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PLUM BING.!NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER EUILDER DELCARATION <br />I hcrcby affrm under pemlty of JErjury that I m exer$ ftrom the Contrrclc' Licrcns law for lhc following Gfnn as6.703l.5 <br />Busincss and Prcfcssk n Codc): Any Ciiy or Couily whbh rcquircs 8 pemit to onslruct, !lts, irDrcrc. &mlish or rpotiny <br />structure. prhr to its irsuare, ds requircs the spplicanl for such pcrmit to file s signed statemnt lhat lE or shc h licnsd puNmt <br />to thc pmvisions of the Contractor's Liensd Lrw (Chapt€r 9. Co|lmming eith Sstion ?000 of Division 3 of llrc Busiress snd <br />PrcfcssionsCode)orthatheorshe iscxcmpttlrcrcfrcmrrdthebssisforthcollcgedexemption. Anyviolstionofs$tion703l.5byrny <br />applicant for a lrcmit subjcrts thc spplicont to s civil peBlty of not mrc than fivc hundrcd dollus ($5@). <br />-1. <br />as owncr of thc proF,crty. or my cmployecs with wagcs as their solc compensation. willdo thc work and thc structurc is not <br />intcndcd or offcrcd for salc (.Sec.70l4. Business and Pnlfessions Code: Thc Contractor's License l-aw docs not apply to an owner of <br />thc property who buil<ls or in{rrovcs thereon. and who docs such work himself or hcrsclf or through his or her own employces. <br />provided that such improvenrcnts are not intendcd orofhrcd for sah. lf. howevcr. the bnrikling or improverrnt is sold within one )car <br />of comphtion. the Owner Buildcr will have thc burdcn of proving that he or she did not build or improvc thc property for the purynse of <br />sBh). <br />-1. <br />as owner of thc property. am cxclusivcly contructing with liccnscd conlraclors lo construct thc projcct (Scc. lOM. Busincss <br />and Professhn Code: Thc Contraclor's Licensc Law docs not apply lo an owner of property who builds or improvcs thcreon. <br />and who contracts for such projccts with a Conlracto(s) licensed pursuant to the Contractor's Liccnse [aw). <br />-IamexemptundcrScction-.B'&P.C'forlhisreuson. <br />Date:( )rvlrer: <br />WORKEITS' COM PENSATION <br />DTCLARATION <br />I hereby affirm under pnalty of perjury onc of the following declarations: <br />[-:rbor Coclc. ltrr the pcrlirrrnancc ol'thc work ltrr u,lrich thc pcrnril is issucd. <br />-l <br />have and will maintain workcrs' comFrensation insurance. as required by Section 37fi) of the Labor Codc. for thc lrcrformance of <br />thc work for which this pcrmit is issucd. My workers' compensation insurancc carricr and plicy numbcr arc: <br />Policv Nunrhcr: Exnires: <br />-l <br />ccrtify that in the pcrforrnance of thc work for which this;rcrmit is issucd. I shall not employ any pcrson in any manner <br />so as lo bcconrc subict to the workers' compcnsalion laws of California. and agrcc that if I should bccome subject to thc <br />workcrs' comJrcnsalion provisions of Section 3700 of thc Latnr Code. I shall. forthwith comply with thosc provisions.. <br />IVARNlN(i: Firilurc l() sccurc workcrs' cornpcnsation c()vcragc is unhu't'ul. arrd shall subjcct arr crrtployer lo critttittll pcrraltics and <br />civil firrcs up lo onc hundrcd thousand clollars (Sl(n.(XX)). in atlclition l() lhc cosl of contpcnsalion. dannges as providcd lirr thc <br />Scclion 3076 of thc l-atnr C<xlc. irtlcrcsl and allrlrncy's t'ccs. <br />Applicant: <br />LICENSED CON'I'RAC'I'OR <br />DECLARATION <br />I hcrcbyal'llrrn undcr pcnaltyof pcrjury lhal I arn liccnsctl untlcr provision of Chaplcr 9lconrrncncing with Scclion 7(XX)) ol'Division 3 <br />of the Busincss and Professiorrs Codc. and my licerrsc is in l'ull lirrcc and cll'ccl. <br />Licensc Class: Licensc Numbcr: <br />floier.Conlraclor: <br />W <br />I hcrcby {ffirnr undcr lEnrlty ofpcrjury thut thcrc is s conslructhn lcnding ogcncy for lhc pcrl'orroncc ofthc work for which lhis lsmit is <br />issucd (Sa. 1097. Civ. C.). <br />hndcr's Nantc: <br />lrndcr's Addrcss: <br />A PPLICAN'T DECLA RA'TION <br />I hcrchy ullinn undcr pcnalty of prjury onc o[ thc folkrwing dcclarations: <br />Dernolition Pcrnrils-Asbcstos Notification Fcdcral Rcgulalions ('l'itlc 40. Parl6) <br />-Rcquircd <br />[-cttcr of Notificalion <br />-l <br />ccrtify thal the fcdcralregulations rcgarding asbcslos rcmovalarc not applicablc kr lhis projcct. <br />_l enify thst I havc rcod this Epplicstion ild ststc that the above infomtion is corc{t. I agrc to otr{rly with sll Cily rnd Counly <br />ordinares snd Statc llws rclaling lo building construction. ud hercby autluizc rclms.nlalives of this City ud County lo enls uFrn thc <br />abovc mnlioned prcFrty for inslEclion purJnss. <br />Applicant or Agent Signature: Date:_ <br />Permltee name (print):_ <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildinq Sewer <br />ArealStorm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT I I - <br />Waste & Vent VZYTJ Drv> <br />Water Piping Yl t€l 70 lbfl#{r <br />Gas Piping trltK'lt,I't/-fl'',to <br />Roof Drain ll f <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />lVlain Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heaterlcas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCap <br />Back FIow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release <br />FINAL <br />Notes, Remarks, Etc.