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PLUM BING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS ( )\\'N l,.lt lt tl I l.l )1,:ll l)l,ll.('A R,\'l'l( )N I <br />reasofi (Sc.c.7031.5I hcrcby affirm undcr grenalty of Jrrjury that I am cxcmpt fmm the Contractors' License [.aw for thc following <br />lJushtcss anil Profcssion Codc): Any City or Counly which rcquires il [smit k) conslrucl. allcr. improvc. dcmrlish or rcpair {ny <br />slruclurc. prior k) its isslancc. slso rcquirc$ thc applicatrl for such fErnril k, fih a signcd statcnrcnl lh{l hc or shc is liccnsd pursuanl <br />lo lhc provixk)ns of thc Conlrachr's Liccnscd tnw (Chuplo 9. (hmrncrcing silh SL{lio[ 7000 of Division 3 of thc Busircss and <br />Proltssions Codc) or lhat hc or shc is cxcmpl thcrcfronr rnd lhc hasis for lhc allcged cxctrlplion. Any viohtion ofSslion T0.jl 5 by atry <br />upplicilnt for { pcrmit suhjccts lhc {pplicsnl to e civil pctrllty of nol morc lhan livc hundrcd dollars ($5(X}) <br />_1. ns owrcr of thc FroFrcny. or nly cntpk)),ss with stgcs $ thcir wlc oupcnsatior. will do lhc sork ud lhc slnElurc is fr)l <br />intcn(lcd or ollcrcd f(tr slc (56.7044. Busincss and Pnrfcssions Codc: 'l'hc Conlrackrr's Liccnsc law docs not apply to an owncr of <br />thcp(r[Erty whrhuildsorhnpnrwsthcm[nndwhod(rssuchworkhimsclforhcrsclforthmughhisorhc.owncmphyccs. <br />Irovidcd thlt such irnpnrwmnrs aru not itilc(kat or offcrcd lbr $k. lf. h)st!tr. lhc txtilding or impro\etrEnI is vrld within oilc )Eiu <br />;fconuletion. thc Owncr Buildcr will havc ttE hurdcn of pmring that hc or shc dil ff)l huiH or improvc thc pmFny li)r thc pu4xt$ of <br />sh). <br />_1. as owncr of thc Jnopcny. am cxclusirrly contrnclilg with liccnscd conlraclon k) construct llE Inltlt (56. 7(114. Busimss <br />iltrd LlolbssiflCodc:'IhcConrrackrr'sLiccnscLawrlocsnolapplykranowncrofpropc]lywhobuildsorimprovcslhereon. <br />anrl who (nilracls li)r such Ptojccls wilh a Contruclor(s) liccnsd pursuul h thc (i)nlrachr's Liccnsc [js). <br />-l <br />iln cxctrrpl undcr Scction-. B. & P (:. for lhis rcason. <br />I )irle._ Owner:- <br />}VORKER^S' CONI PT'NSAl'ION <br />DECLARA'TION <br />t hcrehy al'l'irrn undcr F'^nahy of pcrjury onc of the l'ollowing dccllralions: <br />_l hayclntl will nmintainaCcflificatcofConscnttoSclf-tnsurcfor\r'orkers'cornpcnsatiotl.as providcdforbyScclion-17fi)ofthc <br />l,ulxrr Cotlc. lirr thc pcrlt)rnlancc ol'thc work li)r which thc pcrnrit is issucd. <br />_t havcalttlwill maintain$'orkr.rs'cotnpcnsationinsurilncc.as rcquircdb)'Scctiott.lTU)ofthcLaborCodc.forlhcJrcrltrrnnncco[ <br />thc wgrk frrr rvhich this pcrrnit is issucd. My workcrs' conrpensitlion insur:tncc carricr and policy nutnbcr arc:Sntr fir-a 6-bz (^ <br />Policy D<A <br />_l ccrtity that in thc prlirrrrrancc of thc work for which this pcrrnit is issucd. I shall not ctnploy any pcrson in arrl'n'lanncr <br />so lstobccsrrrcsubjccilothcworkcrs'corngrcnsationhwsol'Calilirrnia.antlagrcclhaliflshoultlbccotttcsubjcctlolhc <br />\l,grkcrs' cor11rclsation llrovisions ol'.Scction .1700 of thc Latxrr (ixlc. I shall. ltrrthu'ith cornply u'ith thosc provisitttts'. <br />.J <br />WARNIN(i: Ijailurc to sccurc workcrs' conrpcnsution covcnlgc is urrtawl'ul. arttl shall suhjcct an cmploycr to crintintl J--rnltics antl <br />civil tines up to one hundred thousand dollars ($100.0001. in addition to the cost of compensation. damages as providcd for thc <br />attorney's fecs. <br />I hcreby affirm under penalty of pcrjury that I arn licenscd under provision of Chapter 9 (commencing with Section 7000) of Division 3 <br />of the Business and Profcssions Code. and my license is in full force and effect. <br />Liccnsc <br />oau: 6-23' ?;?: <br />CONS'TRUCTI(!N LENDING AGENCY <br />I hcrchy aflirm undcr trctrallyofpcrjury lhnl lhcrc is a constructi([ lcndirrg agcncy for thc Jrcrfornuncc oflhc work for which lhis ttrillil is <br />issucd (Scc. 109?. Civ. C.). <br />Lcnder's Addrcss: <br />A PPLICAN'I' DECLARA'IION <br />I lrcrcby allirnr undcr pcnalty of pcrjury ottc ttf the follorving dcclarations: <br />Dcrnolitiort Pcrnrits-Asbcstos Ntttillcatiolr Fc<lcral Rcgulalions ('l'itlc 40' ['rrt6) <br />-Rcquircd <br />Lctter of Notification <br />_l ccrtify that thc fcderal regulations rcgarding asbcstos removal are nol applicable to this project. <br />_l ccrtify that I have read this application and state that the atxrvc information with all City and County <br />and County to entcr u1nn thcordinances and State l^aws rclating to building <br />atxlvc nrcntioned propcrty for <br />Agrplicant or Agent <br />Pernritee name <br />ion. and <br />Ihlr.627'ZaZb <br />UNDER GROUND l/ <br />Waste & Vent v2 'lil&DM,fu-hff <br />Water-Under floor I <br />Gas-Underf Ioor I a I <br />Buildinq Sewer UfuIh r*N <br />ArealStorm Drain I <br />I nterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipinq <br />Roof Drain 0 -a <br />Tub/Shower Test I <br />TfrL au,ul(Nt a <br />Bouqh WatBr.ileater .\I 4r\, 1r <br />alt Dffi,tlx )N/ lg h'lzr Dl*Yry <br />POOL/SPA ,l <br />P-trap/Drain Line <br />lVlain Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heaterlcas Line <br />Misce!!aneous I <br />Gas Service 'l bfl4kr'/ <br />Water Service I I <br />Lawn Sprinkler <br />Sanitary SewerlCao <br />Back Flow Device <br />I I rl /2 <br />Rouqh Plumbinq 1lt,INUW iw <br />Final Gas Test 7 L\Dn/'Vg ? <br />Meter Release I I Il t <br />FINAL I t gA.t@A hK <br />T-f - lt -A rr I <br />o/ltxy y6,l+lq 1trru I (ttllQ e 1, lrTT r <br />-a"/l a I Lar A-+c{/),l, dfiY@ <br />1)I.-t :DU - 01 L - DfJl+{4 <br />,:ufl-7<,.-ZOZO Applicanr: <br />"rrrr, 7 License Numbcr: G <br />contracto( <br />I <br />,,4,Z