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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND ,,,
<br />Waste & Vent L /tt 'n /4^/12 t/Z/,A/
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />ArealStorm Drain
<br />I nterceptor/ Cla rifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test I ,Lc-Z)
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back FIow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back FIow Device I //
<br />[/,rlaho( /r?r 'kn eLTl-/ttt/
<br />Rough Plumbing qsFinal Gas Test
<br />/
<br />Meter Release I
<br />I I
<br />FINAL WZ '(/)Wlc ,fff,l
<br />Notes, Remarks, Etc.t,
<br />()\\,Nl.R Btlll,t)ER
<br />I tmby affm undcr pcmlty of psjury that I m cxctrpt Eom th. Contmctoa' Licor Law for llE following rcen (Sc.7031.5
<br />Businas ard Prcfcsrion Codc): Any City or County which rcquircs a pmh to @[druct, altcr, impmrc, &mliih or ETrir any
<br />structurc, prbr to its irrurcq ds Equic thc elrplbsnt for sch pcmit to ,ih 8 rigcd ltrtmt tlfl hc or she h lierEcd puBad
<br />to thc lmvisions of thc Contrsctu's Liccrlcd L8w (Ch8ptfi 9. Comcrcing with Setion 70fi) of Divirion 3 of thc Busincsi and -
<br />Pmfcssions Codc) or that hc or shc is exempt lhcrc&om and thc horis for thc allcgc{ cxcmptioo. Any violation ofSction 703 1.5 by an),
<br />appli€ntforatrcmitsbje.tsthc applioniaoscivilpcrltyofmtmrclhsntivchur&cd&llm($500).
<br />_1. as owner ofthe property, or my employees with wages as their sole compensation, willdcr tlre work and thc structure is not
<br />interded or offered for sale (Sec.7044, Busirrcss and Professions Code: 'l'he Contractor's License Law does not apply to an owner of
<br />the proJrerty wtn builds or impmves thereon" and who does ruch work himself or herself or through his or her own employees,
<br />provided that such improvements are rnt intended or offered for sale. l[, ]xlwever, thc building or impnrvement is sold within one ]€ar
<br />of comphtion, the Owner Builder will have thc burden of proving that he or she did rnt build or improve the propcty for thc purJnse of
<br />sale).
<br />_1. as owner of the pmperty, am exclusively contracting u'ith licensed conlractors to construct thc pnrject (Sec. 7M4, Business
<br />and Profession Code: 'l'he Contractor's [.icense Law does not apply to an owner of properly who builds or intproves thereon.
<br />and who contracts ftrr such projecls with a Contracto(s) licensed pursuant to the Conlraclor's License Law).
<br />-l
<br />am exenrpt under Section-, B. & P.('. hr this reason.
<br />Date:_()rr rrer'
<br />WORKEILS' CONI PI:NSAI'ION
<br />DECLARA'I'ION
<br />I hereby affrrm under penalty of perjury one of the follou'ing declarations:
<br />_l have and will rnaintain a Certificale of Consent to Self-lnsure lbr rvorkers' contpensalion, as provided fur by Section 3700 of the
<br />Latxrr Code, for the performance of thc work for u'hich the penrrit is issued.
<br />_t have and will nraintain workers' conrpensation insurance, as required by Section 3700 of the l.abor Code, for the perfontmnce of
<br />the u'ork for which this permit is issued. My workers' compensation insurance carrier ard plicy nutnber are:
<br />Frl nn:
<br />Policy 1/2t'1 ta
<br />_l certi& that in the performance of the work for which this permit is issued. I shall not
<br />so as to become subject to the workers'compensation laws of California, and agree that if I
<br />employ any penlon tn any manner
<br />should become subject to thc
<br />workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with ttnse provisions..
<br />WARNING: l;ailure to secure workers' compensation coverage is unlawful, and suhject an employer to criminal penalties and
<br />compencation, damages as provided for thccivil fines up to one hundred thousand dollars (5100,000), in addition to the
<br />Section 3076 of the Labor Code, interest and attorney's fces.
<br />rlate: \L, t Lrtl t r,\-1 | "f
<br />I hercby affirm under penalty of pdrjury that I am licenscd under provision 9 (comurncing with Seclion 70(n) of Division 3
<br />of the Business and Professions Code, and my license is in full force and
<br />License l_
<br />I hereby affrm urder penalty of perjury that ttrere is a crrnstruclion
<br />issued (Sec. 3097, Civ. C.).
<br />agency for the performance of the work for which this permil is
<br />Lender's Name:
<br />/^*,
<br />Address:
<br />APPI,ICAN I' DI.,CI,ARA I'I0N
<br />I hereby affrm under penalty of perjury orrc of the following declarations:
<br />Demolition Permits-Asbestos Notification Federal Regulations ('l'itle 40, Part6)
<br />-Requ
<br />ired Letter o f Notification
<br />_l certify that the federal regulations regarding asbestos removal are not applicable to this project.
<br />_t certify Ilurt have read this application ancl the atnve infornration is correct. I agree to comply
<br />representatives of this City
<br />with all City and County
<br />and County to enter upon theordinances and State Laws
<br />above mentioned property
<br />IAppllcant or Agent Slgnature:
<br />Perrnitee nanre
<br />to building
<br />thtt
<br />ancl hereby authorize
<br />R -f--rq
<br />filt//- ''/>,t/tl
<br />'J-cll4 0h
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<br />".rr,W%'r+_ Contractfr E 4
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