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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNERBUILDERDEI(ARATION r <br />I hmby aIlirm undcr paalty of pcrjury that I m qcmpt ftom thc Corilmton' Licmc tiw for rhc following Itor'1Se.70-!1.5 ' <br />Buincs ard hofeion Codc): Any City or County u,hich requirc a pcmit lo construct, alto. improve donolish or rcpair-any <br />structuc. pdor to its issuucq also rcquiG thc spplicut for such pcmit to filc a signcd statmot thd he or shc b licsc{ pm'uant <br />to rhc provbioN of tlE Contrrctor's Licmscd taw (Chapt6 9. Comocing rvith Sction 7000 of Division f of thc Busins ud <br />Prcfcsions Code) or that hc or shc is crcmp thccfrom md thc bsis for thc allcXcd exmpion. Any violation of S61ion 7031.5 by any ,' <br />applicant for 8 pqmit subjets thc applicmt to 8 civil pcnalty ofnot morc thm five hun&cd dollus (S500). <br />-1. <br />as owner of the propcrty. or my employees with rvages as their sole compensation. willdo the work and the stnrclure is not <br />intended or offered for sale (Sec.7044. Business and hofcssions Code: The Contractor's Licerse l-aw does not apply to an owner of <br />the propa'ty who builds or improves theron. and who does such wo* himself or herself or through his or her own employees. <br />provided that such imp,rovonenls are not intendcd or offened for sale. l[, horvever. the building or improvement is sold within one ]€ar <br />of complaion. the Or,vner Builder will have the btrrden of proving tha he or she did not build or irnprove the popoty for the purposeof <br />sale). <br />_1. as o\\'ner of the properly. atn erclusively conlracting rvith licensecl conlractorc to constnrct the project (Sec. 7044,llusinc'ss <br />and l\rrfession Code: l'he ('ontraclor's l-icense Larv does not apply to an owner oIproperty u'ho builds or improves thereon. <br />and s'ho contracts for such projects s,ith a Contractor(s) licensed pursuant to the ('ontractor's l,icense Lalr'). <br />__l am exernpt undcr Section__ _ . B. & P.C. for this reason. <br />I)nte:( )rr ner: <br />$'() nx r.ns' i'Oirt pi.Nsli'r()x <br />I)11('t.AR,\'l'l0N <br />ottc of' Iltc [oIlorvinu tlcclaral iorrs:I hereby aflirm under penalty of pojury <br />-l <br />have and will maintain a Certifrcate of Consent to Self-lnsure for rvorkers' comp€nsation. as provided for by Section 3700 of the <br />l-abor Code. for thelgf$$ance of the rvork for which the po'rnit is issued. <br />ffi :Iffi i'ltHffiiilliH't;ffii,H,,fi iili',lJ;Section 3700 of the Labor Code. for the performance of <br />carrier and number are: <br />-, <br />Policy l;rpilt's ?0 <br />-l <br />cerrify that in the performance of the rvork for rvhich this permit is issued. I shall not onploy any person in any manner <br />so as to become subject to the workers' compensalion lass of California. and agree that if I should become subject to the <br />workets' compensation provisions of Section 3700 of the Labor Code. I shall. forthwith comply rvith those provisions.. <br />WARNING: Failure to secure u'orkers'is unlarvful. and shall subject an employer to oiminal penalties and <br />addition to the cost of cornpensation. damages as provided for thecivil fines up to one hundred thousand dollars <br />Section 3076 of the Code, interest fees. <br />I hereby aflirm under penalty of periury that I arn licensed 9 (commencing with Section 7000) of Division 3 <br />of the Business and Professions Code. and my license is in full force and effect. <br />,^ <br />License Class: g <br />l)ate:-.<lsl?ort <br />I hrcby aflirm unda pqlatty of psjury that thqc is a enstsction lcnding agmcy for thc pcfomce of thc worl for which this pEmit b <br />issued (Se. 3@7. Civ. C.). <br />knd6's Nmc: <br />- <br />Lcnrlt'r 's r\tltht'ss: <br />A PPLICANT DEC LARA'TION <br />I hertt,y a{linn under penalty of perjury onc of the follou,ing declarations: <br />I)emolit ion Perrnits-Asbestos Notil-rcation Federal Regulat ions (Title 40. Par16 ) <br />_Re<luired l-etler of Notification <br />-l <br />certi& that the federalregulations regrding asbestos rcmovalare nol applicable to this project. <br />@ereadrhis and state that the above infonnation is correct. I agree to comply with all City and County <br />ordinances and State l-arvs relating to construction. and hereby authooze.qccntatives of this City and County to cntcr upon the <br />above mentioned property for <br />Applicnnt or Agent Signatrrre: <br />Permitee nRnle <br />k r)nre: s\t\v <br />UNDER GROUND A <br />Waste & Vent -( - [-Vo Wtt]il ,{l{"/ RaLl /r,L <br />Water-Under floor \-/ <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarifier (tlahn,t ,'(\^r}€ilI ?D) <br />{t U\\ar- <br />TOP OUT A <br />Waste & Vent 1'7-Za Mtl-,Ih <br />Water Piping 7-7-74 '),lLJyll <br />Gas Piping 'v <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbins /r\ <br />Final Gas Test 1-W-'Ia um#d\ <br />Meter Release 1^lt-h VJmqrI <br />FINAL <br />\,'-V) <br />k" <br />h,t31l <br />$<-- <br />u <br />\)v <br />Notep, Bemarks,Etc.