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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/S!G.COMMENTS OWNER BUILDER DETCARATION <br />I h@by alfim und6 pashy of pqjury that I m cxmpt ftom thc ContracloB' Licffe trw for thc following rcen (Se.7031.5 <br />Buincs ad Prcfeiol Co&): Atry City or County which rcquirc a pcrnh to coEtruct, alts, improvc, donolish or rpeir my <br />structw, prior to its isumce. alm rcquis thc applicut for Euch pcrmit to filc a signcd starmmt that hc or slE i! licasod ptmdt <br />to thc provisioB of th€ Contretor's Licascd L:w (Chaptq 9, Commin8 with Sction 7000 of Division 3 of thc BEind md <br />Prcf*ioB Codc) or th8t hc or shc is crmp thscfrom ud thc bBi! for thc sllcgcd qmption. Any violatioo of Sdior 7011.5 by ily <br />EpplicailforEpmitsubjcrsthe applicilttoacivilpoaltyofnotmorcthmfivchutrdrcddolles($500). <br />-1. <br />as owner of the property. or my employecs with wages as their sole comgusalion. will do the work and the structure is not <br />intended or offered for sale (Sec.7044, Business and Professions Code: The Contractor's License law does not apply to an owner of <br />the property who builds or improv€s thcrorr' and who docs such wort himself or herself or through his or her own employees. <br />provided that such improvanents are not intendcd or ofkred for sale. I[, howcvcr, the building or improvement is sold within onc ]€ar <br />of complaion the Orvner Builder will have the hrd€n of proving thd hc or she did not build or improve the propcrty for the purposcof <br />sale). <br />-1, <br />8s own6 of the prop€rty, arn exclusively contracting with licersed contractors to construct thc projecl (Sec. 7044, Business <br />and Pnofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, <br />and who contracts for such projecls with a Contracto(s) licansed punuant to the Contrac{or's Liccnse Law). <br />-l <br />am exempt under Section-, B. & P.C. for this reason. <br />O*nert <br />WORIGRS'COMPENSATIM <br />DECLAITATION <br />one of the following declarations:I hercby aflirm under petraltyof perjury <br />_l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the-ffi;for the performance of the work for which the perrnit b issued. <br />rvi I I maintain worke'rs'insurance. as by Section 3700 of the l-abor Code. for thc pcrformance of <br />,carrier and policy number re:ts <br />in the performance of the work for which this permit is issued. I shall not employ any person in any manner <br />so as to become subject to the workers'compcnsation laws of California, and agree that if I should become subject to the <br />workers' compensalion provisions of Section 3700 of the Labor Code. I shall. forthrvith comply with thosc provisions.. <br />WARNING: Failure to secure rvorkers' compensation coverage <br />civil fines up to one hundred thousand dollars ($100.000). in <br />rs an anployer to siminal paulties and <br />damages as provided for the <br />Section 3076 interest and attorney's fees. <br />I hercby aflirm under penalty of perjury that I am licensod of Chapter 9 (commcncing with Section 7000) of Division 3 <br />of the Business and Professions Code. md my licensc is in full force and effect. <br />License D Number: <br />W <br />I hocby affm unda poalty of pajury thal th@ is a consrruaion lcnding agocy fo. thc pcfomtrcc ofthe work for *'hich this pqrnit b <br />isucd (Sa. .1097. Civ. C.). <br />kndq's Namc: <br />- <br />Lender's Address: <br />APPLICANT DECLARATION <br />I hereby affinn under penalty of perjury one of the following declarations: <br />Demolition Pcrmits-Asbcstos Notification Federal Regulations (Title 40. Par16) <br />_Required Letter of Notilication <br />asbestos removal are not applicable to this project. <br />with all City and County <br />above mentioned property for inspection purposes. <br />Applicnnt or <br />Permitee <br />r <br />t <br />and to upon thc <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />ArealStorm Drain <br />I nterceptor/ CIa rifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipino <br />Fill Line/Back FIow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release rl ^J,_o, <br />F!NAL L 0u1/uff+r c I <br />INotes, Remarks, Etc. <br />,r,u, I { <br />coti$ that I have read this application and <br />State l-aws relating to building