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APPROVALS DATE ID/SIG.otxM-Build6 DelaEtion <br />Ihccby !fi,rund( p.oalry ofp.qurylhll I !n.x.mpt for rh. ContidoB l-6.ns. l,p for rh. lollowrnB r6on Ge 70r l 5 86in6s <br />ed PhfssionCod.): Any Cily o, Counly shich r<un6 a p..nil lo coBlrucl, alr.r. inpro!.. d.molGh or r.prn my 3lru.ru.. prior lo n. <br />issurncq rho r<uirB lhc .ppliq aor su.h D.rmn to fiI. a si8n.d rlr.ncm rh!! h. o. sh. b li..tri.d pu6orn[o th. p6!i.ioB otrh. <br />co.trcrorrLic.n!.dliw{chlprds.conrm.ncinsw'rhS.cr'oiTOooorD'vrbnIorth.au.'nBs!tu1PorerioNCodc)ortnlrh.or <br />sn. n.r.mpl lh.r.&om lnd th. bBn fo, $c.lle.d cx.nprion.Any vi.r.rion oaS.dFn 7031.i by.ny.!Dlic.n! for r p.mir 3ubj..B rh. <br />lpplicrnr lo a civil p.MIy ofnor morcthrn nr. hundr.d doll.E (t500) <br />L a own.r or th. pop.ny. or my .mDloy6 w irh w'3< .r lh.ir 3ol. comD.n$l ion. will do lh. worl ed lh. structor. b nol inldd.d <br />or or.r.d for sb ( Se ,044. Buin63 rnd Prof.,ro.t Cod. Th. contrdolr liccM Lw do6 nor .pply ro .n ow..r of rh. ptupdy <br />wno buildr or imprcvBlhdon..nd aho do6 uh work himklfor hsrlf or throlBh his or h.r oqn .nployG, provid.d rh.r ruch <br />imprcr.m.nB e nol i.l.rdcd or olT.tln aor rk. l( how.v6, lh. blildinr or inprovm. n sB wirhi, onc y.n of.onpLl ion, !h. <br />O*mFBlildd * ill hrv. rh. burdln of prcviry lni h. .r snc mt build or inpro( aor rhc porpoF oafL). <br />,l. a owod olrlE prop.(y, !n crclBivcly conrlcdns *irh li..6.d co rlcio6 ro co$ruc1rh. Foj..i ( S*.7044. Buins snd <br />P,oadion Cod. Th. Conhdoar Lier l:w dG mr lpply b o os.r of proFty who bunds n mp,.v6 rhde. . iftd *ho <br />@m.di for rlch pbj..1! wnh . Conmdo(, lic.ned puBuil ro lh. Con0rdois LieB. trw ) <br />I m cxcmpl ud{ Sdion B. & P( for lhh.c.son. <br />WORKERS COMPENSATION DECLARATION <br />I hftby 6ffim !nd.r p.nrlty ofp.rjury orc of th. rolhwins ddhr.rioB: <br />I h.vc.rd will h.inuin r C.nilor.of CoBdr ro S.lf-l6ur. for Ert6i .omp.nrtio., as provA.d for by Sdion l70oolrh. <br />bbor Codc. for lh. p.rfomtu. of lh. wort for whict lh. Fmn i. bsu.d. <br />_l h!!. rnd eill minl.m vorldr' @mp.Mrion i8ur.@, a r.quu.d by S.clDn r70o ol th. t bor Cod.. aor rh. pofornknc. of rhc <br />so.l tor whi.h rhB p.riir i3 i3iu.d My wo.k.6 ofrp.n$rion itutu. .eid .nd poli., nunha !rc: <br />] \tL.\ <br />('Ihisscclionn..dnor b. compLr.d ifrh. p.dn ir aor otE hund..d dollaB lll0olorl.ss) <br />I ..nify Od in rhc pdforurcc of thc work for which fiit p.mh i3 is!.d, I shlll nor .mploy !.y p.Bon in .ny m!..., so B ro <br />h.qm. 3ubjer ro th. wo ..B @mp.n$rion hws of c.lifornn, lnd rBr@ rhrt ial ihould tEcom rubj.d ro rh. worl.a' <br />ompdllaonpslbioaofSerion]700orrh.hborCod..I3h.ll,,orrn*nhonplywirhrh@Dovi.io.. <br />Appli..ml <br />WARNINC i.ilu.lo seur. @rkdJ @np.Mtion @vcEs! t unLwtul. rnd3h!ll rubj.d d mploltr to diniml p.dhi6 tnd ciril <br />arB !p ro o@ I'undEd lhoqld dollE (S100.000).i! .ddnio! lo $. ccr ofcoop.Nliotr drE E6 B ,.ovidcd ror UE S.ciioo 10?6 of <br />$. bbor co{.. inrdd .nd.non y s fG <br />&tc&lsE0tqNrBAcxoSs-D[qaSara! <br />I h@by rflim urd6 Frli, of pdjwy rhfl I m li.6.d urd.r pt 6io. of Ct pr6 9 (@Mcbg *iln S.cion 7000) of Divi.ioa I of <br />th. Buind 6d Prcfd.ios C.&. .rn 6y lic.M i! in tull foM .rd .fr..r. <br />CONSTRUC'NON LENDINC ACENCY <br />l hd.by d mm undcr p.nrhy ol p.rrury rhal lta. is r coElructiof, lc.din8.rcncy aor ln. praomoncc ot lfi. Nort aor which lhis p(mil is <br />i5!u.d(S( 1097, Cir. C ) <br />APILISANN..OECI4BAUqEltmuion PmireAlb..rB l.lorifi..tion F.ddl R.sul ioa (ThL lo, rrn 6) <br />Rcqdcd t 116 ofNotiliolio. <br />rhal ln. Ld.rll r.sularionr r.Bedin8 dbetos r.movrl o..ot ipplic.bl. to lhir pmj..l <br />ify lnll Ifilv.n drh's Applicdlio tud sr.tc rh.l th. .bov. infomlrion is co&d. I rsc ro conply wi$ all Ciry lnd County <br />io!. dd hdcb, .!iho.i2. r.Dr.6lrri!6 ofrhi! Ci, !.d Cou.ry lo .rlra upon th. <br />UNDER GROUND <br />Waste & Vent <br />Water-Underfloor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough 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 />M isc <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing <br />Meter Release <br />I <br />FINAL 6- */9 J/eJ>-t -@D <br />Notes, Remarks, Etc. <br />PLUMBING.INSPECTOR RECORD <br />COMMENTS <br />Final Gas Test <br />I <br />*" ,3- tlo-tb <br />-------T_-----