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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI.CARATION <br />I h6eby alfm undfr pcnalty of pajury thlt I m cxcmpt ftom thc Contrrctos' Licw trw for thc following twn (Se.7031.5 <br />Bwinqs and Prcf*ion Codc): Atry City or Couoty which rcquie a po'mh to coNtruct. altE improvq dariolish or rcpair uy <br />stluctue, prbr to it! isuocc. also rcquin thc eplh&t for ruch Frmit to filc 8 signcd ststmot that hc or shc b licmscd plMt <br />to thc FovisioN of thc Contracltr's Licascd kw (Chapa 9, Comming with Sc-tion 7000 of Division 3 of thc Busin€s md <br />Prcfssions Codc) or that hc or shc b acmpt th6c&om ud thc basi for the alkgcd qoption. Atry violalion of Serion 7031.5 by ary <br />rppliciltforsp6mitsubj€l!thc applicmttoacivilpcultyofnotmorcth{fivchundrcddollan($500). <br />_1. s oms of thc propdty, or my mplo)6 with wag6 I thcir slc compcnstion. will do the rcrL atd thc atnEtE b mt <br />imqdcd or ofi6r{ for slc (Sc.7O44. Busine md Prcfeions Codr: Thc eonradoCs Licw lrw do6 trot rpply to il ow of <br />thc Fopqty who buildr q hproc ttsatl ed who do6 sch wit himrclf or hffilf or thrcu8h hi! or hq om mploys. <br />prcvidcd that such improvurcnts rc mt intqdod or oflqsd 6r slc. If. howc. tlE tuildiDg or inpowmt is rE within onc )a <br />of mmplaion thc orrna Builda wiu haw thc hrdo of poving tha hc or Cr dit mt buiH or inprorc thc prcpaly for thc prpos of <br />sde). <br />__t. as o\t'ner of the Fnoperty. am exclusively contracting u'ith licensed contraclors to construcl the p,roject (Sec. 7044. Business <br />and Pnofilssion Code: The Contractor's License Law docs not apply to an os'ner of property who builds or improves thereon. <br />and who contracls for such projects wilh a licensed pursuant to the Contractor's License Law). <br />_l am exempt Section- _-P.C. for <br />I hereby alTirm under penalty of perjury one of the following <br />_ _t have and s'ill maintain a Certificate of Consent to Self-lnsure for u'orkers' compensation. as provided for by Settion .1700 of the <br />I.abor Code. for the petfonnance of the rvork for rvhich the pennit is issued. <br />_ -t have and u,ill maintain workers' cotnpensation insurance. .Ls required by Section 3700 of the Labor Code. for the perfonnance of <br />the s'ork for u,hich this permit is issued. My u'orkers' compensation insurance carrier and policy number are: <br />( ;rt t rt't : <br />Policy _Expires: <br />--l certifu that in the pcrformance of the work for which this permit is issued. I shall not employ any person in any manncs <br />so its to become subject to the workers' compcnsation laws of California. and agree that if I should become subject to the <br />workers' compcnsation provisions of Section 3700 of the Labor Code. I shall. forthrvith comply with thosc provisions.. <br />WARNING: Failure to secure rvorkers' compensation coverag,e is unlarvful. and shall subject an anployer to crimiful pcnahies and <br />civil fines up to one hundred thousand dollars ($l ln to the cost of compensation. damages as provided for the <br />Section 3076 labor Code. inlerest <br />ta e <br />I hereby affirm under penalty of po'jury that I am licensed under Chapter 9 (commencing rvith Section 7000) of Division 3 <br />of the Business and Professions Code. and my license is in full force and effect. <br />License Class: License Nurnber: <br />('onlraclor: <br />CONSTRUCTION LENDING AGENCY <br />I hreby aflinn undr poalty of tEjury that thqe is a consiruction lcnding agocy frrr thc Ju'fomancc of thc uork for $'hich lhis pcrmit is <br />issued (S(. -3097. Civ. C,). <br />Lender's Narne: <br />Lender's Address: <br />APPLTCANT DECLARATTON <br />I hcreby alftrm under penalty of perjury one of the follorving declarations: <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Pan6) <br />-Required <br />Letter of Notification <br />_l certify that the federalregulations regarding ashtos removal are not applicable to this project.,a <br />' ( I cefliry thar I have read this application and state that the above information is correct. I agree to comply rvith alt City and Counry <br />ordinances and State Larvs relating to authorize reprsentatives of this City and County to entcr upon <br />abovc rnentioned property for <br />Applicnnt or Agent <br />Permilee nnrne <br />and the <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 /z-2,r9 /2-cA.f, <br />Water Piping <br />Gas Piping /z-l 6-/1 C-I <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />lvlain Drain/Pool Piping <br />Fill Line/Back Flow <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 /b/?-/9 Eezr, <br />Final Gas Test <br />Meter Release lr rl <br />FINAL <br />Etc. <br />-t-D <br />q, pA lZe 65' <br />Pr+> <br />fvrwrty tlNS{7