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APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND -K,o-r <br />Waste & Vent t'Ll(I-AHPT '/ <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />ArealStorm Drain <br />I nterceptor/ Cla rifier <br />TOP OUT -t <br />Waste & Vent LI b-trvYl / <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test 0 l?u PlWK <br />Rouqh Water Heater I <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back FIow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCap <br />Back Flow Device <br />Rough Plumbing <br />Fina! Gas Test <br />Meter Release <br />FINAL to -5 -'l,l Wrnl4U <br />Notes, Remarks, Etc. <br />:} <br />OWNER BUIIDER DET.CARAIION <br />I hw@ affm unda padty of pcrjury thd I @ qmpt &om thc Cotrtnclon' Licffi Law for thc following wn (Sc.7031.5 <br />Buins ard hofeion Crdc): Aoy City or County which rcquiro a pomit to @Etruct, aI6, imgrovc. da6tbh or 4aq uy <br />structuq prior to its isumcc, also rcquirc thc qplimt for such pdrnit to filc I signcd stst@t thal hc or slrc b liccrEcd pwut <br />to thc povisiom of thc Contretor's Licasod L:w (Chryta 9. Comming with Sc,tioa 7000 of Divisioa 3 of thc BEiB &d <br />Prrofasioro Codc) or lhst hc or slE b q@pt thorfroo md thc bssi! for thc allcgcd qmFioa. Any violation of Sction 7031.5 by ey <br />applimt for a pcmit subjctr thc applimt to I civil pmlty of not mrc thcn fivc hundrcd dollu ($500). <br />_1, I om6 of thc prcpqty. or Ey mplo,6 with wagc s thcir mlc ompsuaion" will do the wo* od thc stutw is rct <br />idqdrd or ofiaod for slc (Sc.7044, BBitB ed ProfBrioE Codc: Thc Cotrac{or's Lic@ Lrw do6 ml eply lo o ow of <br />thc Fopqty who bil& or improE ttsort ard who do6 suh wrl hiruclf or hwlf or thrcugh his or hr om mploycc, <br />providcd thar reh improvqmrts rc rct imqxlcd or o&cd br sb, If. how, th. buildiDg or irryovarcrt is rld within orc )s <br />of mmplabn thc Orvna Buikir will harc thc hlda of poviog fra he or shc did mt hdld or itqrow thc pmpaty for thc prrpo* of <br />slc). <br />-1. <br />u ow ofthc prcpcty, m cxcluiwly coilracting with licosod @tnrdoB to @oltuct thc projcr (Se. 7fi4, hsine <br />atd Profissbo Codc Thc Coilrctor's Liccc kw do6 mt apply to s ownq of prcpGty who builds or imprcv6 thaoq <br />ud who coltr8ts for such FojErs with r Coffiaclq(s) licqEcd pNuel to thc Contrsdor's Lirc lxw). <br />-l <br />am exempt under Section-, B. & P.C. for this reason. <br />WORKERS' COMPENSATION <br />DF'CII\RATION <br />I hcreby affrm under penalty of pojury one of the following declarations: <br />-l <br />have and will maintain a Ccrtificate of Conscnt to Self-lruure for workers'compcnsatior\ as provided for by Section 3700 ofthe <br />Labor Code for the pcrformance of the work for which the pcrmit is issued. <br />-l <br />have and will maintain workers' compcnsation insurance, as required by Section 3700 ofthe Labor Code, for the pcrformance of <br />the work for which this pcrmit is issucd My workers' comp@sdion insurance carrier and policy nurnbcr re: <br />q <br />O D <br />-l <br />certi$ that in the pcrformance of the work for which this permit issued, I shall not ernploy any pcrson in any manner <br />and agrec that <br />forthrvith <br />if I should become subject to the <br />comply with thosc provisions..shall, <br />WARNING: Failure to secure workers' compansation covcrage and shall subject an onployer penalties and <br />civil fines one hundred thousand dollars ($100,000), in <br />and attorney's fers. <br />co$as provided for the <br />Sc"ction Code, <br />c <br />I hereby affrnn under pcnalty that I an licensed under of Chapter 9 (commcncing with Secrion 7000)3 <br />of the Business and and my license is in fult force and effect. <br />License <br />,, <br />* <br />CONSTRUCTION LENDING AGENCY <br />I hoeby affrm under penalty of pcrjury that there is a construclion lending agency for the pcrfonnance of the work for <br />issued (Sec. 3097, Civ. C.). <br />this pennit is <br />I-cnder's Namc: <br />Lender's Address: <br />APPLICAI\T DEC I,ARATION <br />I hqdry affirm under penalty of pcrjury onc of the following declarations: <br />Demolition Pcrmits-Asbcstos Notification Fedcral Regulations (Title 40, Part6) <br />A --Trircd <br />rrtter <br />HHKJ: <br />of Notification <br />federal rcgulations asbestos rernoval are not applicable to project. <br />read this the above information is all City and County <br />ordinances and State Laws and County to enter upon the <br />abovc mentioned propcrty for <br />Applicant or Agent <br />Permitee s <br />to <br />and <br />and authorize of this <br />PLUMBI NG.INSPECTOR RECORD <br />( <br />f <br />Expires: <br />L,abor