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PLUMBING.!NSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipino <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouoh Water Heater <br />POOL/SPA <br />Ptrap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Misce!laneous <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 0 <br />FINAL (fipCet <br />Notes, Remarks, Etc. <br />YeYnn,r vnt/,\tA 21Alplor N,/ <br />OWNI]R BTIII,DER I)I:I,('ARA'I10N <br />I hcrchy alfirnr un(lcr Jrcoxlly of pcrjury lhal I anl cxcnrpl liom lhc (inilructor\' l-iccnsc Lrw lbr lhc folk)sing rcn$n (Scc.7{)-11.5 <br />llusincss arkl Profcssion Crxlc): Any Cily or County tr'hich rcquircs a lrcrrril t() con\truct. rltcr. iuprovc. dcnplish or rcplir uny <br />\lruclurc.priorloils issurncc.dhorcquircslhcafplicanltbr\uchpcrnliltrlilcasigncdsl{tcnrcnl thathcorshcisliccnscd pursuvl <br />lo lhc provisions of lhc C(,nlrilctor's l-iccnscd Lrw (Chaptcr 9. (i)tr]nrcncing $,ith Scclion 7(n0 of t)ivi(k)n I of rhc Bnsincss al(l <br />Profcsst)n\Codc)orlhrlhcor\hciscxcnlfllhcrclioilandthchrsislirrthcallcgc(lcxcnulion. AnyviolationolScctiorrT03l.5byany <br />apnlictrnlforrpcrnrilsuhjcclslhc rpnlicanlloilcivilpcnflltyo[nolnn)rclhlnlivchun(lrcddollars($5U]). r <br />-.-1. as owncr ol lhc prI)pcrly, (n'illy cilrnk)yccs wilh waScs as lhcir solc conlpcnsiltion. willdo thc work and lhc stnrcturc is]xl t <br />lhc profrny who buikls or iillp(rlcs lhcunr. and who docs such sork hinrsclf or hcrsclf or lhrough his or hcr orvn cnrpkryccs. <br />o, .onnlction. lhc Os icr Buiklcr will hrvc thr hurdcn of proviiS lhat l* or shc tlitl noi build or improvc thc prfrny lirr thc fuqx)$ ol <br />$lc). <br />-1. <br />as owrer of lhe proJrny. am exclusivcly conlracting wilh liccnsd conlrockrF lo conslrud thc rtroj$t (Ss. 7(X4. Busincss <br />snd ProfsshnCodc:TheContractor'sLiccnseLswd@smtapplyloanowncrofpropcrtywhobuildsorimprovcsthcrcon. <br />and who contnctsforsuchpmj6lswithaConlmcto(s)licenrcdpursuantlothcConlraclor'sLicenseLaw). <br />-lilnlcxeillplundcrsc(li(ln-.B,&P,C,forthisrcason, <br />WORKEIIS' CONIPENSA'IION <br />DECLARA'I'ION <br />l hcrcby atlirrn undcr pnalty of pcrjury rrrc ol thc follorvirg dcclilrnlk)trsl <br />6hrt" rA nilluuintairr a ('cnillcatc ol Conscnt to sclf lnsurc lir $<rkcrs' con1)cnsalion. as provirlcd lirr hy Scctir)n 37{X) ol thc <br />l,atx:r Crrde. lor thc pcrlorilfincc ()f thc sr)rk li,r shich lhc pcrnrit ir issucrl. <br />frrcandu'ill mainlritr$()rkcr\'coilrJtcrsuli([iIsurancc.ar rcquircrl hySccln)n.17(X)oflhcLahorCodc.forlhcpcrfornrnccof <br />lhc utrrk for which lhis;rcrrril is issucd. lvly workcrs corllrcnsxlir)n insurrncc canicr axl p)licy nunlbcr ilrc: <br />civil fincs up to onc hundrcd thousand dollars (S in addition k, lhe cosl of lor thc <br />Scclion -3076 ofthc L{tbr Codc. intcrcst fccs- <br />o,r".ol-27-b <br />I)tict,Ali,|It0N <br />I hcrchy allirrr undcr pcnally of pcriury lhnt I am liccn*{ undcr provision ol Chlllcr 9 (connrcncing with Scction 70fi)) of Divisi{)n -1 <br />of thc Busincss and Prolc\siols (ildc. and rny liccnsc is in lull lorcc rnd cfltct. <br />l-iccnsc 'a6aa-- <br />I hcrcby affrm under lEnally ofp.rjury Ihal <br />issued (Sa. 3097. Civ. C.). <br />[.nder's Name: <br />is a conslruction lcndinS agcncy for thc lrcrformrce of thc work for which this Imil is <br />kodcr's Addrcss: <br />APIIJCANIjECI,ABAIION <br />I hcrcby affim under pen8hy oftEqiury onc ofthc following dcclarations: <br />Dcmolition Pcrmits-Asbcstos Notification Fcderal Regulations (Titlc 40, Pfft6) <br />_Rcquircd Leltcr ol Notificrli(nl <br />-l <br />certify that thc fcdcral rcgultlions rcgarding astEstos rcnovnl arc not upplicablc to this projcct. <br />I lhis application and state thal the ak)vc infonmtion is corct. I 09re to comply with all Cilyand County <br />' rcFescnlBtives ofthis Cily and County lo cnts utnn lherclating lo building construction. ard herehy <br />atnvc mntioncd lirr <br />Applicatrt or Agent <br />lrernrilee nDfirr ry"o,rL <br />o^,", o l'Zz !2 <br />paxy*, *,, u,JC l 06 o? ?6 OO E pn"", a7- 4'bb <br />6".r'tity *utin thc perforroncc of thc work lbr which this pcrmit is issued. I shall not cmploy any person in any manncr <br />so as to becom subjcct lo lhe workers'compensation laws ofCalitbrnia. and agrce lhat ifl should becom subjcct to thc <br />workcrs'comp€nsotionprcvisionsofScction3T00ofthekborCodc.lsh{ll.fodheilhcomplywiththorcprovisions.. <br />l)alr: