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PLUM BING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby affirm under penalty of prjury that I m excmpt fmm thc Conlrrclos' Lkrnrc lrw for lhc following rcarcn (Src.70315 ' <br />Business ard Profcssion Code): Any City or County which rcquircs a Ismit to @nstruct. alts, imprcvc. dcmlish or rrnair ar(y <br />struclre, prbr to its issure. also rcquircr the spplicant for such lrcmit to lih s sigrcd statcmnt thrt hc or she is lienrcd puruq{i .lo the pmvisions of thc Conhetor's Licctrsd lrw (Chrpkr 9. Comrcrcing with S6tion 7000 of Division 3 of the Busincss md <br />PrcfcssionsCodc)orthalhcorshciscxcmpttlmfrcmandthcbasl$forthc8lhgc{cremplion. AoyviolstionofsdhnT0Sl.5byany <br />alrplicant for I Frmil subjcrts thc spplicanl to s civil penally of nol mrc than five hudrd dollus ($500). <br />-1. <br />as owner of thc profrcrty. or my employecs wilh wagcs as thcir solc compcnsation. will do the work ard thc structure is rtrll <br />intended or offercd for salc (Sec.7044. Busirrcss and hofcssions Codc: The Contractor's License hw does not apply to an owncr of <br />the propcrty wtn builds or improves rhercon. and who docs such work himsclf or hersclf or lhmugh his or her own employces. t <br />providcd that such improvc.nrnts are not interded or ofllrcd for sale. lf. howcrer. thc building or improverrnl is sold within orc )eBr <br />of conqrletion. the Owner Buildcr will have thc burdcn of proving that hc or shc did not huiH or inprove the property for thc purynse of <br />s&le). <br />I <br />_1. as owner of thc propcrty. am exclusively contracting with licensed conlractors to construct lhc project (Sec. 7W, Business <br />and Profcssion Code: Thc Contraclor's Liccnsc Law docs not apply to Bn owncr of propcrty who builds or improves thcreon. <br />and who contracts for such projccts with a Contracto(s) licensed pursuant to thc Contractor's License kw). <br />-l <br />am cxempl under Section-. B. & P.C. for this reason. <br />Date: Owner:_ <br />WORKTRS' COMPENSATION <br />NECI ARATION <br />I hcreby affirrn undcr pcnalty of pcrjury one of the following declarations: <br />-l <br />have and will maintain u Ccrtificatc of Conscnt to Sclf-lnsurc for workers' compensation. as provided for by Section 37fi) of thc <br />Labor Codc. for the perfornrancc of thc work for which lhc pcrmit is issucd. <br />_l havc and <br />thc work for <br />37ff) of thc Labor Codc. for the pcrformrncc of <br />luntl nutnbcr arc: <br />C <br />lz,lrnPolicyi! <br />-l <br />ccrtify that in the Jrcrlirrnuncc o[lhc work ltrr which this pcrmit is issucd. I shall not crnploy any person in any tnanncr <br />so as to bccourc subjcct to lhc workcrs' compcnsation laws of California. and agrcc that if I should becomc subject lo the <br />workers' comJrcnsation provisions of Scction 37fi) of thc lnhrr Ctdc. I shall. forthwith comply wilh thosc pmvisions.. <br />WARNING: Failure lo sccurc workcrs'compcnsation coleragc is unlawl'ul. and shall subjcct an employer lo criminal pcnaltics and <br />civil fines up to one hundred thousand dollars ($100.fiDt. in addition lo thc cost of comFrensation. damagcs as provided for thc <br />Section 3076 of thc I <br />I hcrcby aflirrn undcr I)ivisirur.l <br />of thc Business and Profcssions Codc. and rny liccnse is in full force and effect. <br />Liccnsc a .l 5,6 oo <br />CONS]'RUCI'I(IN LENDINC AGENCY <br />I hercby 0lllrfl undcr lrcnilhy of pcrjury th{t lhcrc is d construclion lcndirg agcrrcy lbr thc pcrlonnancc ofthc work for which this lrcrmil ir <br />issucd (Scc. 3(D7. Civ. C.). <br />lrnder's Namc: <br />Lender's Address: <br />A PIDI,ICA N'I' DECLAR A'I'ION <br />I hcrcby all'irrn undcr pcrralty of pcrjury onc ol'thc tirllou'ing dcchrrt iorrs: <br />Dernolitiorr Pcrnrits-Asl^*slos Notificalion l:c<lcral Rcgulatiorrs ('l'itlc 40. l'art6) <br />-Rcquired <br />Lcllcr of Notillcatiort <br />-l <br />ccrtify that lhe fcderal regulalions rcgarding ashcstos removal are nol applicable lo this project. <br />furcertify that I havc rcad this application and starc that thc abovc information is conect. I agree to comply <br />ordinances and State laws rehting to building construction. and hercby aulhorize representalives of this City <br />with all City and County <br />and County lo enlcr upn thc <br />ahove nrcntioncd propcrty for insJrcction <br />Aplllicanl rlr /tgenl <br />Permilee name (ertil): )( ,<,t, <br />I lolo.It 6 <br />UNDER GROUND A <br />Waste & Vent '+-27-n U/tUZh <br />Water- U nder f toor ttFo Ptl4fL \-77A *,IUA) <br />Gas-Underf loor I\J <br />Buildinq Sewer <br />Area/Storm 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 />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />lt/ain Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heate/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test -4. <br />Meter Release tt \ <br />FINAL L-71\r7A S^lt[l)l <br />N Etc.v <br />Expircs: <br />o,r". ' zlcltr,),\ ppliclnl: <br />-. <br />a g/A conrracror:X-x4.