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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE tD/srG.COMMENTS Owns-Builda Delmtion <br />I hocby aftim undqpcndty of pcrjury thatl m cxmpt fm thc CmttEtm'Limc Lsw fo thc follwing ram (tc.7031.5 Bu3in$ <br />md PrcfNion Codc): Any Ciry or Cruty which rcquiG s pcmit to conrnuc! slttr, imprcvo, dmolilh fi Eprir uy lEucturg pri6 !o iE <br />isruucc, also rcquire thc applicut for such pcmit to filc a ri3ncd rtrtdnmt thst hc or lhc h lica:cd pmmt to thc provisior of thc <br />Cmtrctc'3 Licdod Lse (Ch+tr 9, CmadnS with Sc€tion 7000 of Dvirio 3 of thc Buinqs ud Profqiw Codc) w thrt hc r <br />ih€ ir cxmpt rhqcfrom sd thc bsis fn thc sllcgcd oxmption .Any violation of Section 7031.5 by my applicmt fff s prmit $bjcct rhc <br />spplimt to a civil pcoalty of not morc thu fivc hudrcd dollu (3500). <br />_I, a own6 of thc propcrty, or my mployca with w8gcs as thcir rolc rcmpcnsation, will do thc wck md thc ttructrc it not intmd€d <br />or ofratd fc ralc ( 5@.7044, Buinqs ud Prcfsiw Co&: Thc Cotrtrettr't Lic@c Lrw des not spply to u oma of thc prcperty <br />who buildr fi imfoye thm, ud who de ruch wqk hiruclf c h6clf 6 tlrouSh hi! q h6 M 6ployc6, providcd thst sch <br />improvmet! d. nor itrtaded or offrrrd for rolc. If, hwrc, thc building or improvmmt is lold wilhin onc ycu of complction. thc <br />Owncr-Builda will havc thc budo ofproving that hc or shc not build or impovc for thc purpoc ofsalc). <br />_I, s owncr of rhc propqty, m cxcluivcly contrrcting with licm$d mrrctm to conrtruct thc prcjcct ( Scc. ?044, Buin6! ed <br />Profcsion Code: Thc Contrcts's Limsc ln d6 not 8p?ly to e oma of prcpcny who builds c imprcvc thcrcon , ud who <br />conret for such projccts with s Conf&to(t) licatcd pNuut to thc Conrutor's Lic63c L!w.). <br />_I m cxmptuda Seti6 <br />-B, <br />& P C. forthir ruon. <br />Dqtc: Owna: <br />t hmby sffimundq*rO or*i-*ffi <br />_I havc md will mint8in 8 C€nific{tc of Corumt to Salf-Intw for wokm' companrtion, u povidcd fu by Scction !700 of thc <br />Labc Codc, for thc pcrfme of thc work fc which thc pcmit ir irucd <br />_l havc md will mrintain wsk6' cmpc$rrion luursc, u rcquircd by Setim 3700 of thc Lrbq Codo, for thc pcrfoma@ of thc <br />work for which this pqmit ir imcd My worta' mrnpanrslim iEutdtca ffii6 sd Policy numbc ac: <br />Policy Nmbcr: ExPircsr <br />(Thk sctipn nccd not bc ompletcd if thc pamit is for Onc hudrcd dollm {3100} a lcss) <br />J*tty ,lrn in Uc pa'fommrc of thc wfik for which thir pqrnlt <br />l6emc nbjct o the worto ' conpqurtio hm of Cdifmir, ud <br />it isrucd, I shsll not mploy my pmon in mana 30 a lo <br />rgG thd if I 3h@ld <br />compmsation provirions ofthc Labc Codc, I rhall, fsthwith <br />WARNING:to wtrk6' cmpcnsation rubjcct u mploys to riminal pcnahia and civil <br />fin6 up !o thowed doum (S100,000),in sddition to thc cst damrgo u prcvided fr thc Strtion 3076 of <br />$c Lsbq Codc, intfictt ud rttmcy's fd <br />LICENSED COI{TRACTORS DECLARATION <br />I hrcby afrlm udcr poalty ofperjury thrt I m licmrcd unda provilion ofChrptq 9 (commcncing with Scction 7000) ofDivltion 3 of <br />thc Bwinc ud Profesions Codc, ud my licmsc is in frrl fqe md cffet. <br />Liccilsc Licmsc Numbcr <br />I hacby undcr pcnalty ofpcjury that thcc is a construction agmcy ofthe work for which thir pcrmit ir <br />isucd (Scc. 3097, Civ. C.). <br />Ldd6'! Nme: <br />lndq's Addrss: <br />A}PLICANT'S DECLARATION <br />Dcmolition Pmits-Atb6t6 Notilicdion Fcdml Rc8uladmt (Titlc 40, Pst 6) <br />_ Rcquircd Lctta ofNotificalion <br />rcmovsl e rot applicablc to thi! projcct. <br />thc rbovc I agrcc to comply with sll Cit, ud County <br />sbovc mcntioned propcrty for inlpcction <br />Applimt or ag6t <br />Pcmincc nmc <br />ud of thit City Md cnlcf thc <br />UNDER GROUND <br />Waste & Vent <br />Water-Underfloor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipeing <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOUSPA <br />P-trap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Misc <br />Gas Seruice <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release 5Ar IF(trU \ l^, <br />FINAL ll trl .a <br />,I W' <br />(Notes, Remarks, Etc. <br />Fa€.29o,sso,ooz <br />L. <br />rvr! v l, 3vlr,.t (