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APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Water-Underfloor <br />Gas-Underfloor <br />Waste & Vent <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Pi <br />Gas P <br />Roof Drain <br />Tub/Shower Test <br />h Water Heater <br />POOUSPA <br />LineP <br />Main Drain/Pool Pip <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Misc <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sewer/Cap <br />Back Flow Device <br />Rough Plumbin <br />Final Gas Test <br />Meter Release <br />FINAL <br />Notes, Remarks, Etc. <br />Declaration <br />I hecby rllirm uode pcuhy of pajury thrt I m qcmpt folm tho corti.cror!' Liee Lrw for rhc folh*ing rasr (!e.7031.5 Bsin6.lnd Profsion codc): Ary cily o. couoty which rcquirq r pcmir ro @utrucl rltcr, improvq dcmolish or rcpair;y rncruyrlor o ltsirrurncg rko rcquirc thc rppliqnt for luch pamit io 6lc r iigrcd rtatcmcnt thrt hc or rtre ir iiccroJ prrrrJnr m <br />-i, <br />prori.iotr of rhcconrrd.q'! Li@BGd hw (chlpts 9, conmcrcing with Setion 7000 of Division 3 of thc Buinsr rnd profaiou Codc) or rh[ hc orshc is acmpt thac&om rnd thc b.rit for. thc rllcgcd *mptior .Any vbhrioo of sctio" uol r.i uyi"y "-ppii-iloi. pcrmir <br />"uo1c"6 <br />rtrcrppliqnr to r ciyil pculty of not mrc th$ Iivc hundrcd dollrrr (tifi)). <br />- Irs omcrofrhcpropaty'ormycmployaswithmgcrrtlEirmLompcsrtiorlwilldorhcworlrndrhcstrucrucunotinrrtrdcd <br />or offecd for nle ( src.704d Builg rnd Profarioro co&: Th€ conarctori Liccm hw doc mt rppiy o u ouu orrlrc prcpay <br />.who buildr or improw thaeq ud who doa rwh worl himlf or turclf or rluough hir or hq om Gmploy€, providcd thI luchimProvcmcnt rrcrcthlondcdorotfGrcdfor.lrlc-lf,how.vs,rhebuildingorimprovlmiJlr-rJ*,trrir'.rilylriiomprcrtn t"owrBuilds will hrvc the burdcn of proving thrt hc o, lhc not build or impovc for thc purporc of slc). <br />-1, <br />u owt-ofihc propcrty, rm cclurivcly @nroditu wi& liccEcd @ntncro[ to @utrua rhc Eoj€t ( 56. 7044, Burin6! mdProfqsion Codq Thc Coflrraor'! Lienrc [rw doo not rpply ro rn omcr of propcty who Uuilar oi irirpro"i uuon , .nd who@nrrdt for ruch ptojett with r Cootncior(!) limrcd puruor !o thc Conrndor't Limc Lrw.). <br />_-l rnr cxcmpt undo S6iioo .B. & p.C for lhi! ,a!on. <br />Date: -- owncr: <br />I hcrcby a0irm undr O.^n, orr.rlu' onffi <br />-,-l havc rnd will mrintrh r Cstifiqlc of CoEnt to Sclf-lEure fot worlcrs' ompcurioq rs providcd for by Scrion 3?00 of thcLrbor Codc, for ihc performne ofthc work for which the pcrmit ir issucd. <br />-l <br />havc rnd will mrintrin mrkcr' ompcHtion inrurrre, I rcquircd by scction 37oo of tho Lrbor codc, for thc pcrformne of theworl for which this pcrmit is irsued. My worher' compcmtion irourme onicr and poricy numbcr rrc: <br />Crrricr: <br />Policy Numbcr:_ Expires: <br />('l-his section need "* b" *rnpl*d , ff*, tirOO| or less) <br />-l <br />certify that in the pcrformancc of the work for which this pcrrnit is iscucd, I shall not employ sny pcrson in rny 6aons so as tobcceme subject to the workcG ' compenHtion hwc of Californiq and egrcc rtut if I should b;r. cuU.;""t ro tho worke6, <br />comPcnsation provisions of Scction 3700 of the L^abor Codg I shall, forthwith comply with those provisions.. <br />Drte: <br />-r-- <br />fines up to one hundred thousand dollars <br />the l^abor Code, interest and attorney's fees. <br />License Class:____ <br />Datc: <br />compensation <br />($100,000),in <br />Liccnse Number <br />covers8e is unlawful, and shall subject an employer to criminal penalties and civil <br />addition to the cost of compensation, darnages as provided for the Section 3076 of <br />IherebyafTirmunderpenaltyofperjurythatIamlicensed,ncing <br />the Business and Professioru Code, and my license is in full force and effect <br />with Section 7000) of Division 3 of <br />-_Contrector: <br />Ihcrebyalfirmunderpen.ltyofpqjulythr,.*ffirformnccofftcworkforwhichthisp*mitis <br />issucd (S*. 3()!)7, Civ. C.). <br />l.cndcr'i Nanlc <br />l-ender's Address: <br />Dcmolition Pcrmits-Asb*lor Norilicrtiotr Fedr,., *ffiffinttffi* <br />__ Rcquired Lcrtcr of Notifiqtion <br />__-l ccnify thrt thc fcdcrel rcguhtions rcgarding ubetos ronovrl rrc not rpplioblc to this projet <br />--l <br />ccrtify thst I hsve rad this rppliotioo rrd strtc th8t thc rbov€ itrformliion fu @rred. l.gre to @mply with all city.nd countyordimncsend statc lrs rcbting to boilditrB @6tructior\ .nd hcrcby ruthoria repr*notiio ortmt ity <br />",rd <br />County ro *t", ,pon th.rbovc nrentioncd propdty for itrsp€riotr purpo!6. <br />Appliort or rtot rig.:_ Drtc: <br />Pernrittee name (print) : <br />PLUM BI NG-I NSPEGTOR RECORD <br />05 <br />Sanitary <br />Applicant:___ <br />.---.Il-_<