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APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Underfloor <br />Gas-Underfloor <br />Building Sewer <br />ArealStorm Drain <br />I nterceptor/ Cla rifie r <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipeing <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOUSPA <br />P-trap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Misc <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release <br />FINAL /O-1-zl ?at 3q UNC6L 64TU7L <br />Notes, Remarks, Etc. <br />Oma-Buildcr Doclaratim <br />I hmby.fEm undapcnslry of pcrjury rhal t m6mpt fm thcCotrrrctm'Licaruc Law forthc follwingrum (s.7031.5 BuinBs <br />ud Prcfcssion Codc): Any City or County which rcquircs a pmit lo mstruct, sltcr, improve, danolish or rcpair an;rrrgurr,.prjc to itr <br />iswe, also rcquiru thc applicat for such pcrmit o filc a signcd strtcmcnt that hc or shc is limscd pmmt o thc prcvisions of otc <br />Cmt'etq's Lim€d L8w (Chaptcr q Cmacing with Setion 7000 of Dvisim 3 of lhc Buincs ud Prcf*iom Codc) ff thsl hc or <br />shc is amF rhcrcfrm ad thc basis fc thc sllcged aernptior .Any violuion of Scrion 703 L 5 by ,ry spplimt f6 a pgilit subjetr thc <br />rpplirut !o s civil Flalty of not mffi lhu firc hu&ed dollm (5500). <br />_t, E osn6 of thc popary, or my mployc with w.g6 I thcir solc cmpcosalion, will do thc work ud thc strucruc is not intmdcd <br />orcfr@d fa silc ( Se.7044, Busin* ud Prcfxims Codc: Thc Cmtrrclor's Limc Law dG nor spply to m owno of thc propany <br />who buildr d improB thcm, ud who dm such work hiroclf u hmclf tr thrcugh hi8 c ha own mployc, providcd that such <br />imprcvmotr m trot intddcd q offCcd fd sa.lc. If, hwwcr, thc building or imprcvmcnt is sold within mc yo of @mPlction, thc <br />Oma-Buildc will havc thc burdar of prcving dlat hc c shc not build c impovc for thc purposc of salc). <br />_t, s flna of thc prcpcrty, m cxcluivcly ontncting with limcd cmtrrctm to consml thc pojdl ( Sc. 7044, Buin6s ud <br />Prcfsio Codc: Thc Cotre{or'3 Liq3c L.w da not apply to u owns of proFrty who builds fi imFov6 thcmn , 8d who <br />cotr&6 fff such prcjrcB with a Contrrcro(s) limscd punut to thc Conrrctor's Licasc La*,). <br />_I arn exempt undcr Section ,B. & P,C. for this reason. <br />Duc: orrncfi <br />@ <br />I hs6y aflim u&r Fndty of pcjury dtc of thc folloing dcchnrims: <br />_I havc ed will mintain a Ccnificrtc of Cmtcnt to Sclf-lrsw ftr wortm' mpcrratim, s prcvidcd fc by Scclion 3700 of thc <br />hbc Codc, fq thc psfme of thc woil ftr which lhc pamit i3 isucd <br />_Ihavcudwillmintainworkm'omparatimirome,s rcquiRdbyS*tion3T00ofthckbqCodc.fqthcpcrfmccofthc <br />worl fq which this Fmit ir isucd. My wo*m' mFtaim imurmc wia ud policy numbcr m: <br />Policy Number: ExPires: <br />(Thi! ss'tim ned not bc mplacd if thc pcmit is for Onc hudtcd dollrE {$100) tr ls) <br />t srify rhst in thc pafme of thc wu* for which thir pdrnit is isrue4 I sh.ll not mploy my pcm in ey mmns so B !o <br />bcsp rubjet to thc wortm ' mFnraim les of Cdifmi!. md rgre 0nt if I shsld bfiorc subjcct ao thc eo*c' <br />cmparruim prcvisim of Sccdm 3700 of thc Labor Codc, I rhdl, fathwith mply with thcc provisims. <br />Datc: Applicut: <br />\YARNING: Frilw to sccurc wo(t6' cmpcmatiur covmgc is ulryful, md shdl nbjet o mployr to aimind paraltia ud civil <br />fitr6 up !o mc hudrcd rhollsd dolln (S100,000),in rdditim to thc ct of mpcmatim, dama3cs u providcd fr ttc Sccrion 1076 of <br />thc Labc Codc, intact sd lttmG,y's fc€s. <br />LICENSED CONTRACTORS DECLARATION <br />I hmby aflim un&rpcnalty of pcrjury that I m licmscd undq prcvision of Chaptr9 (cmmcncitrg with Scction ?000) of Divisim 3 of <br />thc Buines md Prcfsions Codc, ud my liccnsc is in full fqe ud cffcct. <br />License flooo.License Numbcr <br />Date: Contractor: <br />CONSTRUCTTON LENDING AGENCY <br />I h@by 8tfim urdcr pmalty of pcrjury that thft is a construction lcndinS agcncy fq thc pcrfommcc of thc work for which this pcmit is <br />issucd (Sc. 309?, Civ. C.). <br />Lcndcr's Nmc: <br />Lcnder's Address <br />APPLICAT{T'S D EELARATION <br />Dernolition Permits-Asbestos Notification Federal Regulations (Titlc 40. Part 6) <br />_ Required Lencr of Notification <br />_l certiff that thc fedsral rcgulations regarding asbcstos removal are not applicable to this project. <br />_ I ccniry that I havc rad this applicaio md st&rc thst thr abovc informatio is corect. I agre to omply wifi all City od County <br />ffdinee ild Stsrc lrws rclaring to building mstrucdon, ud hmby aurhoirc rcprmativa of this City ud CMty to 6Gr upon thc <br />ebovc matiotrcd property for inspetio purpoca. <br />Applicut or agot sig:. Datc:- <br />Perminee niune (print): <br />PLUM BI NG.I NSPECTOR RECORD <br />Carricr: