Laserfiche WebLink
PLUM BING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hercby affm under penrlty of periury that I m ercmpt from thc Contreton' Licens hw for thc following tE@n (Se.7031.5 <br />Business ard Prcfession Code): Atry City or County whkh rcquircs 8 Jrcmit lo snslrucl, 81t6. irpmre, dcmlish or rcpoir any <br />struclue. ptbr to its issrc, als rcquircs lhc spplicant for ruch Fmit to filc s sigcd saatcmnt that he or slE is liensd pwfft <br />to tlE prcvisioN of tlE Contracttr's Lien$d Lrw (Chsptr 9. Comrcing with Sstk n ?(x)0 of Divtubn 3 of thc Busire$ ud <br />Prcfessbns Code) or thrt hc or she is cxctrpl thmtom rnd thc b6!is for thc rllcgcd cxctrptbn. Any violation of S€{ion 703 I .5 by rny <br />spplicsnt for 8 pemit subjerts tlE 8pplicant to 8 civil pcElty of mt mrc tho five hundred dollm ($5@). <br />(-$.1. as owm of the prcFny. tr my cmplolss with wrgs Ls rhcir stc oqrcmalion. will do ttE vqt snd tlt srnrrre is mt <br />intcndcd m of[crcd for sb (Se.ZX4, Busircs ud Profqsions Codc: Thc Contretor's LLTn$ llu des mt rDply io m owrer of <br />thc proF ry who huilds q i'prou ilso[ Ud who dc st w* himslf or hcrclf or ]hrcugh his q h€r om etrployces, <br />prcvided thrl such imFownts re mt intandcd or offcrcd ftr sb. lf, howE the buiHirB tr itrproErcnt is $ld wlhin orc lar <br />of onpletior tb Owrcr Buildd will hrw tlI hrden of Imving thar lr or shc dil mt buiH q inpmE $G poFty for tlt Ftrpos of <br />ele). <br />-1. <br />&r wrcr of thc FoFty, am cxclusircly contnctitrg with liccnsd coflretoE to @nslrucl lhe prci:d (56. 7044. Buircs <br />ard Prof63im Codc: The Contrctor's Liccns lle dc3 rct apply to m ownc of prcJErty vho buildr or impmrcs tls6n. <br />8nd who ontrrcts fq srch prcixts with 8 ContEclo(s) lieNed puMnt to thc Conrrclor's Licw Lrwr. <br />-l <br />mcxcmDt urdcr sction- B. & P.C. for this rcmn. <br />oare, \\. ot. \n =_WO RKERS' COIII PFI\SATION <br />NrCLARATI(TN <br />I hereby affirrn under pcnalty of perjury one of thc following dcclrrations: <br />_l havc und will rnaintain a Ccrlificatc of'Consctrt to Scll-lllsurc li)r \\'orkcrs' conrl)cnsalion. as providcd lbr by Scclion -37fi) of the <br />l.alror (-irdc. ltrr lhc pcrt'ornlancc of thc work for which tlrc pcrrrrit is issuctl. <br />lhc work lirr which this pcrnrit is issuccl. My workcrs' conlpcllsaliorr irtsurancc carricr iurd grlicy nutnbcr irc: <br />Policy Numher: Expircs: <br />$Lt certify rhat in rhc ;rcrformance of thc work for which rhis Jrcrmit is issucd. t shall nol cmploy Bny pcrson in any manner <br />so as to bccome subject to thc workers' comFrcnsation laws of California. and agree that if I should beconrc subFct to thc <br />workcrs' conlpcnsation provisions of Scction 3700 of thc l.atnr Codc. I shall. forthwith comply with thosc provisions.. <br />t <br />WARNING: Failurc to surc workcrs' omJEnstion covcEgc is utrllwful. and shrll suhjct an emplolrr to siminsl Fnsltics rrd <br />civil fincs up lo onc hundrcd thousrd dollm (5100,000). in oddition lo thc cost of comlrcnslion. damgcs as prcvidcd for lhc t <br />Scclion 3076 of thc kbor fuq inleres ud otlorrcy's fcs. <br />p"ru, \\- Dk' \1 A rrE <br />LI CT'NSFD C()NTRACTOR <br />DECLAR/t'rl(lN <br />I hcrcby alllrnr undcr Jrcnalty of Jrerjury that I am licensctl urrdcr provision of Chaptcr 9 (cornnrcncing with Scction 7000) of Division 3 <br />of thc Busincss and Profcssions Codc. and rny liccnsc is in tull ftrrcc and clll'ct. <br />License Class: License Number: <br />Dale: <br />W <br />I herby affrm urdcr Fulty of Frjury thsl thcrc is r mnstrudhtr biding rgmy for tlE pctfm of the mrk for which lhis Fmil k <br />issucd (Sc. 3097, Civ. C.). <br />Lcntlcr's Nanrc: <br />Lcndcr's Addrcss: <br />A PPLICAN'T DIICLARA'I'ION <br />I hcr--hy atfirrn undcr pcnalty of pcrjury orrc o[ thc lirllowing dcclarations: <br />l)crrxrlitiorr Pcrnrits-Asbcstos Notification Fcclcral Rcgulations ('l'itlc 40, ['arl6) <br />_Rcquircd Lctlcr of Notilication <br />-l <br />certify that the federalregulations rcBarding asbcstos rcmovalsrc nol applicable to this projcct. <br />(Lrcertify that I have read this application and statc thar lhe atrovc informarion is correct. I agrce to comply <br />ordinanccs and State Laws relating to building construction. and hercby authorize rcprcsentatives of this City <br />with allCityand County <br />and County to enter upon the <br />t\, o8'tl <br />atxrve nrcntioncd proprty for inspcction purfnscs. <br />Applicant or Agenl <br />Permitee name tprintl: ( tt *1 rAt S UQ.E G N <br />l)ale: <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildinq Sewer <br />ArealStorm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <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 />Poo! Heaterlcas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCao <br />Back Flow Device <br />Rouqh Plumbinq <br />Final Gas Test Ia <br />Meter Release ,/ ^ /IFINAL /14 U I '+fu/o9 <br />Notes, Remarks, Etc. <br />7 I <br />a <br />Conlraclor: