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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I herehy affrm undcr pcEhy of pcrjury that I m excmpt ftom the Contracto6' Licg,se l,aw fordrc following re&n (Sa.?031.5 <br />Buincss and Profcssion Code): Any City or County which requircs a ;rmit to construct, alts, improve, dcmolish or rrpair any <br />structure, prhr lo itr issmc, als .equir* thc applicanl for such Jrmit to lilc a signed stalcwnt that hc or shc iq licc[rd purunt <br />to thc pmvisions of th€ Contractor's Liccnsed Law (Chaptcr 9, Commencing with Section 7000 of Division 3 of thc Busincss and <br />PmfcsionsCode)orthath.orsheiscxcmptthcrcfromardthcbaqisfortheallegcdcxemption. AryviolalionofsetionT03l.5byany <br />applicantforapcmitsubjcctsthe applicanttoscivilpcmltyofretmorclhanfivehundrcddollars($500). <br />-1, <br />as owncr of thc prcJrcny, or my emplo)Eca with wages as thcir $l€ omprnstion, will do th. sork ard thc atrctw is mt <br />intended orofferedforslc(Ss.T044,BusinessandPmfcssionsCode:'l'hcConlraclor'sLiccnsLawdocinotapplytoanowncrof <br />thc pmlErty wln builds or impmw the@r\ ard who dc och work himself or hcRlf or thmuSh hii or hcr own cmploym, <br />provided that such impmv€rcnts N mt interdcd orofftrcd for sle. l[ howwo, the building or impmvercnt is sold within onc ,!ar <br />of @rpldioq the crwmr Builder will hsvc ttE burdo of pmvinS lhot h€ or she did ml buiH or imprcw the pmpcrty for thc puIns of <br />sle). <br />-1, <br />asowrcr of the pmpeny, am cxclusively contmcting with licensed contracloB to onsrud thc pmjet (Src. 7M4. Busires <br />and PmfcssionCodc:'[heConlractor'sLicenseLawdoesnotapplyloanownerofpropertywhobuildsorimprevesthcrmn, <br />and who mnlmds for such pmjeas with a ContEcto(s) liccNed purrunt to thc Conlrsctor's Licc[E Law). <br />_l sm excmpt undcr Setion_, B, & P.C. for this ltmn. <br />l)nlc <br />IVORKf, RS' COMPENSATION <br />DECLARATION <br />I hcrcby affirm undcr pemlty of pqjury onc of thc followiog delmtions: <br />_l have ancl will nrainlain n Certilicale of Conscnt tr Scll:lnsure for workers' conpensalion, as providerl lbr by Section 1700 of the <br />l-.h)r Codc. lhr the pcrfoilnance ofthe qtrrk for rvlrich thc pernrit is issucd. <br />-l <br />have S@tion 1700 of lhe lrbor Code, for the pofomrcc of <br />the work carier and Fnlicy number rc: <br />Policy <br />/ aoo"-\7 7 ,I <br />-l <br />ccnify lh.t in thc performnce of the work for qhich this permit is issed. I shall not cmploy any pcrson in any manrcr <br />m as to beom ruhjat to lhc wori(ss' mmpenstion laws of Califomia, and agrc that if I slDuld trcome subjet to thc <br />workers'compensationprovisionsofSection3T00ofthcLatnrCode,lshall,forthwithcomplywiththo*pmvisions.. <br />WARNINC: l;ailure to secure workers'compensnlion/rk)veragc rs unlawful. and sholl suhjrct an employer to criminal pemltics and <br />civil lines upre one hundred thousand dollaF (Sl91000). in addilion ro the cost ofcompensation. damgcs as provided for the <br />S(ti(rn 107(r oflhe Lahor (-ode, intereil nnd attornq/s fees. <br />u,,", rrl-r/t8 "I tct'Nsf,D coNl RAC',t OR <br />Df,CLARA'TION <br />I herehy affirm under penalty ofperjury that I aft licenKl under pmvision ofChapter 9 (connreming with Section 7000) of Division l <br />of Ihc Business aml Pnrfessions Crrde, nrri my license is in full force and effsl. <br />,-E 473/,o3LicenscNumber: <br />\\1 z. <br />C(TNSTRUCl]ON Lf, NDIN(] ACf, NCY <br />I hereby alirm umler penalty ofpcrjury thu there is a construclt)n lencling agency for the performance oflhe work for which this pemit is <br />isrued (Sec. .1097, ('iv C.). <br />Lendcr's Name: <br />Lender's Ad&css: <br />APPI ICANT Nf,CI AITA'I'ION <br />I hsEby affm under pcnalty ofperjury onc ofthe following declaralions: <br />Dcmlition Pcrmits-AstBtoi Noti,icdion l:edtral ReSulatioos ('l'itle 40, Part6) <br />-Required <br />Letler of Noliliqlion <br />-l <br />certify that lhc federal regulations rcgarding sbcstos removal are not applicable to this prcjst. <br />-l <br />ccrti& thot I have read this application and state thal ihc atnve infomtion is corffl. I agre to smplywilh all City and Counly <br />ordimrccs ard State Laws building constructioq ard hcrcbyautlnrizc rcprentativca of thii City and Countyro ors upon thc <br />above mentioncd preperty for purposcs. <br />Applicatrt or Agent <br />Pcmriaee trame ue/ <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOUSPA <br />Ptrap/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 Plumbing <br />Final Gas Test <br />Meter Release t /))/1 /)/ // <br />FINAL Fr) <br />Notes, Remarks, Etc. '" <br />r <br />Dst.:"ft/r f