Laserfiche WebLink
" IELUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby allrm undcr Jrnahy of Jrrjury that I M exempt fmm thc ConlractoF' Liccn* law for thc followinS rc&sn (5(.70.1 1.5 <br />Business ard Profcssion Codc): Any City o. County whkh rcquircs a lrmit lo construcI. altq. improvc. dcmlish or rcpair any <br />structurc. prior lo its issuarce, also requires lhc applicanl for such [Ermit to fih a sigred statcmnt lhat he or shc is lianrcd pu]ruanl <br />lo the prcvisions of the Contractor's Licensd tiw (Chsplcr 9. Commencing with Section 7000 of Division 3 of thc Busircss Bnd <br />Pmfcssions Codc) or that he or shc is exempl lhercfrom snd thc bosis for lhc slleged exemption. Any violarion of Scdhn 703 L5 by 8ny <br />applicsnt for a pcrmit subjects the applicant to a civil pcnalry of not mrc thsn five hundred dotlars (S500). <br />-1. <br />rs ()wncr ol t hc l)roNily. or nly cnrl)k)yccs wilh wrgc{ {s I hcir s()lc cotrrl}drsnl k)r. will do thc work ilnd thc stnlclurc is n(il <br />lhcpr)lEilv whohriklsrrinrprovcslhcrmn.{ildwho(locssmhworkhiillscll'orhcrrcllorlhroughhisorhcr(,wrrcntphyccs. <br />qlcl. <br />-1. <br />as owncr of thc pmpc.ly. am exclusively conlracling wilh liccnscd conlraclom lo construct lhc proj$t (Scc. ?044. Busincss <br />and Pnrfssion Codcr 'l'hc Conlraclor's Liccnsc Law docs not upply lo sn owncr ofpropcrty who builds r)r improvcs thcrcon. <br />rnd who conlracls for such proFcls with a Contmclo(s) liccnscd pursuanl lo lhc Contraclor's Liccnsc [jw). <br />-l <br />am cxcnrpl undcr Scclion-, B. & P.C. for this rcason. <br />I)lrlr ()$ilrr <br />WORKNRS' CoNTPFNSATION <br />DFCLAN,ATION <br />I hcrcby afnrm under pcnalty of perjury onc of lhe folbwing dcclnror ions: <br />[,ilh(n (ixh. lin lhc fcrli]rnHncc ol lhc work l'()r which lhc l)clnit is i\suc(l. <br />_l hrvc and <br />thc work for <br />lvill rnilinlain Section -1700 oflhe lrhor Codc. for thc perforroncc oI <br />lhis caricr and Jblicy nunlbcr sc: <br />Yv|0{t1 LI 1>oPolicy <br />-l <br />ccnify that in lhc IErformrce of lhe work for which lhis pcrmit is irsucd. I shall not employ any pemon in any mnrcr <br />s as to bcmm subjel to lhe workeB' compenetion lsws of Califorris. ond sgre that if I should becom subjst to thc <br />workns' @mJrcnsation pmvisions of Sslion 3700 of the tatnr Codc, I shall. forthwith @mply wilh IhoE pmvisions.. <br />WARNING: Failure to scurc workcrs'comJrcnsalion covcmgc is unlawful. and shall subhct an employcr lo fiiminal fEmltics ard <br />civil fincs up to om hundrcd thousand dolles in addilion lo the cost of compcnsation. darogcs as provided for lhc <br />Scclion l0X) (,1 lhc Latx)r Codc. inlcrcst and <br />Deter t\-a @tq <br />ol' lhc llusincs\ xnd Prrfcsrirms Codc. aml nty Iiccns0 i\ in litll li)rcc oil(l cll'cct. <br />as(Liccnsc <br />I)illr lL/>>/q <br />I hcrcby rfftrm undq pen8lty of perhry that tlm is I onstruction lcnding ogercy <br />issuod (Scc. 309?. Civ. C.). <br />thc performaNc of lhc work for which this Imil is <br />Lrnder's Namc: <br />L'ntlcr'r AriL'csr <br />APPLICAN'I DIICLARAI lON <br />I lrcrchy allirnr undcr pcnrlty ol pcrjury onc of thc li)lk)rving (lcclilrat ionst <br />I)cnx)lilioD I)crnrits-Ashcslos Notilicdti{rr l:edcral Rcgulations (-l itlc.l0. l)ril6) <br />_Rcquircd l-cllcr ol Nolilicali(nl <br />_l ccrlity lhat thc fedcral rcgulalions rcgtrding astrcstos rcnxrval lrc not applicablc h lhis pmjcct. <br />_l ccnily lhal I havc rcad this application.ud slalc lhal lhc atnvc inlbrtrEti(,n is corcct. I agre lo conlply with all Cily and Counly <br />ordinsnccs and Statc kws rcIilhg to of this Cily ed County to entcr ulDn the <br />abovc mntiorcd prcpcrty fo. <br />Applicant or Agent <br />l'rrnrilcc ilsme <br />arxl <br />Dote: <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <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 />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release <br />FINAL ?110(Xr2 Dkttnr --*H <br />Notes, Remarks, Etc I tl