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PLUMBING.INSPECTOR RECORD APPROVALS DATE ID/SIG,COMMENTS UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Building Sewer Area/Storm Drain I nterceptor/ Cla rifier TOP OUT Waste & Vent Water Pipins Gas Piping Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Piping Fill Line/Back Flow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary Sewer/Cap Back Flow Device Rough Plumbing Final Gas Test Meter Release / I ,t ,t .,/ FINAL OWNER BUILDER DEL(]ARATION I hseby aflirnr unds pcnalty of 1Erjury that I an excmpt from the Contracton' Licmrc law for the following rcasn (S(.70.r 1.5 Ilusins and Profession Code): Any City or County uhich rcquirs a Jn'rnit to comtruc1 alts. improve. dmolish or rcpair any struclurc. prior to its i*guance. also requirG the applicot for such Frmit to file a signcd statonmt that Ltrr she b licos.d puEuet to lhe provisiotrs of Ihc Contractor's l,iccnsed l,au, (Chapter 9. ('ommencing with Sfilion 7000 of Division 3 of thc Busines and Prefsions Code) or thal hc or shc is excmpt thsefrom md the basis for the allcged ermption. Any violation of SBtion 7031.5 by any applicantforaJrmitsubjatsthe applicanttoacivilpcnaltyofnotmorethanfivehundrcddollds($50O). _ I. r orvner of the preFrry. or my employG lvith N'ag6 as their mlc compcnslion. rvill do the rvort md the struclrc b nol intoded oroffsedforsle(Sc.7044. IlusinruandPrefsions('ode:TheConlractor'sl,icoscLawdo6notapplylomos'nerof lhe pmpefly rvho builds or improvc thmn. ud rvho dos uch uort himsclf or herclf or through his or ho our employs. providcdthatsuch inrprovmtsrcnotintodcdoroflqedfor$lc. lf.ho$o's.thcbuildiogorimpro\qmtismHu'ithinoncya ofcomplclion. the O$ner Buikls will havc the brrdo ofproting tha hc or she did not build or tnprcic lhc pNpqty for lhe puqn* of sle). ,- l. s ownq of the prepsty. m crclusiUcly contraclin8 $ilh licmscd conlradoB to conslrud the ]rojst (Ss. 7(N4. B6ins od l\ofusion Code: Thc Conlractor's l,icense Las do6 not apply to an o$ncr ofproputy rtho builds or improv6 tho@n. and who conlmcts for such projets wilh a Contmcto(s) liccnsed puEuant to the Contractor's Licmsc [aw), I m exemDt undcr Sction-, , . ..-,---- . B. & P.C. for this rason. Dnte: Owner:_ WORKERS' COMPENSATION DECLARATION I hereby aflirm under poralty of perjury one of the follorving declarations: _ I have and rvill maintain a Cerlificate of Consent to Self-lnsure ftrr rvorkers' compensation. as provided fcrr by Section 3700 of the l-abor Code. for the perfonnance of the rvork for rvhich the pennit is issued. _ -l have ancl *'ill rnaintain u'orkers' conrpensation insurance. as required by Section -1700 of the [.abor ('ode. for the perftlrmance of the s,ork for this is issued. My workers' compensation insurance carrier and policy number are: Policy hrt d q o _l certi& that in the performance of the rvork for which this perrnit is issued. I shall not onploy any peruon in any manner so as to become subject to the workers' compensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Sertion 3700 of the l-abor Code. I shall. forthrvith comply with thosc provisions.. WARNING: Failure to secure rvorkers' compensation coverage civil fines up to one hundred thousand dollars ($100.000). in r is unlarvful. and shall subject an anployer to criminal porahies and the cost of compensation. damages as provided for the Section 3076 of the Labor Code. interest and fees. /, I hereby alTirm under penalty Chapter 9 (comnrencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. e-33 l.iccrtsc z r c()NS'|'RUC'r'tON r.ENpU(;,!(;t NCY I hereby affirrn under is a construction lending agency for the pcrformance of the work for rvhich this pennit is issued (Sec. .j097. Civ. C.). lrnder's Name: l cttrlct''s Attrlt css: APPLICANT DECLARA'TION I hody afiinn under penalty of periury one of the follorving declarations: Dernolition Perrnits-Asbestos Notifi cat ion Federal Regulat ions ('l'it le 40. Part6 ) _Required Letter of Notification __l cof ify that the federal regulations regarding asbcstos removal are not applicable to this project. -l certi&this application and state that the above infonnation rvith all City and Countl' and County to enter upon theordinances and relating to above rnentioned Applicant or 7 Perrrrilce for construction. and Date:,9 Notes, mrc, ll-C2l- r)arc: //-a fJ? b-Fraa