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PLUMBI NG.INSPECTOR RECORD <br />APPROVALS , DATE ID/SIG..,\COMMENTS OWNER BUILDER DEI,CANATION <br />I hqdry affm urd6 pcnalty of pqjury thd I m scmpt from thc Contraclm' Licmc lrw br thc following ron (Sc.7031.5 <br />Buincs rnd Profeion Codc): Any City or Couty which rcquiro a pcmit to oNtruct. altc. imprcvg damtirh or rpoh uy <br />struclure, fior to its irs|mq de rcquiG thc applicet for such pmil to filc I ligtEd 3tatm6t thd hc or drc b licaucd pman <br />to thc prcvisios of thc Coilretor's Licmscd hw (Chaptfi 9, Comacing with Sctiotr 7000 of Divisioo 3 of thc Buirc md <br />Prcfsiom Codc) or that hc or slE b q@pt th@&om md thc bosis for thc allcgcd amption. Any violation of Scrim 7031.5 by my <br />applicet for a pqmit subjcts the applicut to I civil pcnalty of mt mrc thm fivc hundrcd dollm ($500). <br />(1[], r omr of thc propary, or my mplo]6 with wsge a thcir mlc ompcruaion. will do 0E wort ad thc drudw b mt <br />-iDlad€d fi offqcd fc salc (Se.7044, Buine ud hoftssiore Code Thc Coilraclor's Licm taw &c not apply to e om6 of <br />thc poFty who tuilds or irryoE thqan ad who ds sh mrt hiMlf or h@lf or thmugh his or hc om mplolcs, <br />providcd that such improEmts rc mt intqdrd or offqod 6r ub. Iq hw. tlE tuildi!8 or imprcvmt is $U within mc )qr <br />of corylrbn, tlrc Owna Buildq will harc thc hrda of poving th* hc c sllc dirl mt build or imForc thc FoFty br th. Frpos of <br />sb). <br />-1, <br />s owq of thc Fopqty, m cxcluivcly corilrscling whh licos€d coilrrcto8 to @nstruct thc Fojcr (Sc. 7044. &tsinB <br />ard Pofoskn Corlc: Thc Coilrator's Licmc Law dos not apply to e oms of Fopaty who builds or impmB tb6oD, <br />sd who ontncts fu such FojE{s with 8 Codrrcto(s) licascd pmudtr to rhc Contrelor's Liw Lrw). <br />_l arn <br />l <br />P.C.. for this rcason. <br />DECLARATION <br />I hereby affirm under penalty of po'jury one of thc following declarations: <br />_l have and will maintain a Certificate of Consent to Self-lnsure for workers' compmsation. as provided for by Soction 3700 of thc <br />Labor Code. for the performance of the work for which the perrnil is issued. <br />_l have and will maintain workers' compcnsation insurance. as requircd by Section 3700 of the l-abor Code, for the pcrformance of <br />the work for which this permit is issuod. My workers' compensiilion insurance carrier and policy numbcr are: <br />Policy <br />CtL , certiry that in the performance of the work for which this permit is issued. I shall not cmploy any person in any manner <br />so ns to become subject to the workers'compcnsation laws of California, and agree that if I should become subject to thc <br />workers' compensation provisions of Section 3700 of the l-abor Code I shall, forthwith comply with thosc provisions.. <br />WARNING: Failure to secure workers' compensalion coverage is unlawful. and shall subject an cmployer lo criminal pcnalties and <br />civil fines up to one hundred thousand dollars ($100,000),in addition to thc cost of compensation.as providcd for the <br />Section 3076 interest and attorney's fees. <br />a <br />DECI.ARATION <br />I hereby aflirm under penalty of perjury that I am licensod under provision of Chapter 9 (comrnencing with Section 7000) of Division 3 <br />of the Business and Professions Code, and my liccnse is in full force and effect. ' <br />.t <br />Licerue Class: Liccnse Numbcr: <br />flo la. <br />CONSTRUCTION LENDINC AGENCY <br />I hrcby affrm under p€nalty of pqjury lhat th6e is a @ns1ruc1ion lmding agocy for thc pafommcc of the work for which this p6mit is <br />isucd (Se. 3097, Civ. C.). <br />Lender's Name: <br />lrnder's Address: <br />I hoeby affinn under penalty of perjury one of the following declarations: <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) <br />-Required <br />Letter of Notification <br />_l certi$ that the lHeral regulations regarding asbestos removal are not applicable to this project. <br />and state that the above information is correct. I with all City and County <br />construction, and and to enter upon thc <br />above mentioned prop€rty for inspection <br />Applicant or Agent <br />.( <br />Permilee nanre N <br />q LI <br />UNDER GROUND lr nl <br />Waste & Vent \ta 1/t I fill.^ ^,,,rillfl,l <br />Water-Under floor I rt ,"- I ttwtu,'ilv <br />Gas-Underfloor t <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ CIa rifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <br />Flll Line/Back FIow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCao <br />Back Flow Device <br />l^0t /-, <br />Roush Plumbinq tl , <br />d rs6 <br />Final Gas Test <br />Meter Release <br />FINAL b"rP4, <br />Notes, Remarks, Etc. <br />.B <br />l <br />ContrRclor: