Laserfiche WebLink
PLUM BING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DBLCARATION <br />I hcrcby affum under pculy of pcrjury lhrl I m cxctrpt ftom tlE ContBctoF Lienw trw for thc folhwing rcrsn (Se.7031.5 <br />Busincrs ard Prcfession Code): Any City or Counly which rcquircs a pcmit to construct, alts. imprcvc. dcmlish or qEit fiy <br />structurc. prior lo its issuarce. also rcluircs th€ spplicsnt for such permit to fih ! sigred itslerenl thal he or she is lkTnsd pumut <br />lo the pmvirions of the Contrrclor's LLrtrsd t w (Chsptcr 9. Cottffircing wilh Sction 7000 of Divkbn 3 of thc Busiress and <br />hofcssionsCodc)orthothctrshciscxemptthere&omandthcbasisfortheallegcdcremption. AnyviolationofS6lbnT03l.5bysny <br />applicant fo. a permit subjcrts lhc spplicant to a civil penalty of nol mrc than fivc hundrcd dollus ($5fi)). r ' <br />_1. us owner of lhe or lny cmployees with wages as lhc'ir solc compcnsillion. willdo thc work and thc stnrclurc is not <br />intcntlcd or ofl'ercd (Sec.7044. Busincss and Profcssions Code: Thc Contractor's Liccnse Law does not Bpply to an owner of <br />thc pnrJrrty u'ho or imprcves thermn. and who docs such work himsclf or hersclf or thmugh his or her own employecs. <br />providcrl that improvcmenls ilrc not intcndcd or ollbrcd fbr sah. lt. howevcr. thc building or improvcnrcnl is s<lld within onc ycir <br />ol'Owncr Buildcr will have thc burdcn of proving that he or shc did not huild or irnprovc lhe propcrty tbr thc purynsc of <br />sah). <br />of thc property. am exclusivcly contracting with liccnsed contractors lo conslruct thc projcct (Scc, 7A44, Business <br />and Profcssbn Code: Thc Contraclor's Licensc Law does not apply to an owner of propcrty who builds or improves thcrcon. <br />and who contracts for such gnojects with a Contraclo(s) liccnscd pursuant to thc Contraclor's License taw). <br />-l <br />am exempl under B. & P.C. f<rr this reason. <br />D^r", r/-=/1 ?4fi/n <br />I hcrchy affirm under penalty of pcrjury one of thc followirrg dcclarations: <br />-l <br />have and will maintain a Cerlificate of Consent to Self-lnsurc for workers' compcnsation. as provided for by Section 3700 of the <br />labor Code. for the performance of the work for which thc Jrrmit is issued. <br />-l <br />havc and will mainlain compcnsation insurance. as rcquircd hy Scction 3700 of thc lahor Codc. for the grcrformancc of <br />thc work for which this issucd. My workcrs' conr[rcnsation insurancc carricr and prlicy number arc: <br />Policy <br />thal in thc;rcrformance of the work for which this Jrermit is issued. I shall not cmploy any person in any manncr <br />should bccome subjcct to thcso as lo bccome subject to thc workcrs'compcnsation laws of California. and agrcc that if I <br />workcrs' cornpcrrsation provisions of Scction 3700 of thc [:hrr Codc. I shall. forthwith corrrply with thosc provisions.. <br />WARNING: Fhilurc to sccurc workcrs' conrpcnsation covcragc is unlawful. and shall suhjcct an cmploycr to crirninul ;rcnaltics and <br />civil fincs up to onc hundred thousartd dollars (S100.0m). in addition lo thc cost of compcnsalion. danurgcs as provided lbr lhc <br />Scclion 3076 of lhc L,atxrr Codc. intcrcst lc it(,,,W <br />9 (conrmencing with Section 70m) of Division 3I herchy alfirm unrlcr pcnalty of pcrjury thal I anr liccnscd <br />of thc Business and Professions Code. arxt my liccnsc is in full forcc arxl cffect. <br />Licensc Class: License Number: <br />Date:_ <br />W <br />I hcrcby affirm under lEnslty of Frjury thit tlm is I constoclion hnding 8gcrcy for thc Frfomncc of lhe work for which lhis pcmit h <br />issucd (56. 3097, Civ. C.). <br />l.endcr's Namc: <br />[rndcr's Addrcss: <br />APP] ICANT DECLARATTON <br />I hcrcty affnm under penalty of pcrjury one of the following dcclarations: <br />Demolition Permits-Asbcstos Notification Federal Regulations (Titlc 40. Pert6) <br />-Rcquired <br />lrtter of <br />_l regulalions rcgarding asbcslos rcnmvalarc nol applicablc to this projcct. <br />thal I havc lhis application and statc that the atnvc inf<rrnution is corrcct. I agrcc to comply with all City and County <br />ortlirtanccs alrd relaling to building construclion. and hcrehy aulhorize rcprcscnlativcs of this City and County lo cnler uJxrn thc <br />abovc nrcntioncd <br />Applicant or <br />I <br />l'ernritee <br />for ion purposcs. <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 <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain I ,A <br />Tub/Shower Test 917 'Lo Dft rrfit . *6:[ <br />Rough Water Heater t0 <br />POOL/SPA <br />P-trap/Drain Line <br />[Main 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 Sewer/Cap <br />Back Flow Device <br />Rough Plumbinq <br />Final Gas Test <br />Meter Release tl <br />FINAL t7r)DAlw)n,-t llNotes, Remarks, Etc. <br />,'u | ' <br />Exoires: