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APPROVALS DATE ID/SIG.COMMENTS UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Buildinq Sewer Area/Storm Drain I nterceptor/ Cla rifier TOP OUT Waste & Vent Water Pipinq Gas Piping Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Pipinq 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 -4 ,)Meter Release a tID lz2(\lr f.Ol f )FINAL t?u'T) Notes, Remarks, Etc.U\I DEL('ARA'I'ION I hmby affm undo poulty of pa;jury that I m qmpt from the CodactoB' Licoe trw for thc follo&ing lwr (5e.7031.5 Buincs ad Profissioo Co&): Any City or County which rcquirc a pamit to coGtruct. ahc. improvc danlid. or rpah uy stucturc, pdor to its ismcc also rcquirc thc applicmt for such Fmit to filc s sigtrcd strrmat that hc or shc b licascd pmulnt to thc FrovisioG of thc Contrrctor's Liccnscd Lrw (Chapt6 9. ComcrcinS with Sction 7000 of Division 3 of thc Buine ud Prcfc$ioos Codc) or that hc or shc b qmpt th@from ed thc bcais for thc 8lkgcd qmption. Atry violatioD of Scrbn 7031.5 by ey applicet for a pmit subjeis thc applimt to a civil paaly of not morc thu fivc hun&cd dollm ($500). -1. as owner of the property, or my ernployees with wages as their sole compensation. will do the work and the structure is not intendecl or oflcred for sale (Se.7044. Business and Professions Code: The Contractor's License law does not apply to an owner of the propo'ty who hilds or improves therqrn, and who does such work himself or herself or through his or her own employees. provided that such improvoncnts are not intended or offered for sale. If. howwcr. the building or improvernent is sold wilhin one )car of completion, the Orvner Buildcr will have the hrden of proving that he or she did not build or improve the propoty for the purpose of sale). _1. as owner of thc propcdy. am exclusively contracting with licensed contractors to construcl the project (Sec. 7044. Business and Profession Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a Contractor(s) licenscd pursuant to the Contractor's License Law). -l arn e.\empt under Section-. B. & P.C. for this reason. Owner: WORKERS' COMPENSATION DECLARATION I hereby affrm under poralty of perjury one of the following declarations: have and will maintain a Ccrtilicate of Conscnt to Sclf-lnsure for workcrs' compensation, as provided for by Section 3700 of the Labor Code for the performance of the work for which the pennit is issued. and will maintain workers' compensation insurance. as rcquired by Scction 3700 of the l.abor Code. for the performance of the work which this pcrmit is issued. My workers' compeosation insurance carrier and policy numbcr are: Ll cerriff that tn the performance of thc work for which this pcrmit is of California. issued,shall not employ any person in any manner if I should become subject to therui to become subject to thc workers'cornpensation laws and aSree that workers' compensation provisions of Secrion 3700 of the l-abor Code. I shall, forthwilh comply with thosc provisions.. WARNING: Failure to sccure workers' compensation coverage is unlawful. and shall subject an onployer to criminal penalties and civil fines up to one hundred thousand dollars (5100.000), in addition to the cost of compensation, damages as provided for the Section 3076 of thc labor Code interest and attorney's fees.-\-, U I hcreby aflirm undcr penalty of perjury that I am licensed 9 (commencing with Sectbn 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Number: qbLzq,q contractor: I UL ?I o{rrStcna t $r-r'r \d 1'nc1 I hereby affrm under penalty of perjury that issued (Sec. 3097. Civ. C.). Lcnder's Name: CLnr-rn v?r l--LL CONSTRUCTION LENDING AGENCY there is a construction landing agcncy for thc pcrformance of the work for which this pcnnil is Lender's Address: APPLICANT DECLARATION I hcreby affinn under pcnalty of perjury one of the following declarations: Dernolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Par16) -Recluired lettcr of Notification _l ccrtify that thc federal regulations regarding asbestos removal are not applicable to this project. ordinance with all City and County and County to enter upon the above rnentioned property for Applicant or Agent Pernritce nRnle purposes. C-.\-/ PLU M BI NG.I NSPECTOR RECORD 7 fl C1 Y lnqP Tulzl)atc:,b1) cotiS that I