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PLUMBING{NSPECTOR REGORD <br />APPROVALS DATE ID/SIG.COMMENTS Ownr-Buildr Dclsaion <br />I hmby alfim sdrr paalty of pajury thst I m €xcmpt fffir thc CmnacloE' Licsrrc Lsv fothc followingmil ($c.7031.5 Butinrs <br />md Prcfxim Codc): Any City q Cmty whicl rcquiru I pfinit !o mstruct, 8ltcr, imprcvc d€molish or rc?sir uy ltucturq pritr !o itt <br />isswe, also rcquiro thc tpplicst fq ruch p6mit to filc . liFcd srltcmat thst hc tr shc is limcd puEuut to $c prcvisimr of thc <br />Conr&ttr's Licocd ffl (Chsptq 9, Commcing with Scaim 7000 of Divisio ! of thc Bwine ud Prcfsiw Codt) q thrr hc s <br />shc ir gr{npt th@frm ud thc bosir fc thc allcgcd cxmptior .Any violstim of Setio 7031.5 by ay applimt fr a pamit rubjcci tlrc <br />appllfnt to a civil pcndty of ml lm thu fiw hmdrcd dollm (t500)./ <br />1fi, u owna of tlrc propcrty, o my mploys with wag6 I thcir solc ornpcnsation, will do thc work sd thc cructurc ir not intcndcd <br />-or ofrcrcd fc salc ( Se.70,14, Buincr ud Profsiqr Codc: Thr Cmts&tq't Li6sr Lsw dc not spply to e MGr of ihc prcpcrty <br />who builds q imFow thctu, ud who dm such wqk hiroclf o hoclf r thrcugh his c hq oM mployc6, Fovidcd thsl tuch <br />irnprcvmots c not inhdcd tr ollccd for salc. lf, howwr, thc building or imprcvmat is sold within mc yo of cmplaio, thc <br />Ownc-Builda will havc thc bur&n of prcvin8 that hc tr shc trot build c imprcvc for thc purposc of sdc). <br />_1, 0s owner of the property, am exclusively contracting with <br />Profcssion Code: The Contractor's License Law does not apply <br />to constnrct the project ( Sec. 7044, Business and <br />to an of propcrty who or improves thcrcon . urd who <br />contftrcts for such projects with a Contractor(s) liccnsed pursuant to the ) <br />_I anr cxempt undcr Section <br />Date: <br />I hmby affim und6 pcnalty of pajury onc of thc following &cluations: <br />_I havc ad will maiotaitr a Catificatc of Coroqt to Sclf-Insuc for workm' compcnsation, c providcd fo by Scction 3700 of thc <br />Labor Codc, for thc pcrfme of rhc work fq which thc pqmit is issucd <br />_I havc md will mitrt8in wqtG' mpqrsatiotr inswue, I rcquircd by S*tion 3700 of thc Lsbq Codc for thc pcrfomue of the <br />wsk for which this panit is isucd. My workc' cmposatim insumcc wia od policy numbcr rc: <br />Policy Number Expires: <br />(ThisscctionnoanffiepGfinitisforonehundreddollan{sloo}oless) <br />_t certify that in the performance of the work for which this permit <br />becamc subject to the workcrs ' compcnsation laws of California, and <br />is issued, I not employ 8ny in any manner so E to <br />thc worker'become to <br />compensation of Section 3700 of thc Labor Code, I shall,with thqse <br />Due: <br />WARNING: Failure to sccure workers' compcnsation coveragc is subject to criminal pc'naltics and civil <br />fincr up to mc hudrcd thowd ttollrr ($t00,000),in additid to th€ coct of cmpcnlstin, &magcs c provi&d fc thc Sctid 3076 of <br />thc Lrbtr Codc, intaBt ed attmcy'r f6. <br />@ <br />I hmby afiim unda pcnalty of pcdury thrt I m limscd unda psovisim of Chapta9 (mmcing with Scction 7000) of Divisim 3 of <br />thc Buinas ad Prcfqsim Codc, od my liqsc is in firll fmc ud cfret. <br />License Class: Licensc Number <br />Datc: Contractor: <br />CONSTRUCTION LENDING AGENCY <br />I hqcby affim und6 pcnalty of pajury thu th6c is a cosmctio l6din8 agficy fa rhc pcrfomacc of thc work for which rhis pcmit is <br />issucd (56. 309?, Civ. C.). <br />Lands's Nmc: <br />Lender's Address: <br />APPLICANT'S DECLARATION <br />Demolition Permits-Asbcstos Notificuion Federal Rcguluions (Title 40, Part 6) <br />_ Rcquired Lcner of Notification <br />_I ccrtify that the federal regulations asbcstos removal arc not applicable to this projcct, <br />statc that the with all City and County <br />and county to enter upon thc <br />above mcntioned propcrty for <br />Applicant or agent sig. <br />Permittec niune (print) : <br />and <br />ol- <br />UNDER GROUND <br />Waste & Vent *fry/aa I <br />Water-Underfloor t t E- <br />Gas-Underfloor <br />Building Sewer <br />ArealStorm Drain <br />I nterceptor/ 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-trap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back FIow <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 t>lrg6G */d) <br />Final Gas Test rl \--/ <br />Meter Release <br />lt I la- <br />FINAL c +ZL Drrt{")/ <br />Notes, Remarks, Etc. <br />t