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PLUM BING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor ^,1 <br />Gas-Underfloor 20t <br />tvWc( #.-ffii;,'. <br />TTBuilding Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />\ <br />/POOUSPA <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 Flow Device <br />Roush Plumbins <br />Fina! Gas Test <br />Meter Release I ft <br />FINAL l-ultn VKIJI r./*xt <br />\lNotes, Rpmarks, Etc,. <br />tl?,"ru0 ...? Clft -Dt -[Y)qL+wt <br />I <br />\ <br />I hcrcby affm undo pcmlty of pcrjury alut I m dcmpt from thc Contrrcffi' Liccm Law for thc followiog rcmn (Sc.7031.1 <br />Buaim: and Prcfcsion Codc): Any City or County whbh rcquircr a pmit to @nltruct, alta, inlpmvc, dcmlish or cpat my <br />irrudulg prbrro its iw, also rcquim thc qlplicmt 6r sch Imit lo fik t signd $8rmt fttr h.or slE ir licaucd pumul <br />ro rhc povisioro of thc Conrretfi'r Lienrcd Lrw (Ctupar q Cormrcing with Sccrioo 70fl) of Division 3 of thc Bulincs snd <br />PofcsionsCodc)orrhilhcorshcirGxcmptrkrcfromsrdthcbaiirforthcrllcsEdqffplbn. Anyviolationofs6{ion703l.5by.oy <br />applicant for a pcmit sbjels lhc sppli@nt to s civil pcmlty of ml mrc thso fivc hundrcd dollarr ($5ffi). <br />_1, as owr of thc atopcrty. or my cmplo]Gr with wag6 I thcir mlc orposaion. will & thc wor* &d tlE nndw b mt <br />irrcndcd or ofu for slc (Se.?044, Buim rnd Prcfcsiom Codc: Thc ContEctor'3 Liffi Lsw do6 ml rpply to m ow of <br />thc prcpcrty who buil& or inpmu thcmrl ard who doca rut m* himsclf or hcrelf or thrcugh hir or hcr om crPlo]€cs, <br />pmvidcd that sch impowntr rc mt inlqdcd or oftrcd 6r olc. lf, lnwffi. thc building or inpryeGnt i! sH wilhir orc ,8ar <br />of onplaiorl thc Owncr Buildc will harc thc budcn of ppving tha lE or ghc dil mt huild or if,prcE thc pmpqry for th. purpos of <br />sD. <br />-1, <br />I owr of thc pmpsty, m cxclusircly @ilmcting with liccnrcd ontracloB to @ndrud thc pmj$t (S@. 7044, Buitw <br />and PrcGsbD Codc: 't'hc Cont6ctor'! Liccnsc Law doa mt apply to ro owncr of prcperty who builds or imprcvcl thcror\ <br />and who ontncts for mh pmirts with 8 Conttrto(s) licenscd pulwf,l lo ihc ContEctor'3 Lim hw). <br />-l <br />m cxcmpt unda Selion-, B. & P.C. br this rmn. <br />Date'Owner: <br />DECLARATION <br />I hcrcby amrm under ;Emltyof pcjuryonc ofthc following delantiom: <br />_l havc tnd will mintain I Ccrtificatc of Consnt to sclf-ln$rc for rcrkm' conrpenrtion, as pmvided for by Srction 3700 of thc <br />Latnr Code, for thc pdfomrcc of thc mrt for which thc Jrmit is issucd. <br />dllhavcandwillmaintainworkers'compcnrationinsumrcgas rcquircdbyScction3T00oflhcLohorCodc,forthcpdforntsnccof <br />the work for which this pcmit is isscd. Myworker' mmpcnmtion insurancc canicr and gtlicy numbcr ue: <br />Accuc rAl+ed 9.*ve <br />b-ll- <br />_l certi& that in the performance of thc work for which this permit is issued. I shall not employ any lrcrson in any manner <br />so as to become subject to the wo*ers'compensation laws of California, ancl agree that if I sl'nuld become subject to the <br />workers' compensation provisions of Section 3700 of the Lahor Code. I shall, forthwith comply with ttnse provisions.. <br />WARNING: I;ailure to secure workers' compensation coverage is unlawful, and shall subject an cmployer to criminal penalties and <br />civil fines up to one hundred thousand doltars ($100,000), in addition lo the cost of compensatiorL damages as provided for thc <br />Section 3076 of the Latnr Code, interesn and attorney's fees. <br />DECLARA'I'I(IN <br />I hereby aflirm under penatry of perjury that I anr licensed under provision o[('hapter t) (cotnntencing with Section 7(XX)) of Division 3 <br />of the Business ancl Professions C<ldc. arul rny license is in full tirrce and eflbct. <br />Number:krqCqP <br />l- I ? -7e2r). y^es+ }larl<rnd v(t(+;c{t ial} <br />coNs'l'RL'c'l'l(tN LENDIN(; A(;l,N(:\' <br />I hercby affirm undcr Fmlty of pcrjury that thc is I @N|ructhn lcnding agcrcy for thc psfomrcc of thc work for wiich this Imit is <br />issued (Sec. 3097, Civ. C.). <br />Lender's Name: <br />AfILICANLDSCI.AEAIIAB <br />I hmbyaflimundcr pcnalty of pcrjury onc of thc following dclamlions: <br />Dcmlition Pcrmits-AitHtos Notifictrlion l:cdcml Rcgulations (Titlc 40, Psrr6) <br />-Rcquircd <br />Lcttcr of Ndificalhn <br />-l <br />ccdiry thst thc fcd@l rcgul.lioN rcSarding asb.stos Emval arc mt E plicablc lo lhis prcjet. <br />€-l ccrriry th.t I havc rcad fhis application lrd itste that thc otnvc infomlion h corc€I. I alrc lo @mptywilh all Ciryard County <br />ordimmes and Sratc Laws rclating ro building conilructioq and hcrcby autlnrDr rcFcsntativca ofthis Cily and County to cnts utrrn thc <br />above mentioned property for inspection purposes. <br />or Agent o*", l1??k <br />Pernrltee name Orfnt): C)H q Srechori./