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APPROVALS DATE ID/S!G.COMMENTS UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Building Sewer Area/Storm Drain I nterceptor/ Cla rifier TOP OUT Waste & Vent Water Piping Gas Pipinq Roof Drain Tub/Shower Test Rouqh Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Pipins Fill Line/Back Flow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary SewerlCao Back Flow Device Rouqh Plumbinq Final Gas Test Meter Release I FINAL z/nbt JiltA #a Notes Etc. I hqcby affm unda pcrulty of pcrjury that I m qmpt ftom thc Contrsdots' Licre hw for thc followiog lwtr (Se.7031.5 Bwins and Prof6sion Codc): Any City or County which rcquirc a pcmit to @Nlruct. altq. improvc. danolish or rcpoir uy structuc, prbr to its ismcc. also requic thc +plicet for sch pqrdt to file I signod stdmat tha hc or shc b licqBcd puman to thc prcvisioro of thc Contrmror's Liccnscd Law (Chapt6 9. Comcrcing with Sction 7fi)0 of Divisioo 3 of thc Bwins ud Prcfsiom Codc) or rhat hr or shc is qmpt th@from md the bssis for rhc allqcd cxmption. Any violalion of Scction 7031.5 by ey applicmt for a pqrnit subjcts thc spplicut to 8 civil pcralty of oot morc the fivc hundrcd dollrs ($500). _1. as owner of the property. or my employces with wages as their sole cornpensation. will do the work and the structure is not intendcd or offered for sale (Sec.7044. Business and hofessions Code: The Contraclor's License Law does not apply to an owner of the properry who btrilds or improves therqrn. and who does such wort himself or herself or through his or her own employees. provided that such improvonents are not intendod or oflered for sale. If. howwer, thc building or improvement is sold within one year of completion, the Orvner Builder will have the burden of proving tha he or she did not hrild or improve the propcrty for thc purpose of sale). _1. as owner of the property. am exclusivcly contracting with licerued contractors to construct the projea (Sec. 7044. Bwincss and Professbn Code: The Contractor's Liccnse Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projeos with a Contracto(s) licersed pursuant to the Contractor's License l-aw). _l am cxempt under Section-. B. & P.C. for this reason. O*ner' WORKERS' COMPENSAT DECLARATION I hereby affirm under panalty of po'jury onc of the following declarations: -.l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Section -3700 of the l-abor Code. for the performance of thc work for which the perrnit is issued. _l have and will maintain workers' compcnsation insurance. as required by Scction 3700 of the tabor Codc. for the performancc of the rvork for which this p,ermit is issuod My workers' compensation insurance carricr and policy number are: Policy Number: Expires: _l certi& that in the performance of thc work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compcns*ion laws of California, and agrec that if I should become subjcct to the workers' compensation provisions of Section 3700 of the labor Code, I shall. forthwilh comply with those provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an onployer to criminal penaltics and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation, damages as providcd for the Section 3076 of the l-abor Code. intcrcst and attorncy's fecs. Date: Applicent: LTCENSED CONTRACTOR DECI.,ARATION I hercby affrrm under penalty of perjury that I am licensed under provision of Chapto 9 (commencing with Sec'tion 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. W I hqcty affimunds paaltyof pajurythrt the b a @lsnrclbo kndilg sgtry for thcpqfom ofthcwrl br whbhthB pqnit b isucd (Se. 3097, Civ. C.). License Class: License Number: Lcodcr's Name: l'rrtrrilcc trdilrc (prinl): Lcndcr's Address: APPLICANT DECLARATION I hotby affrrm under penalty of perjury one of the following declarations: Demolition Perrnits-Asbestos Notification Fcdet'al Regulations (Title 40. Part6) -Required Letter of Notification -l cdiry tbd thc fcd6d rcgulatiom rcgrding ubctos @val e trot eplioblc to thb projct. -l cdiry rhd I havc Hd thb spplic.tiotr ad statc thrt thc abovc infomdioo is orer. t agrc to ompty with all City 8td County oditlarc and Stsrc tis rclairg to buiuing oErrucriotl ad hqrby authoria rcprstaive of this City ud Couty to otc upotr thc abovc MtiotrGd propdy for iropc-tion prrpos Applicant or Agent l)alc. PLUM BING.INSPEGTOR RECORD Dete: Carrier:.