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PLUMBING.!NSPECTOR RECORD <br />COMMENTSAPPROVALSDATEID/SIG. <br />UNDER GROUND <br />Waste & Vent D ZL t7 <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />ArealStorm Drain <br />I nterceptor/ CIa rifier / <br />TOP OUT .4. <br />Waste & Vent <br />Water Piping y 4;li) <br />Gas Pipinq U \) <br />Roof Drain <br />Tub/Shower Test 0- <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line Y <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 SewerlCap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release ll ^l nA,?2 <br />Etc.Notes Re <br />FINAL <br />t)t:1.('.\R,\'l'loN <br />I hcrcby affm unda panalty of perjury thd I m qmpt from thc ContnctoB' Lic€e l.rw for thc.folloling @n1Sc.7031.5 <br />Buins 8nd Prcfsion Codc): Atry City or Courily which roquira a pcmt to onstruct. altE, improvq &molish or rcpair my <br />structurq prior to its isumcc. also rcquirc thc applicilt for such petrnit to filc a sigtrcd stdmmt thal hc or shc b lic63cd pNmt <br />ro thc provisions of thc Contnctor's Licms€d Lis (Chapts 9. Comcncing with Sction 7000 of Division 3 of thc Busins ud, <br />Prcfgions Codc) or that hc or shc L qopt thacfiom md thc bosis for lhc allcgcd cxmpion. Any violuion of Sc{ion 7031.5 by tny <br />applicaot for I pcmit subjcts thc applicsnt to a civil poslty of not morc thil fivc hundrcd dollm ($500). <br />-1. <br />s omo of thc Fop.rty. or my mployc with wag6 I thcir mlc ornpcnsation. will do thc wort and thc dnE{rc b rct <br />i[tqdGd or offacd for slc (56.7044. BEin* ud PtofcssioB Codq Thc Contraclor's Licdsc law do6 not apply to fi omc of <br />thc FoFty who hrilds or imprcrc thasn. ed who doB such wrt hiruclf or hcrclf or thrcugh his or ha om mployc. <br />provid.d that such imprcvffiB m mt irtodcd or olfmd for slc. lf, hosffi. thc building or imFovaml is sU wilhin one )@ <br />of omplaion. rhc Ovna Buiklq wi[ haw rk hrd6 of pving tha hc or shc dil mt hrild or inerovc frc popa'ty for the prpos of <br />foperty. am exclusively contracting rvith licensed conlracton to construct the project (Sec. 7U4, Business <br />and [\ofission Code: The Contractor's License Larv does not apply to an owner of property rvho builds or improves thereon. <br />and rvho contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License Law). <br />-l <br />arn exempt under & P.C. for this <br />I hereby alTirnr under penalty of po'jury one of the follorving <br />- _ -l have and rvill rnaintain a Certificate of Consent to Self-lnsure for rvorkerc' compensation. as provided for by Section 3700 of the <br />I-alxrr Code. ftrr the perftrnnance of the s,ork frrr uhich the pernrit is issued. <br />_ - I havc and s'ill lnaintain s'orkers' compensation insurance. a.s rcquired by'section -1700 of the l-abor Code. for the perftrnnance of <br />the u'ork for rvhich this perrnit is issued. My s<rrkers' compensation insurance carrier and policy nutttber are: <br />( 'arr icr : <br />l r 1ti1 ("i ' <br />cenify that ill the Frrfonnance of the rvork for rvltich this pernrit ts isstrccl.shall nol employ an\'person lll any nlanner I <br />s()as to become subject lo thc s'orkcrs'cornpensation laws of (-alifornia.and agree that <br />shall. forthrvith <br />ir r sltoulcl beconte subject to the <br />workers'compensalion provisions of Section -3700 of the Labor Code.comply s'ith those provisions.. <br />WARNING: Failure to secure rvorkers' compensation coverage is unlarvful. and shall subject an anployer to crirninal penahies and <br />civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. datnages as provided for the <br />1076 of the Labor Code. interest and fecs. <br />b?4 <br />I hereby a(Tirrn under penalty of perjury that I arn licensed provision of Chapter 9 (commencing rvith Serrion 7000) of Division -3 <br />of the Business and Professions Code. and my license is in full force and effect. <br />License --[,icense <br />Number: <br />('ontraclor': <br />('()NS'l'ltLl("1'loN LENl)IN(;,\(;I1N('\' <br />I hrcby aflim unda pcnalty of psrjury that thq. is s constructior lcnding ag6cy for lhc prforrmcc of the \rcrk br *hich this Fmit b <br />issucd (Sec. 3097. Civ. C.). <br />Lcnder's Name: <br />I .crrtlcr 's Adth css: <br />APPLI('AN'I' DE(: LARA'I'ION <br />I herelr), aflinn under penaltv of perjury one of the follorvirtg cleclarat iotls: <br />Denrolition I'erntits-Asbestos Notification Federal Regulations (f itle 40. Pafl6) <br />_ -Rcquired l-ettet of Nolification <br />certify that the federal regulations regarding asbestos removal ale not applicable to this project. <br />s'ith all City and County <br />and County to enter upon the <br />above rnentioned property for inspection <br />A;lplicnnt or Agertt <br />I'ernrilee name ( print ):{tl Rd <br />3--/7 <br />/,t[fltg <br />/.\ <br />m-l)" Il <br />n <br />ft.V{"}Lv <br />ll*tnnr 7,frr/ <br />4kl <br />7I <br />ry l/ <br />Section <br />7-g a7 "rK <br />l)nte: