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PLUMB!NG.!NSPECTOR RECORD <br />APPROVALS DATE ID/S!G.COMMENTS OWNER BUTLDER DELCARA'IION <br />I hcrcby aflirm under pcnalty of pcrjury that I m cxempl liom the Contraclors' Licensc Law for the following reaon (Se.703 1.5 <br />B$incss and Profession Codc): Any City or County which requires a pcmit lo construcl, ahtr, imprcvc, dcmlish or rcpair any <br />rtruclure, prior ro its isMnce, de rcquirG the applicant for zuch pemit to lilc a si8ned statcment that he or she ii liccnscd pumot <br />to thc pmvisiotrc of dE Conlractor's Liccnsed law (Chapter 9, Comercing wilh Scction 7000 of Division J of thc Business and <br />PmfessionsCodc)orthatheorshciscxcmptth€rcfromandthebasisforthcallcgcdcxemption. AnyviolalionofscttionT03l.5hy6ny <br />applicanl for a pcmit sbjsIs Ihc spplicanl to a civil penahy of mt mre lhan fivc hundrcd dollus ($500). <br />_1. as owr of the pmlErly, or my cmploFes with wag6 as their mle ompensation, will do the wod( ard the smw k ml <br />intcrdcd oroffcrcdforslc(Sc.7(X4,BusindsandPmfessionsCode:'l'heConlraclor'sLiccnsLawdoesmtapplytoanowrerof <br />thc pmfEny who buildq or irlpmvB thgon, and who dos mch work himsclfor hcrselfor thmugh his or her own cmployccs, <br />provided that sch imprcvffints m mt intsdcd oroflcrcd for sle. If, tnwevs, thc building or imprevemnt is sld wilhin onc )@r <br />of omplaior\ the Owner Builds will have thc burdcn of preving that he or shc did rct build or impmve the prcpsly for the pu4n* of <br />slc). <br />_1. as owner ofthe prcperty, m exclusivcly con(racting wilh licensed contractoF lo construct the prcject (Sec. 7044, Busines <br />and PmftssionCode:'lheContractor'sLicenseLaudoesnotapplytoanownerofpropcrtywhobuildsorimprovdlhereon, <br />and who @ntEcts for sch pmjets with a Contmcto(s) licensed pumant lo thc Conltrclor's Liccnse Law). <br />-l <br />m excmpt under Sction-, B. & P.C. for this rcamn. <br />Drt.:_ <br />I hcrehy aflirm under pemlty ofptrjury one oflhe following <br />_l have and rvill nroinlain a Cenillcrle r)f(imsent b Sel['lnsure ftrr rvorkers' conrpcnsalion, ns provided for hy Seclioo ]7(X) ol lhe <br />l-nhrr (ixle. for the performnncc oftlrc work for which the permit is issued <br />_l have and will maintain workers' compensation insumnce, as required by Sccrion 3?00 ofthe Lobor Code, for the pcrfomome of <br />thc work for which this pemit is issed. My work6' compcnstion i[srame cmicr and ;xtlicy number rc: <br />Policy Numher: Expires: <br />_l cc.tify that in thc pcformrcc of thc work for which this permil is ismed, I shall not employ any peFon in any manncr <br />s as to ttromc subj(t to th€ workm' ompcnmtion laws of Califomia, and agrcc thal if I should bccome ruhict to the <br />workm' mmpeffialion pmvisions of S6tion 3700 of thc Labor Code, I slull, fonhwilh comply with llps pmvhions.. <br />WARNING| railure to rcure workcrs'compcnsataon covemge is unlawful, and shall subject an employer to criminal pcMhies and <br />civil fincs up to one hundrcd thousnd dollars ($100,000), in addilion to the cost ofcompensation, daroges as provided for thc <br />scction 1076 ofth€ Labor Code, inlcrcsl and anomey's fes. <br />Applldnt: <br />LI <br />DTCLARA'IION <br />I hercby allirm under pemlty ofperjury that I am licen*d under prerisioil ofChsptcr g (@mmencinE wilh Sslion 7000) ofDivision l <br />of the Business and Prefessio[s Code, atd my licen* is in full force nnd efTect. <br />Liccmc Clas:-Licensc Numbcr: <br />- <br />l)ilte ('ottlrilckrr <br />C()NS'I'RI'C'I'ION Lf, NDIN(I A(;TNCY <br />I hcrehy allirm under penalty of perjury that there is a construction lcndin8 agency lirr the perforurance ofthe work ft)r which lhis pennit is <br />issued (Sec. ll)97. Civ. C.). <br />Lender'3 Name <br />Lendcr's Address: <br />APPLICANT DECLARAl]ON <br />I hertby alim umler pennlty of perjury one ofthc folkrwing declaralions: <br />Dcmolition Perrhits-Asb€stos Notiflcation l;cderal ReSulations ( l ille 40, Pan(r) <br />-Requircd <br />Letter of Notifi cation <br />-l <br />cenify lhat the federal regulations rcgarding asbeslos removal are not applicahle lo this preject. <br />_l c.niry rhst I h.vc rsd lhis applicstion aDd statc thal thc abovc infomlion is coret. I o[ra lo @mplywith all Cityand County <br />ordinarcB and State Lam rclatinS to building co[structior\ ard hereby authorirc rcprcsotativs ofthis City and County to ciltr upon the <br />atnvc mntiorcd pmpcny for iNp.ction purJnks. <br />Appllcsnt or Agent <br />Permltec name (prlna):_ <br />l)ate <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOUSPA <br />P{rap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill LineiBack 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 />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release ^Ll tll- /E) <br />F!NAL T;r[p/o uKa/o Tdaa\ <br />Notes, Remarks, Etc.