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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS oIVNER RT]II,I)T:R DEI,('ARA'T'I0N <br />npplicilillli)rrfcillrilsuhjuclslhc ilpplicnnlloacivilpcnilllyrrlnolilr)rulhilnlivchuxlrcd(k)llxrs(S5(I)). <br />_1. n\ (^rncr {il thc pi()lr-n\'. (tr trrv cnlpl()}rc\ $,ilh u'r{cs r\ lhcir solc coilll)cr\nti()i. Bill do th( sork rnd thc slnEtnrc i{ fn <br />thcp()Itrly Nhohlriklsorirnpro\c\thcrc\ilr.iln(llvhodocssuchworkhirrscll-orhcrscllorthrrrughhisorhcrowncnlpklycc\. <br />qrht. <br />__1. il\ os'ncr ()l'lhc l)ropcrl)'. anr cxclusivcly conlrrcliDtl s ilh liccn\cd aonlrrck)r\ to coilslrlrct tlt pKicct (Scc. 7(N.1. Ru\inc\s <br />xnd who c{rnlrrcl\ li)r such pr(),rcls \rilh r (i)rilricto(s) liccn\c(l pursurril to lhc Corlrnct()r'\ l-iccnsc [-xw). <br />_l am excmrrt utrder Selion-. B. & P.C. for this rcason. <br />Dole:- Owner:--- <br />WORXF'RS' COMPENSATTON <br />DT'CLARATION <br />I hcrcby aflirm undcr tEnahy ofpsjury one ofthc following dtrlrrations: <br />-l <br />hrvc aftl will iluintain a Ccrlificutc of Conscnl to SclLlnsurc li)r workcrs'cornpcnsrtk)il. as providcd li)r hy Section .1700 of thc <br />Latxrr Codc. for thc pcrfornlancc oflhc work for which thc Jrcrillit is issucd. <br />-l <br />halc and uill nuintain workcrs' conrJtnsalk[ insurancc. ar rcquircd hy Scction -17(X) oflhc tjbor Codc. for thc pcrfornuncc ol' <br />lhc work for which this pcrnrit is issucd. My workcrs' compcn\ation insuruncc caricr nftl F)licy numhcr arc: <br />Policy <br />-l <br />cenify lhrt in thc lrerfornuncc of the work for which this pcrmit is issucd. I shall not cmploy any pcrson in any monncr <br />$ as lo hccom subjccl to thc workcrs' compcnsnlion laws of California. snd agrce lhal if I should becom subjcct to thc <br />workcrs'comlEnsatiof,pmvisk)nsofSstion-17fi)oflhebk)rCode. lshsll.fof,hwilhcomplywilhlhospmvisions.. <br />So.li()0 .1076 r)l the l.rhtr (ixlc. inlcrcsl rn(l xtkrncv \ li'c\ <br />I)sle: <br />LICENSI II CON'I'RACTOR <br />DI.'CLARA'I'I0N <br />ol lhc Busincs( rild Profcssirrrs Crxlc. and nv liccnsc is in lirll litrcc rnd cllccl <br />l,iccnsc Nunrhcr: <br />C0NSTRTJC'I'ION LENDINC ACENCY <br />isructl {Scc. l{)97. ('iv. C.). <br />Lcndcr's Nanrc: <br />lxndcr's Addrcss: <br />APPLTCANT DECLARA'I'ION <br />I hc['hy ammr undcr pcnillty ol pcrJury onc of thc followiflg dcclonr ions: <br />Dcnx)lition Pcrmil\-Asbcstos Nolillciltion Fcdcrrl Rcgulalions ('l-itlc 40, Pxn6) <br />-Rcquircd <br />lrttcr of Notilicalil)n <br />-l <br />cerlify lhat thc fedcrBl rcgulations regarding asbcshs rcfr)vsl arc not applicthlc lo this pmFct. <br />-l <br />ccflify lhal I hnvc rcnd lhis upplication rnd slalc lhat lhc rlx)vc infornrlion i\ corccl. I ilgrcc to comply with oll City and ('ounty <br />ordinanccs and Stulc l-nws rclilting lo huilding c(,nslruclion. and hcrchy ruthorirc rcprcscnlalives ofthis City and County h cntcr uFx)n lhc <br />otx,!c nrntioncd propcny for inspcclion purF)\cs. <br />Appllconl or Agcnt Signeture: <br />It'rnrilrr namr lt,rinl) <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 Pipino <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 <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbinq 6 -t-72 ll*27 <br />Fina! Gas Test <br />Meter Release <br />F!NAL 6+za &c-ts Nfifr z7 <br />Notes, Remarks, Etc <br />('irrricr: <br />Applicsntl