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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby lffrm undcr penrlty of Frjury thsl I m excmpt fmm thc Contraclon' Li€€ns lrw for thc following rcasn (Ss.7031.5 . <br />Busincss and Prcfcssion Code): Any City or County which rcquircs s pemit to snsiruct. ah6, impmrc, dcslish or Epair uy <br />srucnrc. Jtrior to its irsusme, ds rcquires the applicanl for such lEmit to filc 8 signed statcmnt that lp or she ir lienscd plmmt <br />lo thc prcvisions of thc Contractor's Licens{ tlw (Clupts 9. Collmrcing with Strlbn ?fi)0 of Divirion 3 of thc Busir&ss and <br />PrcfcssionsCodc)orthsthctrsheiseremptlhwfromrndthcbasisforthcalhgedcrcmplion. AnyviolationofssfbnT0.ll.5byany <br />applicsnt for r tEmit subjcgrs thc rpplicant to 8 civil ,Euhy of nor mrc rho live hundrcd dollars (9500). <br />-1. <br />as owner of lhe Fnopcrty. or my cmployces wilh wagcs as lhcir sole comlrcnsation. will do the work and thc stnrturc is not <br />intendcd or offcrcd for salc (Sec.7044. Busincss and hofcssions Code: Thc Contractor's Liccnsc Law does not apply to an owner of <br />the progrerty wtrl builds or improvcs thcrcon. and wlxl does such work himsclf or hersclf or thmugh his or hcr own employees. <br />providcd that such improvcnrents are not intended or offered for sah. lf. howevcr. thc huilding or improvcntnt is sold within one )car <br />of conpletion. thc Owner Buildct will have thc burdcn of proving that he or she did not build or impmrae tlrc profrny for thc purynsc of <br />salc). <br />-1. <br />as o\t'ncr ot'thc propcrly. artt cxclusivcly conlracting with liccrrsccl cotrtraclors to conslruct thc projcct (.Scc. 70"14. Busincss <br />tnd Prrrt'cssion (irdc: 'l'hc Co nlraclor's l-iccnsc [-nw docs not app ly to an owncr o l' propcrt y u'ho hu ilds or ilnprovcs I hcreon. <br />and rvho conlracts fbr such projccls rvith a Cortlractor(s) Iiccnscd pursuanl lo thc Conlraclor's Liccnsc l.aw). <br />-lirtncxt.!llptundcr.Scctirln-.B.&P.C'lbrthisrcastln.I)ittc ( )lllrer: <br />IVORKERS' COITPFNSATION <br />DT'CLARATION <br />I hcrehy affirm undcr Jrcnalty of Jrcrjury onc of thc following dc.clarations: <br />by .Scction -17(X) of thc <br />for the pcrfonrrancc of <br />L (cttt <br />Policy a <br />-l <br />ccrtify that in thc performancc of lhc work l'or which this pcrnrit is issucd. I shall not employ any person in any manncr <br />so as lo bccome subjcct to thc workcrs' comlrcnsation laws of California. and agrcc that if I should bcconr subjcct lo thc <br />workers' compcnsalion provisions of Scction 3700 of thc l.abor Codc. I shall.with lhosc provisions.. <br />WARNIN(i: Failure to sccurc workers' cornpcnsalion subjcct an crnploycr to criminal penaltrcs and <br />civil lines up to onc thousand dollars (S 100.ftn).<lf compcnsation. damages as providcd for the <br />Scction 3076 intercst and attorrry's fccs.!w <br />I <br />I hercby afTirm under pcnalty of pcrjury that I am liccnscrl provision of Chaptcr 9 (commcncing with Scction 7fin) of Divisi,rn 3 <br />of thc Busincss and Professions Code. and nry liccnsc is in full alxl <br />t <br />Liccnsc <br />a <br />I hcrcby allirm undcr pnalty of Frjury th8t thm is r onstruction lcnding agcrcy for lhe ]rcrfornErce of thc mrk for which this lErmil is <br />issued (Scc. 3097. Civ. C.). <br />l-cndcr's Nanrc: <br />Lcndcr's Address: <br />APPLICAN'T DI.'CLA RATION <br />I k'rttry aflinn unclcr pcrralty of pcr.fury orre of thc lollowing dcclarations: <br />Dcrnolitiorr Pcrrnits-Ashcstos Nolil-icalion Fcdcral Rcgulutions ('Iitlc ,{0. Part6) <br />-Rcquircd <br />Lcltcr of Notilication <br />-l <br />ccrtify that thc fcderalrcgulations <br />atnve nrcntioncd proprty for inspcction <br />Applicnnt or Agent <br />I'rrnrilee nitnre <br />asbcslos rcnmvalare not applicablc to lhis projcct. <br />UNDER GROUND I <br />Waste & Vent 7l to 20 .+fl <br />Water-Under floor I I rl <br />Gas-Underf loor <br />Buildinq Sewer <br />ArealStorm Drain <br />lntercepto r I Clarif ier <br />TOP OUT <br />Waste & Vent tlrq ao <br />Water Pipinq iltu 1o *n <br />Gas Piping I ,ll / <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 FIow <br />Pool Heaterlcas 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 ll \-I ,rt <br />FINAL t)LKH'ilzt +TD( <br />_llqtes,Femarks, EtQ.I U .rI2/ lzlus-DClft r',1 > fr-,Oot J <br />I I 7 <br />U I b <br />aCarricr:-lL <br />l)nte: . <br />n <br />?O contracto*DA <br />N lvt ,, <br />vl--{11)v <br />I <br />)8.ry.)-, <br />b rqhhnz <br />I