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APPROVALS DATE ID/SIG COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />ArealStorm Drain <br />I nterceptor/ Cla rifier <br />TOP OUT tl <br />Waste & Vent Dk#E7 <br />Water Piping <br />Gas Piping <br />Roof Drain I I <br />Tub/Shower Test bl t-r I (/'D6ayo./ <br />Rouqh Water Heater t <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Poo! Pipinq <br />Fill Line/Back FIow <br />Poo! Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCap <br />Back FIow Device <br />Rough Plumbing <br />Fina! Gas Test <br />Meter Release <br />FINAL lb-S ./V\0,"^( tu <br />Notes, Remarks, Etc. <br />-LJ <br />a <br />I hreby aI[m unda poalry of pBjury that I m q@pt from thc Cortra.toB' Lhc Law for rhc followi!8 reo (Se.7031.5 <br />Bsitrs md Profcsion Codc): Aoy Ciry or Couttry which rcquirc a pmit to corutruct, alts. imprcvc dmolish or rpeir uy <br />structuc F[[ to its isurec 8l8o rcquiB thc applicet for such pqnit to filc s signcd lt8tqMt thrt hc or lhc ir licmrcd pumam <br />to thc Fovisios of thc Coots*tor'3 Licoscd kw (Ch4tq 9. Comacing with S€1ior 7000 of Division 3 of thc Buirc ud <br />Prcfsiom Codc) or thrt hc tr slE b qmpt thqc&om ud thc basis hr thc allcgcd amption. Any violatioo of S6tbn 703 I .5 by uy <br />applimtforap6mitsubjclsthc rpplicmttoacivilpoa[yofnotmorcthsfivchundrcddollars($500). <br />-1, <br />u oma of thc popaty, or my mploye with wagc a thcir slc @mpqEdion. will rb thc wsh md thc *nnre b mt <br />intqdcd or offqcd for slc (Sc.7044, BBins od ProfBsioB Codc: Thc Contrartor's LiccE Lrw do6 mt rpply to m oms of <br />thc popqty who tuil& or irpros tlreq 8!d wtrc doc sh mrt hirelf or h*lf or thrcugh his or hc om mplole. <br />prcvidcd that such impovmrts rc mt intodcd or ofrrcd for sh, lf. how, thc hrilding or irrywt is oH wilhin onc )ry <br />ofomplabn, thc Orvu Buildc will harc thc hrdar of pnoving tha hc or shc dil Na hrild or h4iow thc pmpcry for 0E Frposc of <br />sb). <br />-1. <br />as owner of the propcrty. am exclusively contracting with licersed contractors to construcl the project (Sec. 7044. Buiness <br />and ftoftssion Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improves thereon. <br />and who contracts for such projects with a Contraclo(s) licased pursuant to the Contractor's Liccnse l-aw). <br />-I <br />arn exempt undcr Section-, B. & P.C. forthis reason. <br />I)otc' <br />WORKERS' COMPENSATION <br />DECI.ARATION <br />I hereby affrrm under pcnalty of perjury one of the following declarations: <br />-l <br />have and will maintain a Ccrtificate of Conscnt to Self-lnsure for workcrs' comperuation. ari provided for by Section 3700 of the <br />Labor Codq for the pcrforrnance of the work for which the permil is issued. <br />_l have and will maintain work€rs' compensation insurance, an required by Section 3700 of the l-abor Code. for the pcrformancc of <br />the work for which this permit is issued. Myworkas' compensation insurance carrier and policy number are: <br />I tPolicv Number: Exoires: <br />-l <br />cerri& that in the performance of thc work for which this is issued, I shall not anploy any person in any manner <br />so as to become subject to the workers' compensation laws if I should become subject to lhe <br />workers' compensation provisions of Section 3700 of the Labor comply with those provisions.. <br />WARNING: Failure to sccure workers' compensation coverage shall subject an onployer penalties and <br />civil fines up one hundred thousand dollars ($100,000), in cost of as provided the <br />Section 3076 Code attorney's fees. <br />I hereby affrm under penalty of perjury that I am licensed 9 (commencing with Scction 3 <br />of thc Business and Code, and my liccnse is in full force and cffect. <br />J <br />t a <br />J <br />CONSTRUCTION LENDING AGENCY <br />I hoeby affirm under penalty of pcrjury that there is a construction lcnding agcncy for the performance of the work for <br />issued (Sec. 3097, Civ. C.). <br />this pennit is <br />Lender's Name: <br />l.cnder's Address: <br />APPLICANT DECLARATION <br />I hcr€by affirm under panalty of perjury one of the following declarations: <br />Demolition Permits-Asbcstos Notification Federal Regulations (Title 40, Part6) <br />-Requircd <br />lrttcr o f Notification <br />certiff that the federal rqgulations asbcstos removal are not applicable to\ <br />have read this and state that the above information is correct.City and County <br />ordinances and State l-aws relating to upon the <br />abovc mentioned property for <br />Applicant or Agent a.- <br />Pernritee name <br />and <br />project. <br />to cntc"r <br />PLUM BI NG.I NSPECTOR RECORD <br />a <br />Carrier: I <br />4 4 <br />t <br />L