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PLUM BING.INSPECTOB RECORD <br />APPROVALS DATE ID/SIG.COMMENTS owNIR ltult,t)ER t)ltl.cAt{A't roN <br />ilpplicrntli)rflpcrtrrilsuhicctslhc applicanlloxcivilpcnrltyolnottrrotclhxnfivchundrc(ldollurs(5500).. <br />lhc pftrfrly who huikls or inul)vcs llrcrc\)n. and who (l()cs such $(n'k hitrsclf ()r hcrscll or throuch his or hcr own cnuloyccs. <br />salc). <br />-1. <br />as owncr oflhc propcny. am erclusively contracling wilh liccnscd contractors lo construct thc projcct (Sec. 7044. Busincss <br />md Pmfssion Codc: Thc Conlraclor's Licensc Law docx nol apply to an owncr ofproperty who builds or improvcs thcrcon. <br />and who conlracts lbr such projects wilh a Contmch(s) licenscd pursuonl lo thc Contractor's Licensc Law). <br />-Iamexemplundersection-,B.&P.C.forthisreason. <br />1V()R.KI,)lS' CONIPt.]NSA',ilON <br />t)r:cl,ARAl'l0N <br />I hercby alTirm !nder pcnalty of pcrjury onc of the follow ing dcclarat ions: <br />Lrhor Codc. lirr thc pcrlirrnrancc ol'lhc work for which thc pcrnlit is issucd. <br />lhc work for which lhis pcrmit is issued. My workers' compcnsation insurance caricr ud policy numbcr trc: <br />I)r,licv Nurrrhcr: <br />-l <br />ccnify lhat in the pcrformance of thc work for which this pcrmit is issucd. I shall not employ any pcrson in any manner <br />so as lo tEconrc subject to thc workcrs' compensalion laws of Cnlifornia. and agrce that if I should bccolre subjccl lo lhc <br />workers' compcnsation pmvisions of Scction 3700 of lhe Labor Codc. I shall. ti)nhwith comply with ltnse provisions.. <br />WARNING: Failure to sccurc workers'compcnsation covcragc is unlawful. and shall suhjcct an employcr to siminal FEnalties and <br />civil fincs up lo one hundred thousmd dollss ($109.fiD). in addition to the cost of compcnsation, daroges as provided for thc <br />Scction 3076 Codc. inlcrcst and s fecs.d <br />I hcrcby afllrm undcr pcnalty of pcrjury I anr <br />DECI-ART{TION <br />under provision ofChaptcr 9 (commncing with Section 7000) ofDivision 3 <br />of lhe Business and Profcssions Code. md my liccnse is in full force ond effect. <br />[-iccnsc <br />issucd (Scc. 1097. Civ. C.). <br />Lcndcr's Nantc <br />[rndcr's Addrc.s: <br />APPT,ICANT Dt,;CLARATI(TN <br />I lutlbyutlirmundcr pcnally ofpc{ury onc oflhc li)lhwinS dcclardlioils: <br />Dcilrrlilion I'crnrils-Ashcslos Nolificilion Fcdcral Rcguhrions ('l illc 4{). [,rrl6) <br />_Rcquircd Lcllcr ol Nolilicalknr <br />_l ccrtify lhal thc fcdcralregulations rcgeding asbcslos rctnovalurc nol dpplicablc to this pmjccl. <br />rcM this application and statc that thc atnvc is corcct. I agre lo comply wilh all Cily and Counly <br />Liws rclating to building <br />abovc prepcrty lbr <br />Applicanl <br />Pemrilce <br />Agent <br />reprcscntativcr oflhis City and Counly to cnter u[Dn thc <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildino Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipino <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <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 />I I t ,a <br />Rough Plumbing II 16 lltd lv*till (16/ <br />Fina! Gas Test I I t <br />Meter Release I T , ^^?/FINAL T 15 rual 'lXlttUJ ?tY0 <br />INotes, Remarks, Etc.