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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILIIER. DEI ARATION <br />I hmby affm undc pctrslty of pgjury thd I m qmpt from th€ Cofrac16' Lirc kw for tlE folbwiDg roa (Se.7031.5 <br />Buinas 8nd Prcfcsion Codc): Any City or Couty which rcquiro a pcnit to @Etrucq altq, improvg dmlish or rcpair my <br />st uctur, prior to it! iswcq also rcquiH thc eplicfit for such pcrmit to filc I sigDcd stdamr thd hr or slE ir licasrd puBret <br />to thc provisioB of thc Cortstor's Licmsod Law (Ch!pt6 9. Comming with Scrion 7000 of Division 3 of thc BBiBard <br />ProfBioB Codc) or thlr hc or shc b qmF thc€Aom ad ilE bcsb for thc rlkgGd qmption. Any viohtioo of Sccbn 703 I .5 by my <br />spplicut for E psmit 3ubjEt tbc applidt !o I civil pcuty of mt mrc the livc hundrcd dollm (t500). <br />A{ * omr of thc propcrty, or my mplo}B with wag6 I thcir slc @mpcrEation. wil do thc wr* sd thc structw is rct <br />imqdcd or offcrcd for $lc (38.7044, BuitB ud Profeshu Codc: Thc Contraclor's Lic@ Law do6 not apply to & owG of ' <br />th€ Fopqty who buil& or irryos thaot! Ed who do6 $eh wr* hirelf or h6elf or thrcugh hir or hr om oplole, <br />prcvklcd that such itrlFoEc{s m mt htqd.d fi ofrrld br slc. l[ how. th. building or imprcEEil is rcld withio orc ]ry <br />of omplaio4 thc olvu Buildc wi[ haE rhc hda of pmvirg 0u hc u shc dil mt build tr itqrorc thc popoty br th prpos of <br />slc). <br />-1, <br />u omq of thc pmpcty, m acluivcly contracling with licoscd @nfrcloB to @rstrud tlE prcjet (Sc. 7044, BGiB <br />ard Proftssim Corlc: Thc Cotrretor's Licmc Law dG not agply to e owtr6 of prcpqty who builds or imprcv6 thmD. <br />ud who snlstt for such Fojcds wilh E Cofrcto(s) lic@lod pBut to thc Cotr8c1or's Lic@ kw). <br />-l <br />am exempt undcr Section-, B. & P '}lil/ <br />o",.' 6;- &\- L\ <br />I hereby alfirm undcr penalty of po'jury one of the following <br />-l <br />have and will maintain a Ccrtificate of Consmt to Self-Insurc for workcrs' compcosation, as providcd for by Section 37@ of the <br />labor Code for the performance of the work for which the pcrnrit b issued. <br />-l <br />have and will maintain workers' compcmation insurance. as rcquired by Section 3700 of the Labor Code, for the performance of <br />the work for which this permit is issuod. My workers' comperuiation insurance carrier and policy numhr are: <br />in the performance of the work for rvhich this permit is issued. I shall not qnploy any person in any manner <br />if I should become subject to the <br />comply wilh thosc provisioru.. <br />so as to become subject to the workcrs'compensation laws of California, and agrec that <br />workcrs' compqnation provisions of Section 3700 of the labor Code I slull. forthwith <br />WARNTNG: Failurc to sccure workcrs' compcnsation coverage <br />civil fines up to onc hundred thousand dollars ($100.000), in <br />Section 3076 of the labor Code, interest and attorney's fees. <br />is unlawful, and shall subject an employer to criminal penalties and <br />addition to the cost of compcnsation. damages as provided for the <br />,",., 6-[\- t\ <br />I hereby affrm under penalty of perjury tha I am licensed 9 (commencing with Section 7000) of Division 3 <br />of the Business and Professions Code. and my license is in full force and effect. <br />Liccnsc Class: Liccrse Number: <br />I ):r I r.'f ana;aatnr. <br />W <br />I hcrcby affm uda FEhy of pqjury thd th@ b a @trdructbtr knding agcy for thc pqfoIr@cc of thc wu* br wiich thb pqoit b <br />isucd (Se. 3097. Civ. C.). <br />lrndcr's Name: <br />Lcnder's Address: <br />APPLICANT DECI..ARATTON <br />I hcrEbyaffirm under pcnalty of perjury one of the following declarations: <br />Demolition Permits-Asbcstos Notification Foderal Regulations (Title 40. Part6) <br />-Required <br />Lctter of Notification <br />_l certi& tha the federal regulations regarding asbestos rernoval are not applicable to this project. <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />ArealStorm Drain <br />I nterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Poo! Pipinq <br />Fill Line/Back FIow <br />Pool Heater/Gas Line <br />Miscellaneous <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 ,t t <br />FINAL tol I th:J-,rNao <br />Notes Remarks Etc. <br />, <br />I <br />V1 <br />t <br />W <br />2l cariry tU I ta* rqd thb ,pptierios ed 3t.tc thd 0E rborc infonndion is corGl. t agc to smply with all Cty and Couny <br />ordiM dd Stdc t w rclding to buiuing @osruction ad tlrcbyrutlDria rrDrsatotiv6 of thi! City ed Couty to qrtq upos thc:,,,-,:^ilil:" ** 5- Ll-8.l <br />,-or,--rulpan,r t --- <br />a