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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION <br />I hacby allim unda pcnalty of po'jury thal I m cxempt from thc ContractoG' Licsc Law for thc follou.ing r@n (Ss.7031.5 <br />Busine and Prof*ion Codc): Any City or County which require a pmh to congruct. alt6. improvq dmolish oi repeir oy <br />structurc. [rior to its iswce, ako requirG thc applicilt for such tmit to file a signcd statmot rhat hc or shc b licoscd pwuet <br />to lhc prcvisioB of the Contmctor's Licmsed law (Chapts 9. Commencing with Scction 7000 of Division 3 of thc Busins md <br />ProfcsionsCodc)orthathcorsheisercmptthscfromedthebasisfortheallegedexmption. AnyviolationofscctionT0Sl.5byany <br />applicanl for a p€mit subjtrts lhe applicant to a civil penahy of not morc than fivc hundrcd dollus ($500). <br />-1, <br />c orvno of thc propcrty. or my €mploy$ with wag6 6 lheir sole compmsation, will do thc work md lhc strucluc is not <br />intoded or off6ed for ele (Se.7044, Bsins and Prcf6sions Code: Thc Conlractor's Licmsc Law do6 not apply to an ownq of <br />the prcpcny who builds or imprcve ths@n. md who do6 such uork himsclfor hesclfor threugh his or hd own cmployces. <br />providcd that such impro!'mmts ilc f,ot intmdcd or offtred for sle. If. hosd(. thc building or improvmmt is $ld within one y@ <br />ofcomplction. th€ OMq Buildq will have thc hrda ofprcving thal hc or shc did not build or improvc the prepoty for the purlnsc of <br />sle). <br />-1. <br />romaoftheprop6ty. m crclNivelycontractiilg wilh licmsed conlractoclo construct lhc prej$t (S(. 7M4. Buins <br />md PmfsionCodc:TheContractor'sLicenseLawdocnotapplytomown6ofpropcflyrvhobuildsorimproveth6eon. <br />and who contmcts for such trojds with a Contmcto(s) licrucd pusuanr to lhe Contractor's l-icffc Law). <br />I arn erempl unds S(tion , U. & P.('. for lhis rcason. <br />l)ile:ONner: <br />WORKERS' COI\IPENSAT'IdN <br />DECLARA ]ON <br />I hacby affim undc p€mlty of pqjury onc of the following dalrations: <br />-l <br />havc and will mintain a Certificste of CoNsl to Self-lnsurc for work*' compwtion. r pmvidcd for by Sstion 3700 of the <br />tabor Codc. for thc pofommce of the work for which thc pqmh b issucd. <br />_l havc md will maint.in $ork6'Setion 3700 of the Labor Codq for thc pofnmmcc of <br />thc work for which this permit is ised.cmic and policy numbo ue: <br />Policy l;rpircsr <br />-l <br />ccfliry lhsl in thc psfomance of the work for which lhis pcmit is issued. I shall not mploy any pcmn in any monc <br />s s 1o bccomc aubjet to the Nork6' compsstion laws of Califomia. and agrc thd if I should bccomc aubjGt to thc <br />wortm' compwtion prcvisioro of Section 3700 of the t bor Cod€. I shsll. fonhwith comply with thos prcvisionr.. <br />WARNING: Failurc to sure workm'compmation covmge is unlarvful. and shall subjrt m mployfi to qiminal pqnhie and <br />civil fincs up lo one hundred thowmd dollars ($100.000), in addition to thc cost of compqnsation. damagcs o providcd for the <br />S{lion inls6t md attomcy's fe6. <br />\ <br />pE('l,An n()N <br />of lhc l]usirrcss and Profssions Code. md rnv license is in full lirrcc antl cll-cct <br />\ o \srcNunrhcr: <br />l)ate:o <br />CONS'I'RUCI'ION t,ENDING ACEN('Y <br />I hoeby allirtn under lmalty o f pejury lhal lhtre is a conslrucl ion lendirg agoc.v for I hc pofonnance of lhe srrrk for rvhich this fmit is <br />issucd (Sr. .1097. Civ. C.). <br />[rnd6 s Namc: <br />Lcods's Addrq: <br />APPLICAN DE('LARATION <br />I hoelry affirm undo penalty ofpojury one ofthe follos ing declarations: <br />Demolition Psmits-Asbeslos Notilicatiof, Fed6al Regulalions ('l ille 40. Pm6) <br />Raluircd Lettq of Notification <br />I cdiry lhat the fedral regulatioro reguding 6b6tos rmoval tre not applicablc to this prcjcct. <br />-l <br />cotiry that I havc rad this applicaliotr fid statc that the above infomation is corct. I agrc to comply wilh all City and County <br />ordinancs md Statc Larvs relating to building comtruclion. @d hseby aulhorize relrGotativs ofthis <br />above mentioned pmpety for impation <br />Applicrnt or Agent <br />Pernilee nnme <br />City ild Counly to <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <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 <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />t/I ,11 .^R) <br />Rough Plumbing ,au%D7 <br />Final Gas Test il <br />Meter Release I <br />FINAL <br />Notes Re Etc. <br />(-ailicr: <br />,,",., I arl <br />Tub/Shower Test <br />r//y ry <br />, <br />T)ffV Vr 6(*5/ <br />l0 <br />ll <br />I