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PLUMBING.! NSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DEI,CARATION <br />I hftby aftm und6 poalty of pqjury thst I m qcmpt from thc Contrrcloc' Licw Law for thc following Iwn (Sc.7031.5 <br />Buinas and Prcft*sion Codc): Any City or Courty which rcquiro a pannit to corutrucl, alts. improvc. &tmlish or rcpah uy <br />strucle prior to ils ilsumce" d$ rcquiB thc eplimt for such Fnrit to filc s signcd statml thd hc or $c is licoEcd pmuant <br />to thc provisioru of thc Contrscttr's Licmscd taw (Chaptq 9. Commacing with Sction 7000 of Division 3 of thc Busine ud <br />PrcfeionrCodc)orthsthcorsh€isqmptthrcfromddthcbaisforthcallqgcdamption. AnyviolationofsetbtrT03l.5byay <br />spplicmtforsp6mitsubj€tsthc applicuttoacivilpcrultyofnotmorctfunfivchundrcddollm($500). <br />_1. as owner of the propcrty. or my cmplolccs with wages as their sole compcnsation. will do the wort and thc structure is not <br />intcndod or off€red for sale (Sec.7044, Business and Professions Code: The Contractor's Liccnse l-aw does not apply to an owner of <br />the property who tuilds or improves tlreron" and who does zuch wort himself or hersclf or through his or her own cmployees. <br />provided that such impovcnrents arc not intendcd orofferod for sale. If. however. ttrc tuilding or improvemcnt is sold wilhin one ),!ar <br />of compktion the Orvner Build€r will have the hrrdcn of proving thd he or she did not build or inrprove the p,roperty for the purposc of <br />sale). <br />_1. 8s owner of the propcrty, am exclusively contracting with licenscd contractors to construcl thc project (Sec. 7044. Business <br />ard Pnoftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improve thereon, <br />and who conmds for such projects with a Contracto(s) licanscd punuant to the Contractor's Licensc law). <br />_l am under B. & W. for this r@son. <br />l/-7.r-, I nta-o,nn..lD(. <br />of the following'declarations :I hereby affrrm under penalty of perjury one <br />_l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as providcd for by Section -3700 of thc <br />Labor Codc. for the performance of the rvork for which the permit is issucd. <br />_l have and will maintain workers' compensation insurance. as required by Section 3700 of the labor Code. for the perfrrrmance of <br />the work for which this permit is issued My workers' compensation insurance carrier and policy number arc: <br />Policy <br />_l ccrtify that in the performance of the work for which this permit is issued. I shall not cmploy any person in any manncr <br />so as to become subject to the workers' compcnsation laws of California, and agree that if I should become subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code, I shall. forthwith comply with thosc provisions.. <br />WARNING: Failure to secure workers' compemation coverage is unlawful. and shall subject an onployer to oiminal penalties and <br />civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the <br />fecs. <br />t <br />I hereby affirm under pcnalty of perjury that I am licensod of Chapto 9 (commcncing with Scrtion 7000) of Diuision 3 <br />of the Business and Professions Code. and my liccnsc is in full force and effect. <br />Licensc Class: License Number: <br />W <br />I hmby affm uda pqulty of pcrjury thd th@ is r coDstruclion loding agacy for thc pqfomcc of thc wrk for which thb pqmit b <br />issucd (Sc. 3@7, Civ. C.). <br />Lender's Name: <br />Lender's Ad&ess: <br />APPLICANT DECLAfuITION <br />I herdry affrnn under penalty of perjury one of thc follorving declarations: <br />Dernolition Permits-Asbestos Notification Federal Regulations (Title 40. Pafl6) <br />-Required <br />Letter o f Notification <br />_l certi$ that the federal regulations regarding asbestos rernoval are not applicable to this project. <br />with all City and County <br />and County to enter upon the <br />Applicrnt or Agent , <br />Pernritee nnnre <br />b 4^ <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor ,I ,1 <br />Building Sewer f175['?,1 Dfr-W1 wtst- *o bitto\- c'lu <br />Area/Storm Drain I <br />I nterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas 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 I ,4 \. <br />FINAL Z/*lzt rLD(17 ) <br />Notes, Remarks, Etc.lf \r'Z <br />-f, <br />Carrier: <br />Expires: <br />a <br />Conlrnctor: <br />lprint): K 4-r.7 <br />,