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PLUMB!NG.INSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS OWNF:R BUll.l)llR l)l;L(:ARA1'lON <br />I hcrchy rffirm undcr pcnally ol pcrjur), lhill I urn cxcillfl frotrr lhc Conlrncl(trs' I-iccnsc l-ru for thc tbllosiltg rcason (Scc.70-1t.5 <br />Ilusincrs and P(,lission C(ilc): Any City or County which rcq[ircs r lrennit l() construct. ahcr, inprovc. rlcnxrlish or rcprir any <br />\truclurc. prior k) its issuancc. also rcquircs thc lpplictrnl ti)r such rcfinil to lilc i signcd slrlcnrnt th:il hc or shc is liccnscd purruant <br />b thc provisi(rrs of lhc Coillrack)r's l-iccnse(l Lils (Chrptcr 9, Cotnnrcncing u'ilh Scction 7(XX) ol Dirision 3 of thc llusincs\ and <br />npflicanlli)rapcrnlitsuhjcct\lhc xpplicanln)acivilpcnxhyolnolmorclhrnlivchundrcd(lollars(S5(X)) <br />-1. <br />as owrcr of lhc pmpcrty. or my cmployecs with wagcs as lhcir $lc compcnsalion. will do the work and lhe stmrc is ret <br />inlcndcd oroffcrcdfi)rsle(SN.7044.BusinesssndhofcssionsCodc: ThcContrsclor'sLicensLswd@snotspplylornowrcrof <br />lhcpmFrty whobuildsorimprorestlEmn.Bndwhodessuchrcrthimsclforhcrelforthmughhisorhcrownemployecs. <br />providcd thal such imprcvcmnls @ ml inlcrded orofM for sh. lf. howevs. thc buiHing or inpmvemnt is sld within orc ,cs <br />of onphlion. thc Owner BuiHer will haw lhc burdcn of provinS thal hc or shc did nol build or in{,mve lhc prcFEly for lhe purFrcof <br />sb). <br />-1. <br />us owncr of lhe prepcny. am cxclusivcly conlracting wilh liccnscd contracloF lo construct thc pmjccl (S(. 7(X4. Busincss <br />and ProfssionCodc:ThcContraclor'sLiccnseLawdocsnolapplylornowncrofpro[rcrtywhobuildsorimprovcsthercon. <br />and who contEcts for such pmje{ls with a ConlEclo(s) licensed pursunl to lhe Conlractor's Licensc Law). <br />lanrcxcntptun(lcrsccli()n-'B,&P'C.li)rlhisrcilsotl' <br />Dttc: _ , Owner: <br />WORI(ERS' COMPENSATION <br />DECI.ARATION <br />I hercby affirm undcr penalty ofpcrFry onc ofthc following declarations: <br />l-ahrr Crxlc. li)r lhc pcrloriluilcc (,1 thc rvork lirr shich lhc pcrmil i\ is\uc(l. <br />_l havc and ss rcquired by Seclion 3700 of lhc labor Code. for lhe lErfolmnce of <br />lhc work for insurancc canicr arxl g)licy numbcr ilc: <br />Policy <br />_l ccnify that in rhe pcrforronce of thc work for this FErnlil is issucd. I shall not cmploy any persn in any milner <br />ofCalitbrnia. and agre lhat if I slnuld bccom subjccl to lhem us to becorc subjel to thc worke6' comlrcnsation laes <br />workcrs'comFnsalionpmvisionsofSalion3T0OofthchtnrCodc. lshall.forthwithcomplywilhlhoscprevisions.. <br />Scctbn 10?6 of thc tjtxrr Corle. irlcrest and <br />o"o, . lo 3- ?i7c <br />oi lhc BrciDcs{ nod Prolcssions Crrdc. aml mv liccnsc is in ltll li)rcc an(l cll'cct. <br />l,iccnsc Nunrltr:&Aa ll(/ l -11n <br />CONSTRUCTION LF'NTUNG AGENCY <br />lhcrchyrllirmundcrpcntrltyofpcrjurythsllhcreis.conslntclionhndilgagcncyforlhclrcrlirrmanccofthcworkforwhichlhi\fErmilis <br />issucd (Scc. 3097. Civ. (:.). <br />lrndcr's Nanrc: <br />kndcr's Addrcss: <br />APPLICAN'I' i)ECLARA'I](IN <br />I [r*hy allirnr untlcr pcn{lly of perjury onc of thc lirlkrwing rlcclarat ions: <br />I)cmolition Pcrnrirs,Ashcstos Nolillcatioil Fedcrr! Rcgulations (Titlc 40. Prn6) <br />_Rcquircd [.ltcr ol' Notilicrtiul <br />_l ccrtili'thal thc fcdcrnl rcguliltions rcgarding ashcskrs rcrmrval rrc nol upplicahlc n) this projcct. <br />!l.",rity rt,,n I huvc rcud Ihis rpplicxtion dnd strlc thnt thc iltnlc in,i)rnution as corcct. I rgr!rc k) comply with all Cily an(l CounIy <br />ordinances and Slate hws rclating lo building construction. ard hcrebyauthorizc represnlativcs ofthis qillSnd County to enlcr upon lhc <br />above renlioncd pmFrly for <br />/\pplirilnt or Agrnl <br />Pemile nanle <br />uiu, l-1-7.to <br />UNDER GROUND <br />Waste & Vent lt tllut 1 ?l.'fiM v9) <br />Water-Under floor L I UI, <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipino <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />[/ain Drain/Pool Pipino <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 />Rouqh Plumbinq <br />Fina! Gas Test <br />Meter Release <br />F!NAL 7t lM\...d % <br />EtcNotesRemarks ,I ulI