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OWNER BUILDEN DELCARATION <br />I hcrcby atfrm undcr fEnalty of Frjury lhal I m erempt frcm lhc ContractoF' Liccnre hw for thc following rcssn (Scc.703l.5 <br />Business and hofession Codc): Any Cily or Counly which rcquircs a permit lo construct. altq. improvc. demlish or rcpair sny <br />structuc. prior lo its issuance. also requires lhe applicant for such pemit lo file a sigrcd statemnt that he or shc is licensd pusanl <br />lo the pmvisions of lhe Contractor's Licensed hw (Chsplcr 9, Comercing with Sstion 7000 of Division 3 of thc Busiress mi <br />Prcfessions Code) or th6l he or she is exempt thsefrcm and the basis for the allegcd excmption. Any violation of Serk n 703 1.5 by any <br />,ffi:, <br />for a permit subjccls lhc upplicant lo ! civil pcnally of not morc than llvc hundrcd dollars ($500). <br />owner of lhc pDpcny. or my employccs with wagcs as their mlc compcnsation. will do thc work and tlrc stMw is mt <br />or offcrcd for slc (Sr.7044. Busincss ud Profcssions Codc: Thc C<rnlroclor's Licens kw docs not apply lo an owncr of <br />lhcproltrly whobuiklsoritrrl)rovcslhcrq)n.andwhodoc\suchtrorkhinlsclf(rrhcrsclIorthrrughhisorhcrowlctnployecs. <br />ol conrflcli(nr. lhc Owncr Buildcr will hsvc lhc hurdcn ol'prrving thrt hc or shc did not build or improvc thc !n)[Edy li)r lhc purfnsc of <br />salc ). <br />_1. Bs owncr of lhe propeny. am exclusively conlrscling with liccnscd conlBctoF to construct lhe pmjst (Se. 7044, Busincss <br />and Pmfssion Codc: Thc Conlrsclor's Licensc Law d@s not apply to an owncr of prepcny who builds or improvcs thcr@n. <br />and who contmcls for such prcjccts with I ) liccnsed pursuant to Contractor'r Licensc Law). <br />-l <br />anr cxcnlpl <br />a <br />&lor lhis <br />I'ECIdBAIII.IN <br />I hcreby uffinn undcr pcnally ofFrjury ooe ofthc following dcclarations: <br />-l <br />harc rrrd will nuintair a Ccnillcrlc of Conscnl Io Sclf'ln\urc for workcrs'coillpcnsrlifll. rs prrrvidcd lor hy Scctir)n 37(X) of thc <br />l,uhor Codc. lor thc pcrlbnnancc oflhc w(,rk for which lhc pcrnrit is issucd. <br />-l <br />havc and will mainlain workcrs' com;rcnsalion insurarcc, as rcquired by Sstion .1700 of the bbo, Code. for Ihe lrrfotmnce of <br />the work for which lhis pcmit is issuci. My workcrs' comlrcnsalion insurancc cmicr ard lnlicy numbcr uet <br />io as to bccom subjcct to thc workcrs' comfEnstion laws of California. and agrce that if I should becom subFct to thc <br />worktrs'mmlEnsalionprovisionsofStrtion3T0OofthctitnrCodc. lshall. lbnhwithcomplywilhthoBprevisions.. <br />WARNING; Fuilure to scure workcrs'compensation covchgc is unlawful. and shall suhjet an cmployer to ciminal [Enshics and <br />civil fincs up lo one hundrcd lhousand dollars <br />J <br />damges as providcd for thc <br />Scction 3076 oflhe tnbor Codc. intercsl 8nd atlomy's <br />I)I.,CI,/\RA I'IoN <br />I hercby affrm under Jrcnalty of perjury that I am lienrcd undcr pmvision of Chspls 9 (@mncing with Section 7000) <br />of lhc Business and Pmfessions Code, md my licensc is in full forcc and elfcct. <br />Liccnsc Cluss:_l,iccnsc Nunlhcri <br />IN <br />Jt'"." <br />0l c0'ilnroli,,n. <br />Drte:_ <br />CONSTRUCTTON LENDING AGENCY <br />I hcrcby all'irrrr un<lcr Jrcn{lly of pcrjlry lhat thcrc is a conslnrctkrn hnding agcncy lbr lhc pcrli)rnuncc ol the work for which this pcrntit il <br />issucd (Scc. .3097. Civ. C.). <br />lJndcr's Namci <br />kndcr's Address: <br />APPLICANT DECLARAl'ION <br />I hcrr$yailirmundcr pcnillly ofpcrjury onc oflhc following dcchrtrtiols: <br />Dcmolitbn Pcrmirs-Ashcslos Nolificatkil Fcdcral Rcguliilions (Tillc.10. Parl6) <br />_Requircd hllcr of Noliflctrthn <br />ccrlily that thc fcdcrill regulalbns rcgdding dsbcsk)s rcmoval arc n(il ilpplicahlc to this prejccl. <br />that I havc rc{d lhis and thrr rhc informdion is corccl. I agre lo comply with all Cityand County <br />and Slale Laws rchting irulhorizll rcprcscnlativc\ of lhi( City and/L- <br />,J n^,-. 2 <br />Counly k, cntcr ufnn thc <br />.l"r/LaL'atx)ve srntioncd property for <br />ApplicoDt or Agrnl Signetu <br />Pemriaee nunre qf\n- <br />APPHOVALS DATE !D/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildino Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trapiDrain 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 />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release , <br />FINAL Ul4l?P1 Vzr--e)^E>) <br />Notes, Remarks, Etc.AfIv <br />'-5) <br />PLUMBING.INSPECTOR RECORD <br />Dole:- <br />Policv Nuntbcr: F-xoircs: <br />$("n,rr,nr, in thc Frcrformncc of thc work for which this pcrmit is issucd. I shall not cmploy any pcrson in any manncr <br />u,", 'r\1\t u u'