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7 <br />PLUMBING.I NSPECTOR RECORD \ <br />APPROVALS DATE ID/SIG COMMENTS Om6-Build6 DccJmtim <br />f h@by affim udfi padty of pcjury that t m cxmp fm thc Conrrrc6m' Li6sc Law fc thc folloving m (s6,7031.5 Buind <br />md Prcf*ion Codc): Any City c Cmty which rcquiro a pmit to cmstruc! 8lter. imprcvc, dmoli3h s rcpair my stsucturc, priq to its <br />isrwe, dso rcquiru thc .pplimt ftr sush pcmit !o Iilc a liFcd slstsncnt thd hc q shc is limscd puEult to thc prcvisions of thc <br />Cootactq's Limrd L.w (Chatrq 9, Comaciog with Sccrim 7000 of Divirio 3 of thc Buins ad Profsiffi Codc) n that hc G <br />rhc fu qmpt th@from od thc b6i! fa thc sllslcd cxmptin .Any violstim of Scdo 7031.5 by ily appliui fa Epamit subj€ts thc <br />sppliot io s sivil pqdty of trd |tW thu fivc hu&cd dollm (5500). <br />_I, 8!i owner of the or my ernployees with as their sole compcnsation, will do thc work and the structurc is not intcnded <br />or offocd fq sale ( Scc.Thc Contractor's Licsnse Law does not apply to an owncr of the property <br />who buildr q imprcvs thm, ud who dm ruch wqk hiruclf q hmlf c throqh hir c ha om cmploye, povidcd dtu ruch <br />improvmr re not intadcd s olf6d ftr sdc. If, hwcvr, thc building u imprcvmmt is rcld within onc ycu of mplction, thc <br />Ownc-Duildc will havc thc burden ofprcving 0ut hc tr 3hc not b[ild o impovc for thc purposc ofsalc). <br />-6*o orn propqty, m cxcluircly mtr&ting wirh lic#d mtreror !o omtuct thc prcj61 ( sc. 7044, Bwitrd ild <br />Prcfcgim Codc: Tbc Corndfi's Licre lxw d6 not ap,ply ao u om6 of Fopcrty who buildB c imFov6 thm , &d vho <br />contrircts for such projeca with a Contracto(s) liccnscd pursuant to the Law.). <br />_I arn <br />Date: <br />for <br />I hatby rfiim uda padty of pajury oc offic foll*iag dcclrrtiw:. <br />_I harc ud will mintain a Ccrtificac of CoMt to Sclf-Intw ftr wortm'conpanratim, u povidcd fr by Scrtim 3700 of thc <br />Iabor Codc, fc thc pcfcmcc of lhc waL fc which thc pqrnit ic irurd. <br />_I have and will maintain workers' compcnsation insurance, as <br />work for which this pcrmit is issucd My workers' compensation <br />requircd by Scction 3700 of thc Labor Code, for the performancc of the <br />insurancc carrier urd policy numbr are: <br />Policy <br />(This section nccd not be completed if the pcrmit is for One hundred dollars {5100} <br />in the performance of the work for which this ls not emPloy in any manner so as to <br />to the workcrs 'laws of workefs' <br />of thc Labor Codc, I shall, <br />WARNING: Failurc to secure workcrs' compcnsation coverage is unlawful, and iu ernployc to criminal penalties and civil <br />fines up to one hun&ed thouand dollrs ($100,000),in addition to the cost <br />thc Labor Codc, intcrest 8nd atromcy's feca. <br />damages as provided fs the Scction 3076 of <br />LICENSED CONTRACTORS DECLARATION <br />I hmby sfiim ud.r paElty of pcrjury thrt I u limscd uda prcvilim of Chrpt* 9 (cmacing with Scctio 7000) of Divisim 3 of <br />thc Bwitrca! ud Prcfsim Coda ud my liccrc is in full fm ud cfiet. <br />Liccnsc Class, Liccnse Numbcr <br />Datc: Contrastor: <br />W <br />I halby affim uda pqulty of pqjury th.t thft is 8 ffitsuctio l@ding rgacy fa thc pcrfmcc of thc wct fc which this Fmit is <br />Civ. C.). <br />Lcnder's Address: <br />APPLICAT{T' S DECLARATION <br />Denrolition Permis-Asbctos Notificuion Fcdcral Regulations (Title 40, Part 6) <br />_ Rcquired l'rttor of Notificuion <br />rcgarding asbestos removal are not applicablc to this project. <br />with all City and County <br />above msntioncd <br />and County to cntcr upon the <br />epprican\hgqt <br />r"r,n@gintl' <br />tb' <br />.?.lQ <br />UNDER GROUND <br />Waste & Vent <br />Water-Underfloor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <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-traplDrain 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 Sewer/Cap <br />Back Flow Device <br />Rough Plumbing * <br />Final Gas Test <br />Meter Release <br />FINAL <br />Notes, Remarks, Etc. <br />-I t, <br />a <br />&,)Iu <br />, <br />( <br />?