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APPROVALS DATE ID/SIG.COMMENTS OI4NER BUILDEN DEL(:ARATION <br />I h€rc6y afiim uid.r p.dhy of Fdury lh, I m ci€fl{,t fom rhc Colltncro6 LLII$ tiw for tlE followir8 Easn (S€..?o3l.J <br />Buiirc$ aod Prcf6sion Cod.): Any Cny or Cou.ry vhhh rcquiB a tFnn ro @nnruc( llci inprcG .Lmlhh or qet !., <br />stdclurc. prior ro irs tsuec. a&. Eldrc. E @plica for soch r.mir ro 6h a si8rtn shrcm rnd hc or sh. is lian$d p!m8n <br />lo rhc Imvhioni of ltE Conlrldd s Li.ensed b* (Ch.pl.r 9. Cootrrcing *ilh Sccrion 70@ of Divi$ion ! olrlrc Bu.inc$ and <br />Prcfcssions Codc) or lhar h. or shc is e xcq)r d@fionsnd thc hsh lbr thc dk8cd.rmprion. Any viol ionofsc.lkn7011.5 by@y <br />.pPli.a.l for a lcmil rubjals ltc spplic.nl lo 3 civilpcultyofiot mrc thm fivc hlndrd doll&s (5500} <br />-1. <br />$ owrcr of $c p@Fny. n ny cnplortii *nh etBcs !x thcn oh omrensdion. eill do tlE *ot &d tlE 3rBiE ie mr <br />i sdcd or ofcrcd for slc (Se 7044. BusiEsi.rd &ofcsions Codc TIE C.nl@roas Li.cn* L3o do.s rct ortly to & oqmr of <br />0E p6Fn, $ho hrur or i,!,rcB rhdEn. !n wh .rE Bh m.t hiN.r or hceu dr thsud [ii 01 h.r oe .nploycci. <br />povaedlh{ such in{mvmoB a mt hroi.d 6r o,IcEn for sh, lf. ioM. llE tDildins or irymEmnt is $ld withi om le <br />olonphibG tlE o'rfti Buiu.a qil hsE rhc bord6 of Fovin8 our lE or slE did mr tiild or inlrlE rhc pmpdiy fo. tlE Ftrpos of <br />-1, <br />nsowncrof lhc prcFdy. Mdclurilcly.o.r6rins Birh licctrsd conrr rouro on$dcr rhc pmjd (Scc 7044, Busrcs <br />dnd Eoltssk{ Codc: Thc Conlroctor's Liccnsc L.w docs nor lptly 16 u owrfi .l propcny *16 boil& or iopmlcs rhcrcoo.and wlD .odacN for ru.h F,jccrs with a ConrEcro(t liccnd purowl ro rhc Confudols Lkcns. L3w). <br />-l "n cx.mpr uhd.r S*r B. & P.C. for fiis rcamn. <br />IAAf,E8Ii:COMIENSAIIO! <br />DEIIi/TSAIIQN <br />I hctby amrm und.r p€Elty of I,&Ju.y onc ofrne following d*ldadom: <br />l hrvc arill'mirhirr(rnilicircol'Conscrrr.Sclf-lnnrcfrwoitch.otrtctsrtl.r.rspn)ridcdfdhySccrii:1?0Oofrhc <br />l)htr Codc. lbr lic pcrltam(c ol I hc rorl lur whi.h rhc ltnnir is i\\ued <br />-I <br />hatc rnd will tui.lain worlc6 coq'enstion insuflKc. !s Eqlied by setion lT0oof r& kbo. C.d.. for lh. Frfoll1uc of <br />lhc vu* to. *iich lhis t.mjl is tscd. My sorksl .omFnsrbn insulec .6i d Flty nunb.. e: <br />I c.niryrhar inlhcl]crfordln.coflhc,ortfor whichlhk!.rmit is issucd,I shrll nol cmpky!.yF^on in.ny'nnnmr <br />s as lo txsm srbr.. o rhc srl6s sn{E.salion hwr of Califomii. and asB rhlr af I should tEo* sbjcct to rL <br />wo.lc6'smFtrsrionpmvisionsofserio.3?0Oofrh.LaborCo<lc.lshdl.tonnBirh6qrlywirhtbepovhio.r.. <br />WARNING: F,ilurc lo sft *orkcn' ompcnsarion sv.n8! is unhwftl. and ,h,ll sbtrl m cmploFr to siniMl FMhi.s md <br />civil nrc. up ro o* hundred rholsnd doll6 (slm,Ooo), in .ddnion to th. cosr of conpcN ion. damlca as prcvid.d for rlE <br />Sdion 3076 of rhc L,bo. C.d4 i crcst ed .no@y s f.cs, <br />LISINIILCONIAACIAB <br />DECIAXAIIQII <br />I h.eby drln und.r lcnahyoflcrfuylhll I ah liensdund.r t,ovision ofChaplcr 9 (o EminS with Sc.l6n 7000) of Division 3 <br />of thc Busimss ed Pmlcashns Con , rnd my lic.s ie in tull l6re dd clt6l <br />CANEIAIICIII}NIINDINC.AIiEIII <br />I h.Eby irfird undf li.nrky dr p.rjury <br />'hd <br />rhce h a con(rcthn lcndin8 lscncy for thc ,,crfumrc of rhc wort for whicn lhG lEnnir is <br />i\sucd lss.lO97.Civ. C ). <br />AI&TC NI.D&CLA8{IION <br />I hctly Dltmr undcr pciulry orrcriury onc of rhe t)llowinx delrations: <br />Dc.x'lirn,n Pcrmirs A\hc{os N{rinclrnnr Fcdc.llRc8ul{lions (l nh tO. Pd6) <br />-R.quncd <br />btrcr of Norifrdlion <br />-l <br />ccnify rhar rtu fcdcEl rc8! hr ions <br />-l <br />arrifrthar I have rcod rhh n i\comcr I rgr( h complysirh rlt Cirya0 Couhry <br />ordinamcs and Strlc trws rl in8 drtuiriTr r.lrscnlrivcs ofrhi\ Cir, and Counr, t, cnrcr uF,n(r <br />lhovc ftntnrn.d pbp.ny ltn -t <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarilier <br />Waste & Vent <br />Water Piping <br />Gas Pi ptng <br />Roof Drain <br />Rough Water Heater <br />POOL/SPA <br />P.!rap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SeweriCap <br />Back Flow Device <br />Ro ugh Plumbing <br />Final Gas Test <br />Meter Release <br />FINAL ?-7tg $.-A+".'-vD <br />PLUMBING-INSPECTOR RECORD <br />Gas-Underfloor <br />TOP OUT <br />Tub/Shower Test <br />Miscellaneous <br />Notes, Remarks, Etc. <br />Policy Numb.r:-Ertnrs: _ <br />,cB,!olsrc nor 3pplicahlc lo rht pmtccr <br />l-L