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PLUMBING.INSPECTOR RECORD APPROVALS DATE ID/SIG,COMMENTS OWNERBUILDERDELCARATION -I hmby affm undq pcnslty of pcrjury that I m qmpt iDm thc Coilr8cloE' Licw L:w for thc following r@n (Sc.7031.5 Buins ard Prcfcsion Codc): Any City or Courty which rrquirB a pqmit to o8truct, 8ltq. imprcvc, danolish or rcpair my structre, prbr to its iswcq also rcquira thc applicst for such pqmit to filc a signcd 3t8tm6t that hc or shc b licerscd pwilt to thc FovisioB of thc Cortrrctor's Licascd Law (Chapta 9. Commmcing with Setior 7000 of Division 3 of thc Buins md PofcsioN Codc) or thar hc or shc is amp thqcfom ud thc b6sis for thc rllcaod cxanpioo. Any violaion of Sction 7031.5 by my applicmt for a pcmit sbjetr thc applicet to a civil pcmlty of not mG thu tivc huodrrd dollm ($500). _1. as owner of the property. or my cmployees with wages as their sole compensation. will do thc work and the structure is not intendod or offered for sale (Sc.7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of the property who builds or improves theron, and who docs such work himself or hcrself or through his or her own cmployees. provided that such imp,rovenrants are not intcnded or offerod for salc. I[, however. the building or improvemcnt is sold within onc ]€ar of completiorl the Orvner Builder will have the hrdcn of proving tlra he or she did not build or improve the propoty for the purpose of sale). _1. as owner of the profrcrty. arn exclusively contracting with licensed contraclors to construct the projecr (Sec. 7044. Business and Profission Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improves thereon, and who contracts for such projects with a Contrac-to(s) licersed pursuant to the Contractor's License Law). -l am cxempt under Section-, B. & P.C. for this reason. Owner: DECII\RATION I hereby affrm under pcnalty of pcrjury one of the following declarations: -l have and will maintain a Certifrcate of Consent to Self-lnsure for work€rs' comperuiation. Blt provided for by Section 3700 of the Labor Code. for the performance of the work for which the pcrmit b issued. iZ havc md will maintain worl6' @mpcffition irormcc, u rcquircd by Setion 3700 of thc Lrbor Crdc, for ttc pqfome of'thc rc+ for which this pcrnit ls isrcd My mrt6' omposdion irrslrruc uio ard polhy nmbc rc: _l certi& that in the pcrformance of the work for which this permit is issued. I shall not ernploy any person in an;r mann6 so as to become subject to the workers' compensation laws of California. and agree that if I should become subject 'er the worfters' compensation provisions of Section 3700 of the l":bor Code I shall. forthwith comply with thosc provisions.. WARNING: Failure to secure workers'compensation coverage is unlawful. and shall subject an onployer to oirninal panalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation.as provided for the Section 3076 of the labor Code. interest fecs. DI.,('t,AR,\r't0N I hereby affrm under penalty of perjury that I am ticensed under provision of Chapto 9 (commcncing with Section 7000) of Division 3 of the Business and Professions Code, and my liccnse is in full force and effect. Licerse rr*, / ( ,6 LicenseNumber:, I I hrcby affm undo pcnalty of pcrjury that thqc is a construciion loding agocy for thc pqfomncc of thc work for which this pqrnh b issued (Sec. 3097, Civ. C.). lender's Name: l,cnder's Address: AI'PI TCAI\T DF'CLI]II{TION I hcrcby affinn undcr pcnalty of perjury one of the following declarations: Demolition Permits-Asbcstos Notification Federal Rcaulations (Title 40, Pfi6) -Required l-etter of Notificaion _l certify that the fedcral rcgulations rcgarding asbcstos removalare not applicable to this project. with all City and County and County to enter upon thc above mcntioned property for Applicant or Agent Permitee nnme information is /-da UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Buildinq Sewer ArealStorm Drain I nterceptor/ Clarifier TOP OUT Waste & Vent I Water Piping ttlL0 L / htrfr.,? Gas Piping til?o',ra 7 Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Pipinq Fill Line/Back Flow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary Sewer/Cap Back Flow Device Rough Plumbing Fina! Gas Test Meter Release ,,I FINAL tz / Drf;767 Notes, Remarks, Etc.I ( Dale: c*,,*,{a{r,ner I l** F:4^,*^q e Poricy ""^*, 41?{ { 6ld / - \-t ordinances and State Laws relating to building construction. and