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PLUMBI NG.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DET,CARATION <br />I hqcby aftim unda pcnalty of pajury that I m cxmpt ftom thc ContractoB' Licre Law for thc followinS r€en (Sc.7031.1 <br />BuinGs 8nd Profsion Codc): Any City or County which rcquim a pomit to omtruct, dta. imprcva danolish or rgair uy <br />structuc. prior to its issuacc, also rcquirc thc applicfit for such pcmit to 6lc 8 signcd ststmmt tha hc or shc b limscd prmaa <br />to thc prcvisioB of thc Contractor's Liccmcd [aw (Chapttr 9. Commcncing with Setion 7000 of Division 3 of thc Busin* uid <br />Prcfessions Co&) or thst he or shc is qcmpt th@ftom md th€ basis for thc.llcScd cxmptior. Aoy vblation of SGtbr 7031.5 by alty <br />applicantforapcmitsubjetsthc applicmttoacivilpcnaltyofnotmorcthelivchundrcddollars(S500). <br />-1. <br />as owner of the p,ropcrty, or my employees with wagcs as their sole compensation, will do the work and the structure is not <br />intendod or offercd for sale (Sec.7044, Business and hofessions Code: The Contractor's License law docs not apply to an owner of <br />the propcrty who builds or impoves theron. and who does such work himself or herself or through his or her own employee. <br />provided that such improvancnts ane not intendod orofFencd for sale, I[, however. the building or improvcmcnt is sold within onc ]car <br />ofcompkxiorL the Orvner Builder will have thc hrden of proving tha he or she did not build or improve the propcrty for the purpose of <br />sah). <br />-1. <br />as owner of the propcrty. am exclusively contracting with licensed contractors to construcl the project (Sec. 7044. Business <br />and hof€ssion Code: The Contractor's License Law docs not apply to an owner of propcrty who builds or improves thereon. <br />and who contracts for such projects with a Contracto(s) licorsed pursuant to the Contractor's License L,aw). <br />-IamexemptunderSection-.B.&P'C.forthisrcason.Date: O*ner <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hereby allirm under penalty of perjury one of the following declarations: <br />-l <br />havc and will maintain a Ce-rrifrcate of Conscnt to Self-lnsure for workers' compensation. as provided for by Section 3700 of the <br />Labor Code. for the performance of the work for which the perrnit is issued. <br />-l <br />havc and will maintain workers' compensation insurance. as required by Section 3700 of the l-abor Code. for the performance of <br />the work for which permit My workers' compcnsation insurance carrier and policy number re: <br />Policy <br />'2, ( <br />y'rotitythat in the performance of the work for which this pcrmir is issued, I shall not <br />so an to become subject to the work€rs' compensation laws of California, and agree that if I <br />employ any person in any manner <br />should become subject to the <br />work€rs' compensation provisions of Section -1700 of the Labor Code. I shall. forthwith comply with those provisions.. <br />WARNING: Failure to secure workers'is unlarv[ul.shall subject an andlo <br />civil fines up to one hundred thousand ($the <br />Section 3076 of the Labor Code. interest and attorney's fees.t <br />Dere: to/t zr/Zz <br />I hereby affirm under penalty of perjury that I am licensed Chapto 9 (commencing with Soction 7000) of Division 3 <br />of the Business and Professions Code. and my liccnse is in full force and effect. <br />License -io Number:ZlZ <br />LA <br />CONSTRUCTION LENDING AGENCY <br />of perjury that there is a construction lending agency for the performance of the work for which this permit is <br />lrndcr's Address: <br />APPLICANT DECLARATION <br />I hady affirm undcr pcnalty of pcrjury one of the following declarations: <br />Dernolition Permits-Asbestos Notification Foderal Rcgulations (Title 40, Part6) <br />-Rcqu <br />ired Lrtter of Notificaion <br />-l <br />certi& that the lcderal regulations regarding asbestos removal are not applicable to this project. <br />-l <br />ceni& that I have read this application and state that with all City and County <br />and County to cnter upon thcordinances and State Laws relating to building <br />above mentioncd property for inspection <br />Applicant or Agent <br />Pernritee <br />,-l <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq 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 />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous , <br />Gas Service y/ <br />Water Service lr ,(L <br />Lawn Sprinkler (/' ,)" l--, <br />Sanitary Sewer/Cap Lfr/ tY C,[- <br />Back FIow Device Au' J ,\Z'(,D <br />t/'l v' ),I <br />Rough Plumbing lo/t{/21 ,/*5n vfio) / <br />Final Gas Test -lt V / <br />Meter Release I t6 /?a/*'{J-/**fiQ <br />FINAL lo/i/z"t J)d{o'b€7> <br />Notes, Remarks, Etc.r7 <br />Dale:*4 <br />Lender's Nane: <br />U4.- <br />above <br />p orr", tlz/u