Laserfiche WebLink
PLUM BING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNEN BUILDER DEI.CARATION <br />I hercby aflirm under Fnrlty of tEtiury that I m exempt frcm thc Contrrctor' Licenrc Law for the following rcarcn (Sec.7031.5 <br />Busincss and hofcssion Code): Any City or County which rcluircs a lmit lo mnstruct, slter, imprcvc, dcmlish or rquir my <br />structurc. Firr to its issuance. also rcquircs thc spJrlicant for such [Emit to filc a signcd statercnt that lE or shc is lien${ puNant <br />to the pmvisions of thc Contnctor's Liensd lrw (Chaptq 9. Commrcing with S$tion 7000 of Division 3 of tlE Busiress and <br />PmfessionsCodc)orthstlEorshciscrcmptlhscfromandthcbcsisfortherlhgcdcxemption. AnyviohtionofSelknT03l.5bytny <br />applicant for a lErmit subtTts the applicant to r civil pcnalty of not mrc thun fivc hundrcd dollus ($500). <br />-1. <br />as owner of thc prof,crty. or my employees with wagcs as their sole compcnstrlion. willdo llrc work and the strrcturc is nol <br />intendcd or offered for sale (Scr.7O44. Busincss and Pnrfessions Codc: The Contraclor's Liccnse law does not apply to an owner of <br />thc proJrrty who builds or in{,mvcs thcrf,rrn. and who drrcs such work hinrself or hcrself or thmugh his or her own cmployecs. <br />providcd lhat such improvcrncnts are not intendcd oroffcrcd for sale. lf, however. the huilding or irprovenrcnt is sold within onc year <br />of completion thc Owner Builder will havc the burdcn of proving that hc or she ditl not build or in{novc thc proprty for lhe purpsc of <br />salc). <br />-1. <br />as owner of thc properly. am exclusivcly contracting with liccnsed contraclors to construct thc propct (Sec. 7W1. Busincss <br />and h,ohssion Codc: The Contractor's License Law docs not apply to an owncr of property who builds or improves thereon, <br />and who contrdcts for such projccts with a Contracto(s) liccnscd pursuant to thc Contractor's Liccnsc Law). <br />-lamcxemptunderSection-.B.&P.C.forthisrcason.Date: Owner: <br />W0RKERS, Coilt pENSATION <br />DECLARATION <br />I hcreby affirm under pcnalty of pcrjury onc of thc following dcclarations: <br />-l <br />have and will maintain a Certifrcate of Consent lo Self-lnsurc for workers' comlrcnsation. as povidcd for by Section 3700 of the <br />l^abor Codc. for the performance of the work for which the permit ls issucd. <br />-l <br />have and will ntaintain workcrs' contpensalion insurancc. as rcquircd by .Scctiolr 37fi) of thc Lahor Codc. for lhc Jrcrfornrancc o[ <br />thc work ltrr this Jrermit is issucd.compensation insuruncc carricr rud plicy numbcr are: <br />Policy <br />-l <br />ccrtify that in the lrcrformarrc of thc work for which this Jrcrmit is issucd. I shall not cmploy any Frcrson in any manncr <br />so as to bccome suhject to thc workcrs' cornpensalion laws of California. and agrce that if I should become subject to thc <br />workers' compcnsation provisions of Section 3700 of the L:bor Code. I shall. forthwith comply with thosc pmvisions.. <br />WARNING: Failurc lo sccure workers'compcnsation covcrilgc is unlawful. und shall suhjcct an enrployer to criminal grcnalties and <br />civil fincs up to one to thc cosl <lf cornpcnsalion. damages as provided for thc <br />.Scction J07(r ot'Lahrr and allrlrncy's <br />DECLARATION <br />I hcrcby alllrnr utttlcr pcnalty of pcrjury that I artt liccrtscd unclcr provision ol'C'haptcr 9 (conrnrcrrcirrg with Scction 7(Xn) oi'.Division .l <br />of thc Busincss and Profcssions Codc. arxl rny licensc is in full lbrcc and clfcct. <br />[,iccnse ))o <br />('oltlr:rclor. <br />C(TNSTRUCTION LENDING AGENCY <br />I hcrcby allirnr undcr Jrnally of Frjury thd ths.' is a conslruction hnding agcncy for thc pcrfornuncc of lhc *ork for which this Jrrnlit is <br />issucd (Scc. .1097. Civ. C.). <br />lrndcr's Namc: <br />kndcr's Addrcss: <br />APPI ICANT DT'CLARATION <br />I hereby affrrn undcr penalty of prjury one of thc following declarations: <br />Dermlition Permits-Asbestos Notification Fedcral Rcgulations (Title 40, Part6) <br />-Requircd <br />lctter of Notification <br />rcnxrvalarc nol applicablc lo this projcct. <br />is correct. I agrcc to comply with all City and County <br />rcprescntativcs <lf this City and <br />ahove rrcnliorrcd property for <br />Applicant or Agent <br />Pernrilee n$me <br />ahrvc <br />cnlcr lhc <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildinq Sewer <br />ArealStorm Drain <br />I nterceptor/ C !arif ier <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 />Main Drain/Pool Piplnq <br />Fill Line/Back Flow <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 I <br />FINAL ///, /7.o .'Wffi n <br />Notes, Remarks, Etc.{-- lu <br />Expires: <br />- <br />#-ApJrlicant: <br />arrd Statc l-aws <br />_l a LEV