Laserfiche WebLink
PLUM BING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS OlvN r:R Bt, I Ll)ER DI.ll.('A RA't'l()N <br />I hercby sflirm undcr Fnalty of pcrjury thsl I am crempt frcm lhc Coilrrctm' LLus hw for lhc following rc&sn (56.7031,5 <br />Busincss and.Profcssion Code): Any City or Counly whhh rcquircs a pcnnil to conslruct, slt6. irprcve. demlish or rcJnir any <br />structurc. Fior to its issusrcc. als rcquircs the spplhant for such tEmit lo fih a sigrcd slslcmnt lh.l hc or she is liccnsd puNuant <br />to thc povisions of tlE Contrctm's Licurd Lrw (Chapter 9. Commercing uith Sction 7(n0 of Division 3 of thc Busincss and <br />Pmfcssions Codc) or that hc or shc is cxempt thcrcfrom snd thc h6is for thc allcgcd cxcmption. Any violation of S6lion 70.1 1.5 by any <br />8pplicrnt for I Frmit subjsts the Epplicant to 8 civil penolty of rcl mrc than live hundrcd dollus ($5U)), <br />_1. as owncr of thc proprty. or nly ctnployccs with wagcs as thcir solc cornpcnsalion. u'illdo thc u'ork and thc slruclurc is not <br />illcnrlc{ rlr gffercd ltrr salc (Sc.c.7(}14. Busirrcss and Profcssions Ctxlc: l'hc Cortlractor's l-iccttsc l;rw docs not apply to an owncr of <br />thc pnrJrcrty who buil<ls or itnprovcs thcrcorr. ild who drrcs such work hitttsclf or hcrsclf or through his or hcr <lwn ernployccs. <br />provitlctl thirt such itnprovcrrrnts arc not irrtcrrtlerl or olTcrcd ltrr snlc. lf. howcvcr. thc building <lr improvcrncnt is sold within onc ycilr <br />ol'cornlllctiorr. thc Owncr Buiklcr will have thc hurdcn of proving that hc or shc did nol buikl or itnprove thc pn:J:crty for thc purynsc of <br />salc). <br />_1. asowncrof thc proprty. amcxclusivclycontracting u,ith liccrrscd conlraclorstocottslruct thc projccl (Scc. 71A4. Busittcss <br />arxl lrroli:ssionCodc: 'l'heContraclor'sLiccnscLawdocsnolapplyloan()wncrol'propcrtywhobuildsorimprovcsthercott. <br />and who conlracts tbr such projccls with a C<lnlractor(s) liccnscd pursuant to thc Conlractor's Liccnsc Llw). <br />-l <br />anr excmpt B. & P.C. for lhis reason. <br />I herchy affirrn under Jrcnalty of Jrcrjury one of thc <br />_lhavcandwill nuintairraCcrtillcatcofConscnttoSclf'-lnsurclirrworkcrs'corttpcnsaliort.its providcdlirrhyScction-17fi)ofthc <br />l-abor Crdc. forthc pcrtirrrrruncc of thc work ltlr which thc pcrrnit is issucd. <br />_t havc and u,ilt ntaintairr workcrs'contJrcnsation insurrncc. as rcquirctl hyScclion 37(X)ol'thc Lahor(--<ltlc. lirrlhc pcrlornunccol' <br />thc work tirr which this pcrnril is issucd. My workcrs' cornpcnsulion irtsuritncc citricr and ;mlicy nuntber irc: <br />Policv Numbcr: ExPircs:- --'-J <br />_l ccrrify that in the Jrcrforrnance of the work for which this permit is issucd. I shall not ernploy any person in any manncr <br />so Bs to becomc subject to thc workers'compcnsation laws of California. and agrcc that if I should bccomc subict to thc <br />workcrs' compcnsation provisions of Section 3700 of the l-abor Code. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failure lo sccurc workcrs' cotnpcnsalion is unlawful. and shall subject an employcr to criminal Jrcnalties and <br />civil fines up to onc hundrcd lhousand dollars ($as provided for thc <br />f'ccs. <br />DECLARA'I'I(IN <br />I hcrchy all'irrn urrtlcr penalty ol'pcrjury that I arrr liccnscd undcr provisiort ol'('huptcr 9 (cottttncttcing with Scclion 70(X)) of Division .l <br />of thc Busincss and ['rol'cssions Codc. and my liccttsc is in t'ull lirrcc atrl cfl'cct. <br />Licensc <br />Dnle: <br />CONS IRUCTION LENDING AGUNCY <br />I hcrcby alliril undcr Fnulty of pcrjury thal thcrc is a constructkrn hndin8 agcncy for thc pcrfotmancc of thc work for which lhis Frmil is <br />issucd (Scc. 3(197. Civ. C.). <br />knder's Address: <br />APPLICAN'I DECLARATION <br />I hcrcby allirnr undcr pcnalty of pcrjury ottc of lhc following dcclaraliotts: <br />Dcrnolitiort Pcrntils-Ashc'stos Notification Fedcral Rcgulaliorrs ('l'itlc 40' Part6) <br />-Rcquirctl <br />Lctlcr of Notification <br />_l certify that thc fedcralregulations regarding asbcstos rcmoval arc not applicable to this projcct.\ffi,that t have read this opplication and statc that thc atnvc informalion is correct. I agrce to comply with all City and County <br />building construction. arxl hereby authorizc rcprcscntativcs of lhis City and <br />above mcntioncd proJrcrty for <br />Applicant or Agent <br />I'ernrilee name <br />puq)oscs.2 <br />Countvo'to enlcr ugxln thc <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildinq Sewer <br />AreilStorm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heaterlcas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitarv SewerlCao <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release <br />FINAL tl//t /zoz,o ;hr,I <br />rNotes, Remarks, Eic. I 7 <br />/ <br />I)ale: <br />Contractor: <br />?