Laserfiche WebLink
PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DEICARATION <br />I hoetry affim urd6 paslty of pqjury that I m qcnrfl tom thc Contrrcton' Lic@ Iff for thc followiog rcn (Se.7031.5 <br />Buins ard Pmftseioo Codr): Any Cty or Couily which rcquire a pcmit to @Btruct, alts, inprcvc daplish or ttpair uy' <br />$rucruc,Fbrtoit3 islrc.ahoroquicthc@liffitforsuchpcnittofilcasigncdltrtaat thrch.sshcblimcd pmam <br />to thc Fovisiorc of $. Contre{or's Licmscd Law (Chapa 9, Commhg with Sclbtr 7000 of Division 3 of thc Bosirs ed <br />Prcfeiom Codc) or thst hc or shc is smpt thac&on od thc bsis for thc allcacd aopion. Atry violatior of Sctbn 703 I .5 by ey <br />applicot for a pqmit subjets thc applimt to E civil pmlty of not morc the fivc hundrcd dollars (5500). <br />g-t|gs oma of thc pmpcty. or my mploye wirh wag6 a thcir slc @mpddion wilt do th. wort ed thc ltudw b Dt <br />htqdcd or offctcd for sslc (Sc.7044, Buins md Proft*riore Codc: Thc Cotrtrrctor'3 Lice Lrw do6 trot spply to m ous of <br />thc prcpqry who builds G itrprcB tluur1 md who doe sdr w* hirclf or h@lf or thrcugh his or k ow mploy*, <br />providcd tha such imFovqE[s m mt inadGd or oftmd for $.h" If, how, thc hdldirB or iqrovaEd b mld within orc )a <br />ofompLrbn thcovn6Buildawillharcthch[daofproviagthehcordrdilmthrfiorinprcwthcpopctybrttcprpo.sof <br />sb). <br />_1, as owner of thc propcrty, am exclusively contracling with licersed contracton to construct thc project (Sec. 7044, Btsincss <br />and Prlofcssion Code: The Contractor's Licensc Law does not apply to an owner of property who builds or improves thcrcon, <br />and who contracts for such projects wilh a Contracto(s) licerued pursuant to the Contractor's Licerue l-aw). <br />-l <br />arn exempt under Section-, B. & P.C. for this reason. <br />o",", ?-- 27 - ?- I Owner;Qt.zt\o l(o oa-.a/ a <br />DECLARATION <br />of the following declarations:I hcreby affrrm under pendty of pojury one <br />-l <br />have and will maintain a Ccrtificatc of Conscnt to Self-Insure for workcni' compsuation, 8s providcd for by Scction 3700 ofthe <br />I-abor Code for the performance of the work for which the pernit is issued. <br />_l have and will maintain workcrs' compcruation insurance. as requird by Section 3700 of the labor Code, for the performancc of <br />the work for which this p,ermit is issued. My workers' compensation insurance carrier and policy numkr are: <br />Carrier: <br />Policy a <br />1-Lr*iS that in the performance of the work for which this permit is issucd. I shall not cmploy any person in any manner <br />so as to become subject to the wort€rs' compflsation laws of California, and agree that if I should become subject to thc <br />workers' compensation provisioru of Section 3700 ofthe l-abor Code, I shall, forthwith comply with those provisions..t <br />WARNING: Failure to secure workers' compcnsation coverage is unlawful, and shall subject an anploycr to criminal penahics utd <br />civil fines up to one hundned thousand dollars ($100,000), in addition to the cost of compensation, damage alr provided for the <br />Section 3076 of the l-abor Code, interest and dtorn€y's fe6. <br />I herebyaffrmunder 3 <br />of the Business and Professions Codc. and my license is in full force and cffect. <br />Liccnsc Class: Licensc Number: <br />W <br />I ha6y alrrn uods poaftyof pajuryttn ttrcis a ordndha lading agcy forthc pq&rc of thcmrt frr which this pmit b <br />issucd (S*. 3097, Civ. C.). <br />l,cnder's Namc: <br />l,cnder's Address: <br />APPLICANT DT'CU\RATION <br />I hcr*y aftm under penalty of perjury one of the following declarations: <br />Demolition Permits-Asbestos Notifrcation Fcderal Regulations (Title 40, Part6) <br />-Required <br />l,etter o f Notification <br />I csriryftd thc &dqd rqulaior qrdiag ubetos tqmvd e lot @li6blc ro thie pmjcd. <br />qfrdi$, thd I hryc rEd ahb spplicstio! 0!d ststc that rhc ebow itrfomdior is 6nrd. I agrc to @Eply vith dt city ud couty <br />ordimc md Statc LM rclding to building snstuction, ed hcftby authorizc EpGcddiv6 of this City ald Couty to ata upo! thr <br />aborc Mtiotrcd propaiy for i8pcclio[ FlrpB <br />Applicant or Agent <br />\\€ln-'\'e7 <br />Permitee name e Lv<a <br />Z-?3- Z, <br />UNDER GROUND ,/Ir A <br />Waste & Vent f./2-(mt) <br />Water-Under floor ,l <br />Gas-Underfloor <br />Building Sewer <br />ArealStorm Drain <br />I nterceptor/ Clarifier <br />TOP OUT I I l',_41 <br />Waste & Vent A Ufr'I DM,(W w <br />Water Piping t), <br />Gas Pipinq a 4-r{-?l (b(,g) <br />Roof Drain /-\ <br />Tub/Shower Test a /,21 "u J l?t fr (lv <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous a.I \ <br />Gas Service 5'-1 -V JIttLpttU Wtluttt )-tr1 <br />Water Service \J <br />Lawn Sprinkler <br />Sanitary SewerlCao <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test ^ <br />Meter Release / <br />FINAL tI/1t-\l <br />Notes, Remarks, Etc.v tl t I <br />Exoires: <br />oate: L- Z )