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PLUMBING.!NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS Owm-Buil&r Decbuiu , 1 <br />I hftby lffim undcrpcnalty of pcrjury thrt I mcrmF fm $c Coimtm'l,iccnsc Law for rhc following rcrff (s6.?031.5 Biains <br />ud hofsim Codc): Any Cily or CMty whicl rcquic a pamit ro csrirucr. dt6, improvc, dmlish q cpair ny irructw, Fitr ro iisismcq also rcquiro thc appliot fc ruch pcmit to lilc r rignd itctmt lhd hc tr 3hc i! limscd puEumt ro rhc provisiff! of thc <br />Cotrstor's Licmcd Lrw (Chrpa 9, Cmcini wi6 Scria 7(nO of Divirio 3 of thc Buine md Prcfsios Codc) c thar hc 6r <br />shc is cxmpt thmfm md thc bsir fq thc allc8cd danptio .Any violstiil of Sccris 703 I 5 by ay rpplimr ftr I fEmit subjftrs rhc <br />applicut to a civil paahy ofnot mm ihu fivc hundrcd dollu (S500). <br />-l.c <br />maofthcFopcrty,smy@ptoycqirhwag6sthcirsolccmpcntrtio,willdothcworlildrhclhclwiinotinr6&d <br />or offcd fc salc ( Ss.7044, Buin6 md Prcfarios Codq Thc Cmtrrtil't Limsc Law dG nor apply ro u mr of thc propcry <br />who builds or impovc thmo, ud who ds rrch wqt himsclf c hrelf cthrcugh his orhcrwn cmploycc, prcvidcdrhrrsuch <br />improvmcnts re oot intcndcd u offmd for rdc. If, howcva, thc building or improvcmot i3 sold within one ytr of ompldion, ihc <br />Owncr-Buildcr will havc thc burdcn ofproving that hc or she nor build u imprcvc for thc purpoc ofsalc). <br />-1, <br />6 owncr of thc propcny. m cxcluivcly contrrcting with liccNcd cdrrrctotr to construcr thc proj*t ( Scc. 7o44, Buins md <br />Prof6lion Codc: Thc Contnctff'! Lic@lc Law dG nd rpply to e wmr of prcpany who builds r imprcvB rhct@ , od who <br />contruts for such prcjcts with 8 Contmcto(!) limscd pmwt to thc Cmtretor's LiccNG Law.). <br />_l un exempt under Section & P.C. for this reason <br />WORKf, RS COMPENSATION DECLARATION <br />I hscby lffim undcr pcnalry of;rcrjury onc ofrhc following dslrarios <br />-lhavcodwill <br />maintainaCcnifietcofCmaltoSclfJrourcforwckm'mpcnsation,o prcvidcdforbyScrion!70oofthc <br />Labor Codc. for thc pcrfmance of thc work for which rhc pcmit is issucd. <br />_l havc ud will mainldn wffkcB' compcnsation iNumcq I requircd by S*tion 3700 of thc Labor Codc, for thc pcrfmmcc of the <br />wort for shich this pcmrit is issucd. My wulm' cmpensaion insumcc cuicr and policy numbcr arc: <br />Policy Number Expires: <br />(This section need not be completed if the pcrmit is for One hundred dollars {S100} or less) <br />-l <br />cenify that in the performance of the work fa which this pcrnrit ir icsuc( I rhall not employ any penon in any manner so as to <br />bccame subjcct to the worken ' compensation laws of Cdiforniq and agrcc that if I should become rubject to rhe worters' <br />compcnsation provisions of Section 3700 of the Labor Code. t shall. forthwith comply with those provisions. <br />WARNING: Frilurc to sdurc work6' cmparsdm covcrtgc ir unhvful, ud shall subjet u cmploycr to criminal pcrdris md crvil <br />finc up to mc hundrcd thoBild dolla (t100,000),in addirio o thc ur of cmrmsarion, dam886 a prcvidcd fff lhc Scction 3076 of <br />ihc Labor Codc, imcrt ild atrmcy's fG. <br />LICENSED CONTRACTORS DECLARATION <br />I hcrcby affim undr pcnalty ofpcrjury that I m licmscd undq provirim of Chapta 9 (commcncing with Setion 7000) of Division 3 of <br />thc Busincss and Profasions Codc, ad my liccnsc is in full fqcc md cffccr. <br />Licmsc Clus:_ Licosc Numbcr _ <br />Date, Contraptor: <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby alfim undcr pcnalty of pcrjury that thm is a construction lmding agmcy for thc pcrfmancc of thc wok fq which this pcmit is <br />islucd (56. 3097, Civ. C.). <br />Loder's Namc <br />Lender's Address. <br />APPLICANT'S DECLA RATION <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part 6) <br />_ Required Letter of Notification <br />_l certify that the federal regulations regarding asbcstos rcmovat are not applicable to this project. <br />_ I ccniry that I hsvc rcad this applicatim md sot. that thc abovc infmedon is coret I agrc to mply witt all City ud Conty <br />ordinecc ud Stilc Lrws rclating to building conrtructio, md hcby authoria rcprcsotativs of this City ud County to mr6 u[pn thc <br />abovc mmtioned proprny for inspcction purpocs. <br />Applicant or agent <br />Permittee name (print) : <br />-o6 <br />UNDER GROUND <br />Waste & Vent <br />Water-Underfloor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Cla rifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipeing <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain 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 SewerlCap <br />Back Flow Device <br />Rough Plumbing ty -ffh// <br />Final Gas Test $--'z <br />Meter Release <br />tr , -A <br />FINAL \717\/{-t,'6"/ <br />Notes, Remarks, Etc. <br />On" AOOlicmt R. l/o- )o <a@