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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS owNER t]tr[.])Lll l)Ii|.( AR,\'rl(rN <br />I hocb,v allirm under peralry ofpqjury thil I tun exeilrpt frorn lhe (onlraclors' l-icensc l.nN for lhe follo\ring reastrn (Sec.70,ll.5 <br />[]usin6s md Profssion Code): An] City or (hunl]'\rhich rcllrir6 a peilil lo conslnrcl. allr. inlpro\e. dfmolish or rcpair anl. <br />strlrcture.piortoits issuance.alsorequirslhenpplicantforsuchpernrillolileasignedslalsnenl lhalheorsheisliccnsedlnn-suanl <br />to lhe frovisions ofthc Conrracnrr's l-icensed l-at\'((h.fler 9. (ontmcncing shh Srtion 7000 ofDivision I ofthe [lusiness and <br />Professi(rnsCodc)orlhatheorsheise\empttheefromandthel)itsisforlheallegeclexcrnption. AnyviolalioilofS(tion703l.5l)yany <br />applicaill for a pennil subiets lhc applicant to a cir il penaltl ofnot rnole lhan five h{ndred dollars ($500) <br />t. as oNncr o fthe proFd]. or my ernpto] s \ ilh Na!$ as lheir solc cunposal ion. \'ill do the \\ ork and lhe slntdurc is not <br />inmded orolTcrerlforsalelsa.T0{,l.BusillssandProfrssions(irdc: lhe(irnlractn"sLicmse[-aNdosnolapplytomo\\ncrof <br />pro\idcdthatstch impro\.oncntsarenotifllf,dedorollqedlbr*le. lllhosqo.thetuilclingorimp$oncnlissrld\\'ilhinone)6r <br />ofconrpldio[ thc (\ ucr Buikls \\'ill hare the [udo ofproving thal he or she did not build or inpro\ c the pltlEly for lhe Pu{rsc of <br />sle). <br />l. as owner oflhe popqly. nm crclusively c(rnlractirUl \\'ilh licensed conlracloN l() conslrucl lhe ptoject (Sec. 7()l{. Brrsirrss <br />and l,rofsion ('odet I he ( (]ntraclor's l-iccnse Las' docs nol appl]- lo ao oNnfi ofpropen\ \r'ho builds or improtes lhercon. <br />and \r'ho conlmcls for such proiftls $'ilh a Conhactor(s) liccnscd pursuanl h lhe (l)ntrachr's l.icense l.a$'). <br />. I] & l'( . Iirr lhis rcason-I arn cxcnrpt untlcr Scctirrn <br />Otr ner:Dnle: <br />WORKERS' ('ONIPENSA ION <br />DECLARA'T'ION <br />I hoeby allinn undcr penalty ofpojury one oIthe follo$ ing declatations: <br />I have and rvill maintain a ('dtificate of ('onsol lo Sclf-lnsure for \I)rkm' compfisalion. o por ided for by Sslion 3700 of lhe <br />t-abor Code, for the pq fomance of the Nork lor s'hich the pmnit is issued. <br />Code. for the pgfonnancc of <br />ile: <br />I ccdify lhilt in lhc pcrl()tnlancc ofthc rrrrk lir rrhich this pcrnrit is issuccl. I shrll not <br />so as lo lrconrc subjccl lo lhc \okos'conlpensalion lass of( nlilbrtria. and ngiR'lh.l iIl <br />any person in ntAniler <br />bccome subj(t lo thc <br />No11qs'cotnpensationprovisionsofsation-3700oflhel,abor(-ode.Ishall.lorlh\\ilhcomply\iththoeprovisions.. <br />WARNINGT Failure to wurc worlm'compruation covtragc is unlawful. and shall subjst m mploya lo oimiosl pcflalliG and <br />ci|il lincs up lo onc hunrlrcrl thousand tlollars ($l(X).(Xn)). in addilion lo lhc cosl of damages s provided for the <br />S(tion Codc. intsGt md artomey's fc. <br />-o <br />DE('LARAl'ION <br />undcr pror ision of('haptc 9 (cornrnmcing s ilh Sslion 7000) of Division l <br />in full force md effcct. <br />I h@by affm undq poalty of perjury that I m licqEcd <br />of thc Busins sd Profcsions Codc. md my licmc is <br />fz <br />LiceNc <br />Datc:_ <br />_Liccree Number: <br />CONSTRUCTION LENDTNC AGENCY <br />Ih6c is a conslruction lending agqcy for thc psfommce of the sork for s'hich this p€rmit bI hcrcbr affir nr undcr Fnaltl o I pcrjurl' that <br />issucd (Scc. l0')7. ( iv. ('.). <br />l-cnder's Name: <br />APPLICANT DECLARATION <br />I hdaty atrm undq paalty ofpqjury onc ofthe following dcldationsi <br />Dcmolition Pmils-Asbetos Notification Fcdersl Regulstions (Tille 40. Ptrt6) <br />O(ruir".t I erre, (,f N,{ilicarir,il <br />fu ..rift,t,", tlrc litlerrl rcguhtions rcgaxling asbcslos rerrx)\al arc not aPPlicablc lo lhis proiccl. <br />comply wilh all City and County <br />above motioncd prcpcrty for iGpdtion purposd <br />infomation is <br />of <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Cla rifier <br />TOP OUT tI <br />Waste & Vent 'b1 v1 ,lrUntwY /)_ <br />Water Piping ll l4 b^nL6'v <br />Gas Pipinq t A[$b\- <br />Roof Drain ll ^/() <br />Tub/Shower Test *t *Aoh .\an't{aa ftb <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 SeweriCap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release I I l a, <br />F!NAL L 'floo Y,qyawtw <br />Applicrnt or Ag6t Signatrre,F <br />Pernrite name (print): ( <br />j <br />-t <br />Notes, Remarks, Etc. <br />-+ <br />-