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PLUMBING.!NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEIf ARATION I hacby affm undo pcnalty of pa;jury thst I m qcmpt ftom thc Contraaon' Licm Lrw for thc following rcn (56.7031.5 Bwins ard Profcsion Codc): Any City or County which rcquirc a pcmit lo construcl. altc, improvq danolish or rcpoir my structuc. prbr to its iswcc. also rcquis the appli@t for such pqrnit to 6lc 8 signcd stdf,@t thd hc or shc b licolcd plltMa to thc prcvisioE of thc Contrrctor's Licorod taw (Chapt6 9. Commmiog with Sâ‚¬liotr 7000 of Division 3 of thc Busincs md Prcfsions Codc) or thst hc or shc is qcmpt thcdrom ild the basis for thc allcBcd qmption. Any violstioo of Setion 7031.5 by my applicantforapcmitsubjEtsthc applicottoacivilpcnaltyofnotmrcthufivchun&cddollm($500). _1. ES owner of the p,roperty, or my employees with wages as their sole compensation. will do thc work and thc stnrcture is not intcnded or offerd for sale (Sec.7044. Business and hofessions Code: The Contraclor's Licetsc [-aw does not apply to an owner of the propcrty who builds or improve thcron, and rvho does such work himsclf or herself or through his or her own employees, providd that such impovanents are not intcnded orofFercd for sale. I[, howevâ‚¬r. the building or improvement is sold within one ]td of compkxiorL the O$/ner Buildcr will have the hrden of proving that he or she did not hrild or improve thc property for the purposcof sale). _1, 8s owner ofthe prroperty, am exclusively contracting with licerued contractors to construct the project (Sec. 7044, Btsiness and Prrofcssion Code: The Contractor's Liccnse Law does not apply to an owner of property who builds or improves thcrcon. and who contracts for such projects with a Contracto(s) licased pursuant to the Contractor's Licsnsc l-aw). -l am exempt under B. & P.C. for this reason. l):tle WORKERS' COMPENSATION DECI,ARATION I hereby affirm under pcnalty of perjury one of the following declarations: _l have and will maintain a Ccrtificate of Consant to Self-lnsure for workers' compquatior. as povided for by Section 3700 of the Labor Code. for the performance of the work for which the perrnit b issucd. TJ 3700 of the l-abor Code, for the pcrformancc of rvork for this and policy number are: Policy b io _l certi& that in the performance of the work for which this permit is issucd, I shall not anploy any person in any mannef, so as to bccome subject to the workers' compcnsation laws of California, and agree that if I should become subject to thc workcrs' compensation provisions of Section 3700 of the tabor Codc I shall, forthwith comply with thosc provisions.. WARNING: Failure to sccure workers' compemation coverage is unlawful. and shall subject an anrplolcr to criminal pcnaltics and civil fines up to one hundred thousand dollars ($100.000), in addition to the cos of compcruation, damages as provided for the Section 3076 of the Labor Code, interest and attorney's orr", //- 12-b DECTARATION I hereby affrm under poralty of perjury that t am liceoscd under pnovision of Chapter 9 (commorcing with Secrion 7000) of Division 3 of the Business and Profcssions Code, and my liccrue is in futl force and effect. License Date:)-)-z I hereby affirm under penalty of perjury tha there is a construction issued (Sec. 3097. Civ. C.). agency pcrformance of the work for which this pcrmit is Lt'rttk'r's N;uttt:. Lender's Address: APPLICANT DECLARATTON I hsrby affrm under penalty of perjury onc of the following declarations: Dernolition Pennits-Asbcstos Notification Federal Regulations (Title 40. Part6) -Requircd Letter of Notification -l certify that the hderalregulations regarding asbestos removalare not applicable to this project. _l ccrti& that I have read this application and state that the above information is correct. I agrec to comply with all City and County ordinanccs and State [.aws rclating to building construction, and representatives of this City and County to enter upon the above mentioned property for Applicnnt or Agent -12-P UNDER GROUND Waste & Vent It btwffi Water-Under floor Ir Gas-Underfloor Building Sewer It '7 t>A#,ry ArealStorm Drain I nterceptor/ Clarifier TOP OUT Waste & Vent Water Piping Gas Pipins Roof Drain Tub/Shower Test Rouqh Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Pipinq Fill Line/Back FIow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary SewerlCap Back Flow Device Rouqh Plumbinq Final Gas Test Meter Release I I )- FINAL (t1 ?? >W,fr INotes, Remarks, Etc. License )1 f77?