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PLUMB!NG.INSPECTOR RECORD APPROVALS DATE !D/SIG.COMMENTS UNDER GROUND ffitr,Waste & Vent I I 1,D: Water-Under floor I t Gas-Underfloor ,.'? Buildinq Sewer ArealStorm Drain I nterceptor/ CIa rifier TOP OUT 1 Waste & Vent I 7 Water Piping ' '-t' a Gas Pipinq Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Piping Fill Line/Back Flow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary SewerlCap Back FIow Device Rough Plumbing Final Gas Test l0t ?.1 Meter Release I I FINAL Y)t 1t t(tr\4P Etc. I a tlu I l,DIilt Dt,t1,('A ll^'t'l( )N I hacty sffim unda pcmlty of pcrjury tha I m cxmp fiom thc CortrrctoE' Licffi t w for thc following rcn (Se.703 1 .5 Buine ard PrcfBion Codc): Any City or Couily whkh rcquic a pomit to aNtrucl, altr. imprcvq danolish or rpeir oy struclurq prior to its isuucq also rcquic thc spplicmt for such pcrmit to filc I sigtrcd statmmt thit hc or dE is lic@lcd ptllMt to thc FovisioE of thc Contrrctor's Licmscd trw (Ch8flq 9. Commming with Sctios 7000 of Division 3 of thc BBin* md PrcfsioN Codc) or that hc q shc is qmpt thsrfrom od thc bosb for thc dlcgcd qmFioo. Any violatiotr of Setior 703 I .5 by uy applicmt for a pcnrit subjcts thc spplicut to a civil pcmlty ofoot morc thu nvc hundrcd dolles ($500). -1. as owner of the propcrty. or my anployees with wages as their sole compensaion. will do the work and the smntne ls not intendod or offered for sale (Soc.7044. Business and Profcssions Code: The Conbaclor's License law does not apply to an owner of the property who builds or improves thcroru and who does such wort himself or herself or through his or her own anployees. provided that such improvcnrents arc not intendod oroftred for sah. I[, however. ttrc hilding or improvenrant is soH within onc ]car of compklion the Orner Builder will have the hrdcn of proving ttra he or she did not build or improve the property for the purpose of sale). -1. as owncr of the propaty, am exclusively contracting with licerued contractors to construci the project (Sec. 7044, Buiness and Pnofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thcreon, and who contracts for such projecrs with a Contracto(s) liccnscd pursrnnt to the Contraclor's Licensc l-aw). -l am exempt under Section-. B. & P.C. for this reason. WORKERS'COMPENSATTON DECI.ASAIIA! I hoeby affirm undo pcnaltyof pcjuryonc ofthc following delratiom: / havc md will mintain a Cmificatc of CoMt to Sclf-lrcurc for work6' compcnsalion. r povided for by Sction 3700 of the 2/[abor Codc. forthc pqfonnece ofthe work for which thc pqnit ls issucd. and will maintain workers' compensation insurance. as rcquired by Section 3700 of the tabor Code. for the pcrformance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Policy ?/egl z-zt -l ccrtirythat in thc perfomncc of Ihc work for which this pcrmit is issucd. I shall not mploy any pcmn in any mons ,s astobccomesulicttothcrrc*6'compcnsatioolasofCalifomia,ildagrcthatiflshouldbcomcsubjcltolhc wortc' compquation provisiore of S*tion 3700 of thc libor C.oda I dull. fonhwilh omply with thor prcvisiom.. WARNING: Failurc to suc rcrks' compwtion sv@ge is unlawful. ild shall subjet e mploler to qiminal pouhics ud ' civil fine up to onc hundrcd lhouild dollm ($100.000). in addition to thc cost ofcompcEalion. dmag6 s providcd for thc Setion -1076 of the tabor C.odq intcâ‚¬si md attomcy's fs. Ds.et ll l\ot,'2,-2p sgptant \/t*e @l Nflii- LrENSED coNTRAcroR DECI.686JIIAN I h@by amrm und6 pcnaltyof pcrjury thal I m limscd undc povision of Chapte 9 (commocing s'ith Sction 7000) of Division 3 of thc Buins md Prcfasiom Code. and rny licru is in full forcc ad cffct. License ctass, 6 License Number:fvc c?, ortu, ltl3ro)2.c2-F/or- )+*t, bvrv,o J 161('ontraclor:u L,.,- CONSTRUCTION LENDING AGENCY I hereby affrm under pcnalty of pcrjury that there is a corutruction lcnding agency for the performance issued (Sec. 3097, Civ. C.). Lender's Name: APPLICANT DECLARATION I hereby affirm under penalty of perjury one of the follorving declarations: Demolition Pcrmits-Asbestos Notification Federal Regulations (Title 40. Parr6) _Required Lettcr of Notification _l certi& that the federal regulations regarding asbestos rernoval are not applicable to this projcct. and above mentioned property for inspcction purpos6. Applicant or Agent Permilee nnme d of the work for which this pcrrnit is Lcttrlct 's r\tltlt css. the ^ru, tllaolzoto Remarks, l)atc: Ni.\