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PLUM BING.INSPECTOR RECORD APPROVALS DATE ID/S!G.COMMENTS OWNER BUILDER DEITANATION I hreby affim undo paalty of pajury thst I m qcmpt from thâ‚¬ Coilr4loB' Licre Lry for thc following-min (Soc.rc31.5 Busines and Prcf*ion Codc): Any City or Couty which rcquiro a pcmit to sBtruct, alte. improvc, danotish or rrpoh uy structw. prbr to its isumcc, also rcquiro thc applicmt for such pcmit to 611 8 sigocd statqrat thal hc or lhc b licmcd pwml to thc provisiou of thc Controclor's Licmcd L:w (Chspts 9. Commcing with Sation 7000 of Division 3 of thc Busins md Pmfeions Codc) or thst hc or shc is qcmpt thgcfrom ed thc basis for rh. alkgcd qoprion. Any violation of Sctiotr 7031.5 by my spplimt for a pqmit subjcts thc appticmt to a civil pcnahy of not morc tho fivc hundrcd dollm (3500). _1. as own6 of the propcrty. or my cmplo)rccs with wages as their sole compensation will do the work and thc structure is not intcnded or offercd for sale (Se.7O44, Business and Pro ssions Code: The Contractor's Liccnsc law does not apply to an owner of the property who builds or improve thereon and who docs srch work himself or hersclf or through his or her own employec. provided that such imp,rorronorts arc not intendod orof&rod for salc. I[, howorer, the hrilding or improvcnrent is sold within one ]car of complaioru the Ovner Builder will have the hrden of proving thd he or shc did not hrild or improve the p,roperty for the purposcof sale). -1. as owner of the propcrty. arn exclusively contracting with licenscd contractom to construcl the projecr (Sec. 7044, Busincss and Pnofâ‚¬ssbn Code: The Contractor's License l-aw docs not apply to an owner of property who builds or improves ther@n. and who contracts for such projocts with a Contracto(s) licensed purcuant to the Contractor's Licansc l-aw). -l am exempt under B. & P.C. I hereby affirm under penalty of perjury one of the following _l have and will maintain a Certificate of Consent to Self-lnsure for rvorkcrs' compensation. as provided for by Section -3700 of the I-abor Code. for the perfonnance of the work for which thc perrnit is issued. _l have and will maintain workers' compensation insurancc. as required by Section 3700 of the Labor Code. for the perfonnance of the work for which this permit is issuod. My workcrs' compensation insurance carrier and policy number are: Policy , -l certiff that in the performance of thc work for which this permit is issued. I shall not employ any pcrson in any ,Anne, so all to become subject to the workers' compensation laws of California, and agroe that if I should becomc subjectto the workers' comperuation provisions of Seaion 3700 of the l-abor Code, I shall, forthwith comply with thosc prorisfuns.. WARNING: Failure to secure workers' competrsation , is unlawful. and shall subject an onployer to criminal pcnahies and addition to the cost of compensation. damages at provided for thecivil fines up to one hundred thousand dollars Section 3076 of the tabor Code, interest and anorncy's Orr", I hereby affrm undcr penalty of perjury that I am licenscd 9 (commencing with Secrion 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. Liccrse Class: Licerse Number: l)atr CONSTRUCTION LENDING AGENCY I h@by affm udq penalty of pcrjury thar thsc is a congruction knding agocy for thc pafomucc of thc rcrk for which this pomh b issucd (Se. 3097, Civ. C.). kodq's Nmc: - Lendcr's Address: APPLICAIIT DECLARATION I her*yaftrn under penalty of pcrjury one of the following dcclarations: Demolition Perrnits-Asbcstos Notification Federal Regulations (Title 40, Part6) -Requ ired l-ctter o f Notification rl csti& that thc fcdqal rcgulatioN ruBsdirg Gbctog rmoval rc not applicablc to thb prcjâ‚¬t. -l cdiry that I havc rad this .pplication &d statâ‚¬ thrt thc abovc infomation is concl. I agre to comply with sll City 8trd Couty otditrtrc6 md Ststc lrw rclaing to building ongrucliolt ad hccby authorirc rc?raataivE of this City ed Coutrty to 6ts upotr thc above mentioned propcrty for inspection Applicant or Agent Permitee o*", il I l/,1,o UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Buildinq 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/Poo! Pipinq Fill Line/Back FIow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary SewerlCap Back FIow Device Rough Plumbing Final Gas Test n Meter Release Ir.\ F!NAL \-27-A ullll,x\ Notes Re Etc. ",," - tlltlL. Carrier: Expires: ftfuN