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PLU M BING.I NSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS OWNER BUI I.DER DELCARATION <br />I hcEby afiim undcr pcmlty ofperjury that I m crcmpt from lhc Contraclors' Licmrc lrw for thc following rcasn (Scc.7031, <br />Businc$ ard Profasion Codc): Any City or County which rcquiH r pcrmit to @nstrucl, alt6, imprcvc, dcmlish or rtpair any <br />structurc, prior to its iismcq aLs rcquirca thc applicmt f(,r sch pcrmit to filc a signcd statcrcnt thst hc or shc is lienscd pumant <br />to thc provkiom of thc Contrsctor's Liccns(d tas (Chaptcr 9, Comrcing wilh Sation 70fi) of Divishn 3 of thc Busine*r and <br />Pmfcsions Code) or th.t hc or ihc is qcrlpt ttmfrcm ud thc b6sis for thc allcgcd cxmption. Any violatioo of Ss{hn 7031.5 by any <br />applicantforapcmitsubj@tsthc applicsnttoscivilpcmltyofnotmrclhanfivchundrcddollam($500). <br />_1, as owner of the pmperly, or my employees with wages as their sole compensation, willdo the work and ttre stnrcture is not <br />intended or ofFered for sale (Sec.7M4, Business and Professions Code: 'l'he Conlractor's License Law does not apply to an owner of <br />the proprty who builds or improves thermr\ and wtn does nrch work himself or herselfor through his or her own employees. <br />providd that such improverncnts are mt intended or offerod for sah. l[, tnwever. thc huildtng or inprovement is sold within one ]car <br />of conryrletion, the C)ryner Builder will have the burdcn of proving that he or she did rnt build or improve the property for the purynse of <br />sale). <br />_1, as owner of the property, am exclusively contracting with licensed conlraclors to construcl lhe project (Sec. 7044, Business <br />and Profession Code: 'l'he Contractor's License Law does not apply to an owner of property who huilds or improves thereon, <br />and who contracts for such pmjects with a licensed pursuant Contractor's License Law). <br />-l <br />am exempt under B. & P.C llris <br />l)t,:('t.ARA I'loN <br />I hereby alllrm under penalty of ffiury one of the fullowing declarations: <br />_l have ard will maintain a Certificate of Consent to Self-lnsure for workers' conlpensation, &s provided for by Section 3700 of the <br />Labor Code, for the perfonnance of the work for which the permit ls issued. <br />_t have and will maintain wo*ers' compensation insurance, a.s required by Section 3700 of the Labor Code, for the performance of <br />the work for which this permit is isnred. My workers' compensation insurance carrier and policy number are: <br />-l <br />cenify that in the performance of the work for which this permit is issued, I shall not employ any person in anyrnun*t <br />so as to become subject to the workers'compensation laws of California, and agrce that if I stnuld become subject to the <br />workers' compensation provisions of Section 37fi) of the Latnr Code. I shall. forthwith conrply with ttnse provisions.. <br />WARNTNG: I;ailure to secure workers' compensation coverage is unlawfuL and shall <br />a <br />an employer to criminal penalties and <br />civil fines up to one hundred thousand dollars ($addition to of darnages as the <br />Section 3076 of the Latnr Code, interest and afiorney's <br />ltd 16. <br />(>{l{nq <br />r)!.('t,Att^'t'loN <br />I hereby affirm under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 <br />of the Business and Professions Code, and my license is in full force arxl effect. <br />License Clas.s: License Number: <br />Date:_('ottlr:tctor: <br />c()NS t'Rtr(-t'toN t.[.NDIN(; A(;LNCY <br />I hcby.fiirm under tEmltyof pcrjury th.t therc is I @[struciion hnding agcncy for thc pafommc of the mrk ft,r which this tHmit is <br />issued (Sec. 3097, Civ. C.). <br />Lender's Address: <br />APPI ICANT DECI AITATION <br />I hcrEbyaffirmunder penalty of perjury orrc of thc following declarations: <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) <br />-Requ <br />ired Letter of Notilhatbn <br />_l certify that the federal regulations regarding asbestos removalare not applicable to this project. <br />-l <br />certify that I have read this application and lhat the atnve information is correct. I agree to comply with all City and Counly <br />ordinances and State Laws relating to hereby authorize representatives of this City and County to enter uPon the <br />ah<lve mentioned property for <br />,rrr, O'C' 11Applicant or Agent <br />Pernritee nanre <br />UNDER GROUND <br />Waste & Vent cllo rq ca*d,to <br />Water-Under floor til,s-t re 949.* 7a: <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 FIow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCap <br />Back Flow Device <br />I <br />Rouqh Plumbinq .ol frNA{ <br />Final Gas Test -l t \, <br />Meter Release --1 <br />FINAL \LT4 tlt (,[^f-r" earh I /.o>) <br />Notes, Remarks, Etc.ur \-/ <br />,*", -8l1s ll{ <br />Policy Number: ExPires: