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PLUMBING.!NSPECTOR RECORD <br />APPROVALS DATE ID/SIG,COMMENTS OWNER BUILDER DELCARATION <br />I h@by affm unds p€nally of pdjury that I m qcmpt ftom thc ContracloB' Liccrc [rrv for thc following lwtr (Sc.70!1.5 <br />Buinas and Prcfeion Codc): Any City or County which rcquirc a pcmit to coEtruct. ,ltq, improvc. dcmolish or rcpair my <br />strucluc, prior to its isumce. also rcquiE the applicant for such pcnnit to filc a signcd stalmt that hc or shc b lica&d pwmt <br />to thc provisiom of thc Coilractor's Licm*d Larv (Chapl6 9. Commcing rvith SBtion 7000 of Division 3 of thc Buins md <br />Prcfesioos Codc) or that hc or shc is ampt thEcfrom ed thc basb for thc allcged cxmpion. Any violatiotr of Sdtion 7031.5 by any <br />applicant for I pcmit sbjct! thc ap?licant to a civil pmlty of ml morc thil fivc hundrcd dollss (S500). <br />-.1. <br />as owner of the propefly. or my employees with wages as their sole compeflsation. will do the work and thc stnrcttre b not <br />intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of <br />the progrerty who tuilds or improve thersrn. and who does such *'ort himself or hcrself or through his or her orvn cmployecs. <br />provided that such improvanents arc not intfided oroflered for sale. lf. horver/s. the btrilding or improvonent is sold rvithin one )€ar <br />of complaion. the Ourner Builder will have thc burden of p,roving thd hc or she did not build or improve the property for the purposcof <br />sale). <br />_-1. as o\\mer of the properly. am exclusively contracting rvith licensed contradors to construcl the poject (Sec. 7M4. Business <br />and Profcssion Code: 'fhe Contractor's License Law does not apply to an owner of property rvho builds or improves thereon. <br />and rvho contracts for such projects rvith a Contracto(s) licersed pumuant to the Contractor's Liccnse Law). <br />-l am exempt under Section--. B. & P.C. for <br />A lt A JrarI. v [, I <br />I hereby affirm under penalty of pojury <br />t)ti('LARA'l toN <br />one of tlre follorving declarations: <br />_l have and u'ill rnaintain a Ccrtificate of Consent to Sclf-lnsure for s'orkers' compensation. as provided for by Section -1700 of the <br />l,abor Code. for the pcrfionnance of the rvork for rvhich the po'nrit is issued. <br />_-l har,e and rvill nraintain u'orkers' compensation insurance. as required by Section .1700 of the Labor ('ode. for the perfonnance of <br />the w'ork for rvhich this pennit is issued. My u'orkers' compensation insurance carrier and policy number are: <br />Carrier: <br />_-l certi$, that in the performance of the rvork for rvhich this perrnit is issued. I shall not onploy any person in any manner <br />so as to become subject lo the u'orkers' compensation las's of California. and agree that if I should become subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code. I shall. forthrvilh comply rvith those provisions.. <br />WARNING: Failure to secure lvorkers' compensation coverage is unlarv[ul. and shall subject an and <br />civil fines up to one hundred thousand dollars ($l in addition to of the <br />Section 3076 [.atror and attorney's <br />l)t ('t.,\tt^ I t()N/ <br />I hereby affrnn tunder penalty of perjury that I arn licensed under provision of Chapter 9 (commencing rvith Section 7000) of Division 3 <br />of the Business and Professions Code. and nry license is in frrll force and effect <br />l.icensc ('lass: l iccrrsc Nrrrtrltcr': <br />llolp'( 'orrl rlcl rlr: <br />W <br />I horby affinn und6 pcnshy of pcrjury thd thsc is a consrrucrion hnding agocy for the pcfotrmcc of thc rrcrk for shich thb psmh b <br />issued (Sec. 3097, Civ. C.). <br />Lender's Name: <br />Lcnder's Address: <br />APPLICANT Df,CLARATION <br />I ho*yallim undq turalty of pcrjury one of thc following dclarations: <br />Dcmolition Pmits-Asbctos Notification Fcdoal Rcgulations (Titlc 40. Parr6) <br />-Rcquir€d <br />Lett6 of Notification <br />-l <br />cqtiry that the fcdaal rcaulatioro rcgarding rbstos rmoval are not applicablc to lhis prej61. <br />- <br />I cgtify that I havc rad this applicstion md stale lhst thc above infomation is cortrt. I agrcto mmply rvith all Cityand County <br />ordinancd and Statc L.s s rclaling lo building coNtruclion. and hftby authorizc rcpMtalilc of this City md County to otq upon thc <br />above rnentioned properly for <br />Applicnnl or Agent <br />Permilec nRme (print): <br />UNDER GROUND <br />Waste & Vent q-n4?l rL€Z .q <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />ArealStorm Drain <br />! nterceptor/ Cla rifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />ItIain Drain/Pool Piping <br />Fill Line/Back FIow <br />Pool HeaterlGas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />1 <br />Rough Plumbins /oh llq ?t fi /cr/ <br />Final Gas Test <br />Meter Release 6D/ <br />FINAL <br />Notes Remarks Etc. <br />F -2 <br />Expires: <br />7tttffi N <br />G,,", ?l16'/q <br />,olgsl,lta fiaruqya <br />U