION <br />DECLARATION <br />I hcrchy aflirm under pcnahy of pcrjury onc of the follow ing dcclarut ions: <br />_l havc and will mintain a Ccnificalc of Conscnl lo Sclf-lnsurc for wotkcrs'compcnsalion. fls providcd for bySstioil l7U) of lhc <br />titx)r Code. for thc pcrfonmncc of lhc wotk for which lhc l--rmil is issucd. <br />_l havc and will maintain *orkcrs' compcnsrlion insurancc. 0s rcquircd by Scction -1700 ofthc tntDr Codc. for thc pcrfornunrc of <br />thc work for which lhis pernit is isscd. My workcrs' cofllrcnsalkrn insurance caricr ilxi lmlicy nunrbcr arc: <br />Policv Numhcr: Exoircs: <br />_l ccnili thal in thc pcrfornrrncc of lhc ivork for which this pcrmit is issucd. I Nhnll not cnlpk,y rny pcrsoo iil any nlilnncr <br />so as k) trcoilE subjcct h lhe workcrs'c(,nrl)cilsrlion laws ol'Crlilbrnin. nnd agrcc lhal il I shoul(l hcc()nN silh.iccl lo lh(' <br />workcrs'conlpcnsati(rnprovisirmsofScclir)nJ7(X)oflhcl,ahrrCorlc.lshxll.forlhwilhcomplywilhlho\cnrovision\.. <br />WARNIN(;: Frailurc k) scure workcrs'conrlEnsrition covcragc is uillawful. and shall subjcct an cilrpk)ycr h qirnhul FEmllics dld <br />civil fincs up to hundrcd dollnrs {$l(X).0(X)). iil hn to cost of compcnsation.for the <br />Seclion 3076 I -atxrr inlcrcsl rod slk)rncy s l'ccs. <br />I htlr: <br />I hcrchy aflirm undcr Jrcnally ofpcrjury lhal I am Uer{d pmvision of Chapter 9 (comrcrcing wilh Sccthn 7fin) of Division .1 <br />of th€ Busiress aod Prcfessions Codc, and my flccnsc full fore and cffccl. <br />[.iccnsc <br />I hcrchy al'lirnr undcr [Enrlty ol pcr iury thrt lhcrc <br />issucd (Scc. .1097. Civ. C.). <br />agcncy for thc pcrform{ncc ofthc work for which this fEnnil is <br />lIndcr's Nailic: <br />lrnrlcr's Arldrcrr: <br />- <br />APPLICANT DECI ARATION <br />I hcruhy aflinrr undcr penally of pcrjury onc r)f lhc folkrwiilg dcclarations: <br />Dctrr)lilion Pcrmils-Asbcstos Nolificatiol Fcdcral RcSultrlionl ( l'illc 40. Pan6) <br />-Rcquircd <br />Lcttcr of Nolificstion <br />_l certify thar the federal rcgulations rcgading asbcstos rcrmval are ml applicablc to this pmjccl. <br />-l <br />cedify lhol I havc rcad this applicalion ud statc lhal lhc abovc infornulion is I agre to comply wilh all <br />ordinarces and State hws rclatirg to <br />atx)vc mnlioned pmpcny for <br />,\ppliciltrl or,\gcnl <br />Pemilee nanre ( <br />ofrhis City rnd <br />and County <br />thc