Laserfiche WebLink
APPROVALS DATE ID/SIG.COMMENTS OWNI'R BtJILDI.]R D!]I,CARA IoN <br />I hcrchy slrim u cr ncnnlly or pcrjury rhar I um cxcnrnr ri. rhc Cin ftcl',N Ltcnsc li{ Ior rhc folbwnrS e,s'n (S$ 70:ll 5 <br />Au\inc$ frl Pruristnr Cqlc)r Atry Ciry or (1)u y qhirh rcqutcs n rcnnil h .on{dcr, xlrcr. nnpr.rq dcasli\h or rcpun rny <br />{rurrorc. prktr b n\ n$am., rlv) rcquirusrhc rmliclnr ld uch pcnn'l ro ilc r \i!md {rlcnEnr Ihr! tEor shc i\ liccn{d pur\uunr <br />ri rhc lRri\i{ro\ ol lhc ( onnd.ror's !-i..trscd trv (Chrfrcr 9. (lnnnrcncins *irh Sccrn,n 7(XX) of Oivisnrn I oi llrc Busirrc\\ and <br />I'>n,fc\sn,nt C.dc)orrhrl hcorshc i\c$nu rh.rcfron od rhc b!\n nn rh.al!.!cdcx.trrt]ri,,n. Afly violrliorofSccti,n 70.r15 hyriy <br />lprlicr nr!pcDir suhjcc( rhc rpplicrrt, rcivil!.nakyornor murcrh!tr rirc hudrcd dolllr is500r <br />-1, <br />ss owncr of th. pmF y. or my crolore3 {irh qogcs &s thcir sb @mr.nstion, *iI do llt wk atd tlE sltwlc ic mt <br />inrs'dcd n oficEd fd sL (5€.704, a$ims .nd Pr.fesions Codc: TIE Conlrelol! Lice tiw (!o.s ml .PPly lo & ok, ol <br />lh. pmlEly who boildr or nq'mEs da&l! aln who dc! rBh s* hins.lf or hcelf or llhrgh his or hn own cnplottcs. <br />povilcrllh.l .uch i,p,o\rc@nls m mt , .d.d nofidd for slc, lf. lbrt6. rlE trilding or iqmwfrnl is $ld qbhin oE Je <br />of@rphlhr tlE O*nd Builihr wil hlw lhc h(hn ofpmtjng &d h. q rh. dll ml tdild or itrptut thc tiotE y &. ilE P'!Fc ol <br />-t. <br />!so*rcrof rhc Imltay, udclu.iwlymntB.rins wilh lk.ns.d co n lor b onnel [E pmj.d (S(. 71144. Ausimn <br />.rd nDtu.bn Codc: Thc ConrKtor's Liccn* Lap docs nor arptyto un o*nc, ofprcFny eho blilds or imptovcs lh.mn, <br />Md *ho @ rts for s!.h poFcr! siln ! C.n!.io(, ltc.*d pusul lo llr Conoeroar LLr.k ltw) <br />-l <br />dcicmfl lnderSccrh <br />troxf,ESslsoMEEBsAllo! <br />PECLASAIION <br />I hcEby !flirmlndcr pcnohy oI p.rjury.m olrhc lolhwinBdel.rclions: <br />-l <br />hcve dd pilt minrlin . ccrlirKlr of conr.t ro scla-lnsuE lor lorLsi oop.malion. rs povil.n for by seion l7m of th€ <br />Lltnr Codc. for rhc pctolrl@c ol ihc worr for shich thc Frmil is isEd. <br />-l <br />hrE and will mainhin workcr' conpcBaiion in$ramc. a3 r.quircd by Sethfl l7m of thc L!ho, Codc, lor rh. lcrlorroflcc of <br />rhe w for khth lnis l'cmir is ir$cd. M, wo*6 @np.ns,rion insumc. .micr dd policy nunbct ml <br />Poiicy Nunr^(r <br />-l.rpr.' <br />-I <br />.cnify thli in rhe Frrormncc orrh. w6rk fDr *hkh rhis l*rnir h irslcd,I shlll nor cmploy rny !.Mn in onymanrcr <br />o ns ro b.$nE sublxr ro rhc qoicrs con{E.salion hws of Cllifooia. <br />work n mmFneiion pmvishns of Sslinn 3?0O of rh. Lihor <br />vcmC. iq unhwfiil. rnd shlll slhitr !n <br />,oO0). in rddirhn ro thc cosr na coa{Eo\ar <br />IIIIIUiDgTNIAACIOB <br />ITiCLIAAIIOI <br />I hcruhyxflir undcr tl.mttyofpcrjurylhol I am liccnsd !.{icr povi\i.n orchrprn 9 (o'nmrcitrs *irh Sccri,n 7m0) ofDivision l <br />0 <br />Pofcssi.ns Cod., fui nry licens! k in 6iI forc and cller <br />3C <br />cQNSrBUt JtOIiUrSDMi j jillilr <br />I hcr-hy dlfi nuMcr lxnrlrtol tcluryrlurlhcrc n!.on$rucrio', h.di'rgrgci., Iorrhc p.rfonnrmc olrh.s.rk turwhichrhi\ Pcrmtr t <br />i\\ucnrs$ .1m7. civ c ) <br />ATII.ICANLDECI.ABAIII}N <br />I ho$y rrm und6 p.mlty of pdiury oflc of tlt followin8 deLralioN: <br />Demlirhn P$ml.-Asbcstos Nolilicrtion F.d.nl Rcgul,lions (Tilk 40. Pan6) <br />acdcrul rcgrhrn,ns rlt'ding rsh.{osrcnhval <br />-I <br />I havc @d rhi, trpplicarion and srar. ttlst rtc sbov.I rgre ro .onl,l, vilh aU <br />Srmc L!*s rbrins ro blildinB.on(rudion. <br />UNDER GROUND <br />WaterUnder floor <br />Gas-Underfloor <br />Buildino Sewer <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipino <br />Roof Drain <br />Tub/Shower Tesl <br />Rouqh Water Heater <br />POOL/SPA <br />P{rap/Drain Line <br />Ivlain Drain/Pool Pipino <br />Fill Line/Back Flow <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitarv Sewer/Cap <br />Back Flow Device <br />Rouqh Plumbinq <br />Meter Release Ir <br />FINAL l)It l8 t(ii- <br />Notes, Remarks, Etc. <br />PLUMBING.INSPECTOR RECORD <br />Waste & Vent <br />Area,/Storm Drain <br />Pool Heater/Gas Line <br />Final Gas Test <br />Lcndc.\Nam.: <br />- <br />L.nd6 i Adfcs: <br />- <br />f------r----- <br />I <br />f------T------