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PLUMBING.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEICANATON I hmby affm undo paralty of pcrjury that I m qmpt fiom thc Co!tsac1oB' Licce Law for thc following rcn (Se.7031.5 Buine urd Profeion Codc): Aoy Ciy or Couty which rcquirc a ponit to @Btruct. rltc. improvc doolbh or rpo& oy stucturc prior to its islreq slso rcquirB thc applimt for such pamh to filc 8 signcd !td@t thrt hc or slE b licaBcd pwat to thc provisioru of thc Conretor's Liccnscd Lrw (Chapt6 9, Comf,citrg with Sslio[ 7000 of Division 3 of thc BuitrB md ProfeiomCo&)orthathcorshcisqmptthccfromudthcbrsisforthcallcgrdq@p(io[ Anyviol8lionofsodbtrT03l.5byoy applimt for a pmit subjcts thc applicmt to a civil poalty of mt morc the fivc huodrcd dollm ($500). -1, as owner ofthc propcrtyt or my employes with wages as their sole compensation. will do the work ard the stnrclure is not intended or offered for sale (Sec.7044, Business and Profcssiors Code: The Contractor's License l-aw does not apply to an owner of the p,ropcrty who builds or improvâ‚¬s tlrcron" and who docs such work himself or hersclf or through his or her own cmployecs, providcd that such improvcrnants are not intcndod orofiirod for salc. If, howwcr. the building or improvcnrent is sold within orc )car of complaion, the Ourner Builder will have the burden of proving that he or she did not build or improve the propcty for the purposc of sale). -I, as owner of the propâ‚¬rty, am cxclusively contracting with licensed contracton to constnlct the pnoject (Sec. 7044, Buiness and Prroftssbn Code: The Contractor's License Law docs not apply to an owner of property who builds or improvcs thcreon, and who contracts for such projects with a Contraclo(s) licenscd pursuant to the Contractor's Licensc Law). -I am excrlpt under Section-, B. & P.C. for this rcason. Dete: WORKERS' COMPENSATION DECLARATION I hereby affrm under pcnalty of pcrjury onc of the following declarations: -l havc and will maintain a Ccrtificate of Conscnt to Self-lnsure for workers' compensation. as providcd for by Section 3700 of thc Labor Code, for the performance of the work for which the perrnit is issued. -l havc and will maintain worksrs' cornpensation insurance. as required by Section 3700 of the Labor Code, for thc pcrformance of the work for which this pennit is issuod My workers'irsurance carrier and policy numbcr are: Policy -l certi& that in the performance of the work for which this p,crmit is issued. I shall not crnploy any pcrson in any manner so as to becorne subject to the workers'compansation laws of California, and agrcc that if I should become subject to the wort6s' compensation provisioru of Scction 3700 of the l-abor Code, I shdl. forthwilh comply with thosc provisions.. WARNTNG: Failure to sccure workers' civil fines up to one hundred thousand is unlawful. and an anployer to criminal pcnahics and to the cost damages as providod for the Section 3076 of the tabor Code, interest and.L I hereby affrm under pcnalty of pcrjury that I am licensed under (commencing with Scction 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. -? 35 License c-L] -7 7 coNsTRUcTIoI{ LET{DING AGENCY I hlrrbyrlfntruodEFsltyofpgjurythd thci!scoMudb[ koding rgcyforlbcpcforrc ofttEwul 6ru,hichOLpmi b isucd (Se. 3097, Civ. C.). I r'ttrlcr 's Nittttc'. Lender's Address: APPLICANT DECLARATION I holeby affirm under penalty of perjury one of the following declarations: Demolition Perrnils-Asbestos Notification Federal Regulations (Tille 40. Part6) -Rcquired Lctter of Notification -l certify that the federal regulations regarding asbestos removal are not applicable to this project. -I cqrify thst I have red this application ad ststc thst thc sbovc iofomstion b corc1. I agrc to mmply with all City and County ordimrcB md Statc t w rclatfug to building constructio[ md hmby authorirc rcprBotaliv6 of thb City md County to 6tq upon thc above mcntioned property for Applicant or Agent Pernritee l):rle. UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Buildinq Sewer ArealStorm Drain I nterceptor/ Clarifier TOP OUT Waste & Vent ,.,tl a .J Water Piping qrup{ufure 'rudil Gas Piping Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA ,ft -a P-trap/Drain Line /LAN ,bWafr .rug) Main Drain/Pool Pipinq 7/r//trtuhfoi tlftra Fill Line/Back FIow il/*r ttula y'lg_ Pool Heater/Gas Line ilrlLl *fuit ilda) Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary SewerlCap I tl -z) Back FIow Device 7///a/llf,Dh,uaw, Rough Plumbing Final Gas Test Meter Release u, I "l^ll t 17 F!NAL qlruq 1ru,{06 trtou tlNotes, Remarks, Etc. Exoires:-- --, J t