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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS ()IVNI.;R I]t]II-DI.:R I)F:I,CARA'I'ION <br />\lnrclurc.pri(trk)ils i\suuncc.ahorcquirc\lhcxpplicanlli)r\uchFrtrilk)lilcxsigncd\lrlcnrcnl lhhlforshci\liccD\c(l pur\lanl <br />t(' thc provisionr (,[ tlr (irntrrctor'\ l.iccnscrl l.aw (Chnflcr 9. Crrnrntcncinc s ilh Scclion 7(D0 ol- I)ivisiln 3 of thc llusincss.unrl <br />rpplicrnllirrrncrnlilsuhjcclslhc applicilllk)!civilpcnallyofn(ilnr)rclhanli\chundrc(l(lollursl35(X)).I <br />_1. rs owncr ol thc fro|tlly. or ilry ctrrl)loyccs with silgcs is lhcir {olc conrpci\rlt)n. rvill(lo lhc work rnd lhc stnrlirc is n(i <br />thcproFny uhohuildsorirrprorc\tk'rc\nl.rn(ls'ho(l()c\\nch\\orkhinrsclf()rhcr{cllorthroughhisorhcro*ncnrpkryccs. <br />snlc). <br />_1. a\ os ncr ()f lhc propcily. am cxclu\ivcly contrxctiDg \ ith liccn\cd conlraclor\ t() .onstruct tlE p()jcct (Scc. 70,1.1. Ilu\inc\{ <br />iln(l Pfi)ltssi(ntC(xlc:'lhcCoillrdclor'sl-iccn\cl,ilwdoc\n([flpplyl()rlowncrofpropcrlywhohuildsorirnprrvcslhcreon. <br />xnd s'ho coltracts l()r such projccl\ wilh il (i)rilrrclo(s) licc[scd pur\uilnl l() lhc C()nlruclor'\ [-iccnrc I-aw). <br />I amexempt unds Setion-. B. & P.C. for this rc8son. <br />l)xlr ()rrilrr <br />lV()RKr,'RS' COilr Pr-NSA',n0N <br />DECLARAl]ON <br />lh('r+yallirnrun(lcrlennllyoftrcrjrtryonc('IlhclirllirsrrE(kcltrilli(,n\. <br />l.atyr Crrlc. hr thc pcrkrnr:rncc ol'thc rvork lirr shich thc pcrtrril i\ i\\ilcd. <br />thc $r)rk li)r which this pcrrrit is irsuctl. My Nrrkcrs conrlrtrsrli(xr in\rrilncc carricr flnd F)licy llumhr ilrc: <br />Policy bo o6 oq- zGZoZd <br />Jfl ccdih rhxr in rhc pcrli'rilril0.c ill lhc $r)rk liir shich lhi\ pcrtrrit i\ i\sucd. I \hnll nol cnrpk)y rny pcrs(,n in rny nranncr <br />ro rstohccrnrcsubjcclt()lhcuI)rkcr\'coiltpcnsrlioillil\\{,1'Cillili)rrir.undnSrcclhrlill\houklhcconr\ubjcctt()llr <br />$lrrkcrs'conrt--nqxlionprrrisionsr:lScclir)tr.]7(X)ofthel.xh'rC{xlc. l\hull. li)rlh!r'ilhconrply*iththo*provisir:ns.. <br />WARNING: Failurc lo *curc workcrs'comlrcnsation covcmgc is unlswful. and shall subjccl an cmploycr to ciminal fEmlths trnd <br />civil fincs up lo orc hundrcd thousand dollars ($100.flm). in addithn lo lhc cosl of conr;rcnution. damges as providcd for the <br />Scction 3076 oflhc titDr Codc. inlcrest and ttcs. <br />l)ille:ZZ-ZA <br />I hcrcby rll'irnr undcr pcnulty of pcrjury that I am liccnrcd undcr oIChaptcr 9 (comrrcncing with Section 7{XD1 of Division 3 <br />of lhe Busircss and Pmfessions Code. ard my licenre is in full fi)re ard effel. <br />37o6a ?Liccnsc Nunlhcr: <br />lhlr <br />I hcrcby aflrn undcr trnalry of perjury thd Ihc.c is a consrrucrion hnding agency for the pcrfomrce of the work for which this Imil ir <br />issucd (Sec. .3097. Civ. C.). <br />[aodcr's Nnrre: <br />Lcndcr's Addrcss: <br />APPLICANT DECLARATION <br />I hcrL*,y allinn uildcr p(nalty ol pcrjury onc ol thc lirllo$'ing dcclarattrns: <br />DcD(iliti(!n Pcrnrits-Aslxstos Nolillcrlbn [:cdcrrl RcSuhlions (Titlc.l0. Pxrl6) <br />-Rcquirc(l <br />l-cllcr (,I Nolilicali(in <br />-l <br />ccnify that thc fcdcralregulalions regtrding nsbcstos rcnroval urc not applicablc lo lhis pmjcct. <br />I rcad lhis applicdion srd stalc lhal lhc atnvc irfonnation is corEl. I agle to comply with all Ciry and County <br />0rdinrnccs rcluting to huilding rcprcscntalivcs oIthis Cily and County lo ents uF)n thc <br />abovc <br />Applicant or <br />l'ernrilrr <br />for inspcction <br />nftl hcrcby <br />D,r", o/-7 ?'7o <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ 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 />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler ,l nl - o-t <br />Sanitary Sewer/Cap 2t t/7)Wtrlv:t qo , <br />Back Flow Device lu <br />Rouqh Plumbing <br />Fina! Gas Test <br />Meter Release I .l <br />FINAL ',t{IL DtTN,tu+rY/ <br />Notes, Remarks, Etc.I I <br />( <br />'.d-t/Wlz lr 4-.lsL-I <br />9\ <br />I <br />hrn At- <br />I