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PLUM BING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water- U nderTldor GPop NO't "7-z'.) -zl l?L' (A <br />Gas-UnderfhrUr Crz*1rrrD 4 7-Z?- Lr Ro(rr) <br />Buildinq Sewer \.- <br />ArealStorm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain ,/ <br />Tub/Shower Test \ <br />Rough Water Heater \ <br />\ <br />POOL/SPA / <br />P-trap/Drain Line <br />l\Iain Drain/Pool Pioino <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rouqh Plumbinq ,l .4. <br />Final Gas Test 1l*lu fZts 69 <br />Meter Release tl <br />FINAL Y*lzv fu)@:) <br />Notes, Remarks, Etc. <br />\ <br />OWNER BUILDER DELCARATION <br />I hcrcby affirm undcr Jrcnally of lErjury lhat I am excmpl ftom thc ContractoN' Liccns liw for lhc following rca$n (Ss.70-11.5 <br />Busincss und Prolbssion Codc): Any City or County which rcquircs n JrcrmiI to onstruct. altct hnpovc. dcnrelish or rcpir any <br />$truclurc. prior to its issuance. also requircs thc applicant for such Jrcrmit to lilc a signcd stalcmnt that hc or shc is liccnscd pu$uanl <br />Io thc provisions of tlrc Contractq's Liccnscd kw (ChapIcr 9. Comrrcrcing with Sslion 70OO of Division 3 of Ihc Busiress and <br />PmfcssionsCodc)orthathcorshciscxcmptthcrcfromandlhcbosisforthcullcgcdcxcmption. AnyviolalionofsdbnTO3l.5byany <br />applicanl for a pcrmit subjels thc applicant to I civil pcnahy of nol mrc lhil fivc hundrcd dollus ($500). <br />-1. <br />es owncr of Ihc popcdy. or my cmplo)ms with wages {s thcir slc @mpcnsation, will do the wort and thc slrwlrc is mt <br />intctrdcd or oflbrcd for slc (Se.7Ol4, Busincss and hofcssions Codc: Thc Crnlractor's Liccns ljw d@s not trpply to an owncr of <br />IhcpD[rcrty whohuiHsorimprcrerthcmn.udwhodessuchmrkhimsclforhcrslforlhrcughhisorhcrowncmployccs. <br />providcd thrt such imprcwmnts rc mt htcndd or oflercd for sh. lf, horcw. lhc building or impmvcmnl is $ld wilhin oilc )ts . <br />ofcorplcthn. thc Owncr BuiLdcr will harc thc burdcn ofprcving that hc or slrc dii mt build or impmvc 0rc pmFrly for thc purfns of <br />sle). <br />-1. <br />as owncr of thc pmfErty. am cxclusivcly contracting with liccnsd conr&lon b conslruct thc projct (56. 7(X4, Busircss <br />and ftafcssion Codc: The Contrrclor's Liccnsc Law docs not apply lo an owncr of prctEny who builds o. impmws thcrcon, <br />and who conlructs for such prcjccts with a Contmcto(s) licensd pursuant lo lhc Contrrclor's Liccns [aw). <br />-lamcxcmplundcrscclion-.B,&P.c'forlhisrcasn. <br />floIr.' <br />EOEtrEINTOMPIN&IIION <br />DECIdMIIQN <br />I hcrcby affirnr undcr pcnulty of psjury orc of thc following dcchations: <br />b&u" und *ill minlain tr Ccnificorc of Conrcnt ro Sclf-lnsurc for workcrs'orrrrcnsation, as prcvidcd for by Section -1?00 of thc <br />-,a/hbor Codc, for thc lrcrformrcc of thc work for which thc fsmit is issucd. <br />)L4.n*c and by Scction 3700 of the l-abor Code, for the perfonnarcc of <br />thc work for plicy numbcr are:G.rnilo <br />t <br />\ ,nu.y Z <br />)t1, ccrtify that in rhe pcrformance of thc work for which this pcrmit is issued. I shall not cmptoy any pcrson in any manncr <br />so as lo become subjcct to the workers'compensation laws of California, and agree that if I should becomc subict to the <br />workcrs' compcnsation provisions of Section 3700 of the L:bor Code. I shall, forthwith comply with thosc provisions.. <br />WARNING: Failurc lo sccurc workers'compcnsation covcragc is unlawful, and shall subjcct an employcr to criminal pcnaltics and <br />civil fincs up lo onc hundrcd thousand dollars ($l00.UlO). in addition to thc cost of compcnsation. damages as providcd for thc <br />os <br />I hereby affrm undcr penalty of pcrjury that I am liccnsed undcr (commcncing with Section 7000) of Division 3 <br />of thc Busincss and Profcssions Codc. and my liccnse is in full forcc and effecl. <br />Nurnbcr: <br /><)qg <br />W <br />I hcrcby affirm undcr Fnahy of perjury lhat thcrc is a construction bnding agcncy for thc [ErfoMcc of the work for whhh lhis pcmit is <br />issucd (Scc. 3097, Civ. C.). <br />lrndcr's Namc: <br />[-cnder's Address: <br />APPLICANT DFCLARATION <br />I tnrcby allirm undcr pcnalty of prjury onc o[ thc following dcclarations: <br />Denrolition Pcrmils-Asbestos Notification Fcdcral Rcgulations (Titlc 40. Parl6) <br />_Rctluircd lrttcr of Notilication <br />-l <br />certi& that the federal regulations regardrng asbestos rcrnoval are not applicabh to this pmject. <br />>81*ify that I havc read this applitxtion and state that thc above information is correct. I agree to comply with alt Cityand County <br />ordinanccs arrd Statc [.aws relating to building collstruction. and thc <br />abovc mcnlioncd propcrty for <br />(/Applicant or Agent <br />, Permitee name <br />rcprcscntativcs of this City and lo cnlcr <br />and BCI2 qlt <br />4 <br />s