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BING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor I .l I .d l- <br />Gas-Underfloor iT?t 'lgp uwrM id0? <br />Building Sewer J <br />ArealStorm Drain <br />I nterceptot/ CIa rifier <br />2trre loX € <br />TOP OUT <br />Waste & Vent <br />Water Pipins <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 Piping <br />Fill Line/Back FIow <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 />/,I -4 <br />Roush Plumbins O.brh)eVff <br />Final Gas Test lr <br />Meter Release tl ^s, t) <br />Uluclb*lll ,FINAL tt)ffnW <br />Nqtes, Remarks, Etc.r , <br />NWNOW I 2 <br />bws li,*l1c{WWratil r b 4ttt/leo4W <br />U <br />OWNER BUILDER DELCARATION <br />I hercloy affm undc pmlty of pcrjury thar I m cxcmpt fiiom thc ContrEctoB' Licens lrw hr thc following msn (Sc.7031.5 <br />Busincss alrd Prcfsion Codc): Any City q Coudy which EquiG . pcmit to o[itruct, alts, imprcvc, dcmlish or rqdr any <br />structuq prbr to its isrurcq sl$ (!uiH thc applicmt for such pcmit to filc . sigrcd stalcmnt that hc or shc ir licmrd pumru <br />to thc prcvisioN of thc Contrsctor's Lienscd Law (Chailtr 9, Comcrcing with Setion 7000 of Division 3 of thc Busincs and <br />PmfcssionsCodc)orthathcorshcisexcmptttmfmmandthcb&iisforthcallcgcduemption. Aoyviolaiionofs6{hn70ll.5bysny <br />applicant for a pcmit sbjats thc applicant to 8 civil pcmlty of mt mc thsn fivc hundrcd dollffi (3500). <br />_t, a.s owner of the profrerty, or my employees with wages as their sole compensation, willdo the work and ttre slnrcture is rnt <br />intended or oflered for sale (Sec.7044, Business and Professions Code: -l'he Conlractor's License Law dnes not apply to an owner of <br />the property whcr builds or impmves thcreoru and who does such work himself or herself or through his or her own employees, <br />provided that such improvenrnts are rnt interded or oflered for sale. l[, trrwevq the building or impmvement is sold within one year <br />of completioq the Citrner Builder will have the burden of proving that he or she did rrlt build or improve the property for lhe purpose of <br />sale). <br />_1. as owner of the pmperty, am exclusively contracting with licensed contractors to construct the <br />arxl Profession Code: 'l'he Contraclor's License Law does not apply to an owner of property who <br />[]usiness <br />thereon. <br />and who contracts for such projects with a Contracto(s) licensed pursuant to the <br />-l <br />am exempt under B.P.C,reas()l'1. <br />- ?-11 <br />I hereby a{Tirm under penalty of perjury one of the following declarations: <br />-l <br />have and will maintain a Certificate of Consent to Self-lnsure for workers' contpensation, as provided for by Section 3700 of the <br />Labor Code, for the performance of the work for which the permil is issued. <br />_l have and will maintain workers' compensation insurancer as required by Section 3700 of the Labor Code, for the performance of <br />the work for which this permit is issued. My workers' compensation insurance carrier and plicy number are: <br />Policy Number: Expires: <br />_l certify that 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'compensation laws of Califomia, and agree that if I stnuld become subject <br />$,orkers' compensation pnrvisions of Section 3700 of the Latnr Code, I shall, forthwith comply with tlnse <br />WARNING: l;ailure lo secure workers' conrpensation arrd shall Jrcnalties and <br />civil fines up to one hundred thousand dollars (S in addit the cost providedrfor the <br />Section 3076 of the Labor interest and attorney's <br />e1-l <br />I hercby affirm un<ter penalty of perjury that I am licensed under provision of Chapter 9 (contmencing with Section 7000) of Division 3 <br />of the Business and Professions Code, and my license is in full force and efIect. <br />License <br />Date: <br />Numbcr:--. <br />faml:oalar. <br />W <br />I hcrcby alfm undo pcmttyof perjury that tlur i! a orutruction knding sgmy ftrr thc pcrfomc of ftc rcrk 6r wtich this pcrmil ii <br />is$(d (Sc. 3097, Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />APPLICANI' ITECI ARA'I'I()N <br />I trreby affinn under pennlty of perjury one of the hllowing declarations: <br />Dernolit ion Permits-Asbestos Notification l;ederal Regulat ions ('l'itle 40, Part6) <br />-Required <br />Lelter of Notification <br />-l <br />certify that the federal regulations regarding asbestos removal are nol applicahle to <br />-l <br />certify that I have read this the atnve is to comply with all City and County <br />ordinances and State Laws of this City and County lo enter uJxrn the <br />above mentioned pmperty for 8--l- '1Applicarrt or Agent <br />Permitee nfl nre (prlnt): <br />ancl <br />a <br />I )q tr.' <br />ll/26t /9 <br />(lu-t <br />iill <br />gD