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PLUM BING.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DETTARATION I hm! alfrrn unda pqElty of psjury thd I m ampt from thc CoolretoE' Liccm Ls for thc following Iuon (Sc.7031.5 Bwias ard Profsion Codc); Any City or Coutrty which rcquirc a pamit to coNtruct, 8ltq, improvq daolish or ftDsir my Etructurq Fior to fu isuucc, also rcquis thc epli@t for such pannh to filc a signcd stdmt thd hc or shc b lictrâ‚¬d pwatt to thâ‚¬ FovisioN of thc Contrctor's Licoscd L:w (Chaptq 9. Comacing wirh Setion 7000 of Division 3 of thc Buim md PrcfcsiomCodc)ortharhcorshebqmptthsctomandthcb6sisforthcalhgcdumption. AnyviolationofScrbnT03l.5byuy applicaot for a psmit subjcts thc applicmt to 8 civil pcmlty of mt morc thm livc hundrcd dollm ($500). _1. as owner of the property. or my employecs with wages as their sole compctrsation. willdo the work and the structure is not intended or offered for sale (Sec.7044. Business and [tofessions Code: The Contractor's l-icense Law does not apply to an owner of the property who builds or improves thermn. and who does such wort himself or herself or through his or her own employees. provided that such improvanents are not intendod orofFered for sale. Ifl however. the building or improvement is sold within one yâ‚¬ar of cornplaion, the Or,vner Builder will have the burden of proving tha he or she did not build or improve the property for the purpose of sale). _1. as owner of the property. am exclusivcly contracting with licensed contraclors to construct thc project (Sec. 7M4, Busincss and hofession Code: The Contractor's l-icense Law does not apply to an owner of propcrty who builds or improves thereon. and u'ho contracts for such projects with a Contracto(s) licersed pursuant to the Contractor's [.icense law). -l am exempt under Section-. B. & P.C. for this reason. WORKERS' COMPENSATION DECLI\RATION I hercby alTirm under penalty of perjury one of the following declarations: _l have and will maintain a Certificate of Conscnt to Self-lnsure for workers' compcnsation. as povided for by Section 3700 of the Labor Code for the performance of the work for which the permit is issued. -l have and the work for will maintain workers' cornpensation insurance. as required by Section 3700 of the Labor Code. for the performance of which this permit is issued. My workos' compensation insurance carrier and policy number are: 5e cuLr;+l" lV*l-iou I j"r, ". /^Carrier:)g /r/ .oztPolicy _l certi& that in the performance of the rvork for which this permit is issued. I shall not cmploy any pcrson in any manner so as to become subject to the wo*ers'compcnsation laws of California and agree thd if I shoutd bccome subject to the workâ‚¬rs' compensation provisions of Section 3700 of the tabor Code, I shall. forthwith comply with thosc provisions.. WARNING: Failure to secure workers' civil fines up to one hundred thousand Section 3076 of the Labor Code. intcrest compcnsation coverage is unlarvful. and shall subject an to and dollars ($100.000). in to the of thc and 4 ?)z o DECLARATION I hereby affirm under panalty of perjury that I arn licensed under provision of Chapto 9 (cornmencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License o"r", lt[![zozo CONSTNUCTION LENDTITG AGENCV I hcrlby stfinn uda psuhy of pqjury thd tlt6 i! I onnruclbo ladilg sgtry for thc paforrrc of thc mrt br vhich thb pmt ir isucd (Se. 3097. Civ. C.). I .t'rrtlcr 's Nittttc. Lender's Address: APPLICANT DECLARATION I hoeby affinn under penalty of perjury one of the following declarations: Demolition Permils-Asbestos Notification Federal Regulations (Title 40. PaI16) -Required Letter of Notification _l coti$ that the fderal regulations regarding asbcstos removal are not applicable to this project. state that thc above information is correrl. I agree to comply with all City and County authorize representatives of this City and County to enter upon the above mentioned propcrty for inspection Applicant or 4yt o,r", lt f 't f zoe O UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Buildinq Sewer ArealStorm Drain I nterceptor/ CIa rifier TOP OUT Waste & Vent Water Piping Gas Pipinq Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Pipins Fill Line/Back Flow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary Sewer/Cap Back Flow Device Rouqh Plumbinq Final Gas Test Meter Release FINAL ll,l6ar lLLtr r/6b s GZrT Notes, Remarks, Etc. I)ate:0wner: