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PLTIA4BING-INSPECTOR RECORD <br />APPROVALS DATE tD/stG.COMMENTS OWNBR BUILDER DEL(}RATION <br />I hcrchy alfrm urd.. nelalry ol pcrju.y rhar I m excmDr fmrn th. C.ntw_1oN Liccnsc Lrw tor lhc folloshE cen (S.r.7031.5 <br />Btsin.ss and ftof.*rion Codc): Ary Cily or Cou y whi.h Equircs a pemi' to @Elo.l, rlt6. irqrcvc. d.mlLh or rcpan y <br />rtrudurc. Prior h ils hsuarc., ako Equtd lhc amlicel lor $cn Fmit lo 61. r si8md sl3l.mnl lha! hc or ihc h liccnscd plrsanl <br />ro rhc l,nvlsions of tlE Conk&rols Licflsd Lrw {Chlprtr 9, Conrcndng snh Sr.tion 7000 of Division .3 of th. Busincss and <br />Pref.xsions Codc) or rhll lE or shc is crenfl rhcrcftbn ad rhc h6si3 for lhc allcS.d crcmr,tion. Any !hl,ri,n of S.cliotr ?031.5 b, lny <br />q,plic.nr for. lcm iubjftk lh. appli.!fl roa.i!ilpcnlltyofnor morcrhan filc hondrcd dollds (S500). <br />-1, <br />ai owmr of rhe protEdy. or oy .nployEs wi$ *agd &{ lhcn $E comp.Bdion, wilt do the mrk ard tE slrucl@ is m <br />irtcdH or otcEd for $lc (Se.?044. Busifts srd PrDfcsioN C.de TIE C.Mor's Ltcn* trw rlo.s mt .pply lo { opffi of <br />llE pmFny vho hl*r! o Ly{ms tlE@n. .d sho d(a s.h }orlr him.lf or hcMlf or rhrcugh his d lEr own cmphrrs. <br />pmvkLd th.l slch in!rcllmlfl e 'bt inloicd ffotu for elc.IL lmwi dE trildinS or irprcEmnr i! sb widin orc t@ <br />or onpLrbn tu Oeftr Brild.. *ill hre tlE tonhn of Fovir8 rlr.r h. or sh. dil mr txild u inprDw 0E p'DFry for rh. puFe of <br />-1, <br />!s o*mr ol ihc popeny, d qctusiwly .onr.cirg enh lan*d conlr*roh ro ensuucr rlE rftjc.r (S(. 7044, Blsirc$ <br />8rd FDfssbn Codc: The Contulolr Liccnsc lj* docs ml aprlylo mo*nr ofproF.ly who buildsor iq,rolcs ltcrcon. <br />and who o Bc ld .h p'!id3 *nh i Conr&b(s) lixned lu|\@r ro rhc Co!u6r6i. Lien* t:w) <br />I amcrcm und6 S*rDn .4.&PC lorrhirE.bn. <br />llt8xEBt-ctlMPasallaN <br />Dncr.al"{.I.roN <br />I heE$y lmrn und.r l,cElly oalEjury om oath. r.[owi.B &.lrrdjons: <br />Lrhrcodc.l({rhcNrfon rtrc.of rhc{orklartrhichih.p&nir i\issucJ <br />_l h!!c and qill m.inlah worlcB omp.nsllion insuramr, as equiBl by Selioo ]r00 oflnc tlbor Codc. aor thc Frforrorcc of <br />rlE work lor whi.h lhn pcmil n hs.n My eort.R ompcnslion i.sur0ft cai. ud polky numb.r m: <br />Policy Nurbcr jpiEs: <br />-l <br />c.nify lMl in ihc lcrlormna of lh. v.rk ao! whi.h lhis pcrnn is issuc.L I shall nol cmpk'yany p.Mn in my tmmt <br />s N ro h@m sun c.r ro rh. workql conlE.s|bn Lws of Califomi0, and sBE rlEr if I sholld bc.otu $h!.r lo rlr <br />wtc 'coq,cnsrrionpmlirionsofsdlion3T00ofth.t h.r Codc.l nr[. fnrltviltoq,lywilhlho$ ptuvisio.s.. <br />WARNING: Faiturc lo surc m.k6 .ompcndion @vc6gc is unlawtul. a.d shrll subirr o enDlorrr to dininrl pcmhiB.nd <br />civil fin s u! lo o* hu.d.cd riou{.d dollo( (1t00,000), h eddiln n lo rlE cosr ofconFBdion. d!mg$ pmvid.d forllE <br />Sdhn 1016 ol rlF L.bor Cod., 'nr.E{ .nd dofty s 16 <br />D.ler Applol: <br />LICENIEIIjANIIAEIIIf, <br />DES/AAII!]N <br />I h.nb, ar,ln. nnd.r rEnlhy ol pcrjury lnar I ai liccnsn undcr rrovisionofChlplcr 9 (ohnrmio3 wirh S(rb.70d)) orDililb.l <br />or rhc lru\incssand Prclcrsions Codc.0nd nryliccnsc is h full fd.c !c8!cl <br />caNsrx!!.:rDtru;NDlNc-tcliNr.r <br />I hcrhy .ll trn udcr Jrnrhy of p.rluy rhnr rh.rc i\ a .onndcri,n t.ding rg.ky lu rhc l.rtordM.c dt rhc $otk br uhi.h rhis Isnrir Lr <br />i\sucd(SN :1097, Civ. C.) <br />ATTUIANfDICLd.ITUQN <br />I lrlrny dninn r nd.r Ilcnali, orF j!r, ooc ofrhc follo*in8 dsl({rbns <br />I)emlibn l,crnitsAshcsros Nori,icolion l;cdcrol RcBuldiotrs (Iirlc40, Pin6) <br />-Rcqund <br />bii$ of Norifi cllhn <br />l.difyrhd rhc tcdcrrl reg lart,nvcltdillg !sbc\ro( rcmovll !.c fr, omlicahk b rbt pnjccr <br />-lccnifyIhaiIh.v.rcadrhhapplt{ionadn.rhrrrlEdbov.inrolmrionh.mr.IogieiosnplyeithallCnyandCounryordiMftcs snd Sratc L{ws Elaling ro huildin8 coNtru.tio.. s,n hcEby aurh.riz rcIJrenklircs oa rhis Ciry and Counry to cnts upon th. <br />lbovc mflrioncd lot ny ror insF.lion purrbs.s. <br />ADlrlicnnl.r ABcnl si*nsluft : <br />P.@lte ,.@ (prl!t):_ <br />UNDER GROUND <br />Waste & Vent <br />Water-Under lloor <br />Gas-Underlloor <br />Building Sewer <br />Area./Storm Drain <br />lnterceptor/ Clarilier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas P iping <br />Roof Drain <br />Tub/Shower Test <br />Rouqh 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 />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbinq /?*z,t-1t\6 <br />Final Gas Test t <br />Meter Release <br />FINAL l%ll't'.\4f6 <br />Notes, Remarks, Etc <br />Dbr.: <br />lrn'lci\ AdJrr\.: