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- <br />PLUM BING-INSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS OWNER EUILDER DEI.CARATION <br />I hercby affrm undcr Fnally of [Erjury thlt I m exempl ftom lhc Conrrctm' Licenrc lrw for thc following rcen (Se.7031.5 <br />Busincss and Prcfcssion Codc): Any City or County which rcquircs a Frmit to @nstrucl, altq, imprcre, &mlish or rcpah my <br />stlucrurc, prior to ils i$uarcc, af,so rcquircs the sppltet for such pemit to file I sitncd stalerent thal hc or dE ir licensd pu$&r <br />to lhc prcvisions of the Contrrctor's LLrcns{ t w (Chapts 9, Comrcing with S6tiotr 7000 of Division 3 of thc Busircss ud <br />PrcfcsionsCodc)orthstlEorsheisexcmptttwfromaldthcbosisforthealhgcdcrcnptbo. AnyyiolstionofS6tbnT03l.5byrtry <br />applicsot for 8 pemil suhj$ts Ihe applicsnt 1o r civil pcn8lty of ml mrc thstr fivc hundrcd dolles ($50O). <br />-1. <br />as owncr of the prolrcrty, or my employccs with wages us their solc compcnsalion, will do tlrc work snd the stnrturc is not <br />intcndcd or offered for salc (Scc.7044, Busincss and hofessions Codc: The Contractor's License lxw docs not apply to an owner of <br />thc propcrty who builds or improves thercon. and who does such work himself or hersclf or through his or her own cmployees. <br />providcd that such improvcnrcnts are not intendcd or offered for sale. If. however, thc building or improrrcnrnt is sold within onc ),ear <br />of complctiou the Owner Buildcr will harrc thc burdcn of proving that he or she did rrct buiH or inprove tlrc property for the purynse of <br />sale). <br />-1, <br />as owner of thc propcrty. am exclusively contracting with liccnscd contractors to conslruct the projcct (Sec. 7W. Business <br />and Profcssion Codc: Thc Contractor's Licensc Law docs not apply to an owner of propcrty who builds or improvcs thercon. <br />and who contracls for such projccts with a Contracto(s) liccnscd pursuant to thc Contraclor's Liccnsc [:w). <br />-lamcxcmptundcrSc'ction-.B.&P.C.forthisreason.\ <br />hola. f lunar. <br />WORKERS' COMPT'NSATTON <br />DF'CLARATION <br />I hcrcby affirm undcr pcnalty of pcrjury one of the following declarations: <br />-l <br />have and will maintain a Certifrcate of Conscnt to Self-lnsure for workers' compcnsation, as provided for by Section 3700 of the <br />I-abor Codc. for thc pcrformancc of the work for which the pcrmit is issued. <br />_l havc and will maintain workers'Scction 3700 of the [abor Code. for the pcrformancc of <br />the work for issucd.carricr and plicy number arc: <br />Policy O aouL :la Itl .-l-? <br />-l <br />ccrtify that in thc performance of thc work for which this pcrmit is issued, I shall not cmploy any pcrson in any monncr <br />so as to bccomc subjcct to the workers'compcnsation laws of California. and agrec that if I should bccornc subjcrct to the <br />workcrs' compensation provisions of Section 3700 of the [:bor Codc. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failure lo sccurc workcrs' compcnsation covcragc is unlawful. and shall subict an cmploycr to criminal pcnaltics and <br />civil fincs up to one hundred thousand dollars ($100,000), in addition to the cost of compcnsation, damagcs as providcd for the <br />attorncy's fccs. <br />{,G^\ <br />DECLARATION <br />I hcrcby affirrn under pcnalty of pcrjury that I anr liccnscd undcr provision of Chapter 9 (commencing with Scction 7000) of Division 3 <br />of thc Busincss and Pnrl'essions Code, and nry liccnse is in full force and cffect. <br />\ Dscr *rrr* ,Liccnsc <br />W <br />I hcrcby 8ffrm under pcnslty of perjury that tlre is a @nstruction lenditrg agcrcy for thc pcdomc of thc mrk for which this pemit is <br />issuei (Se. 3097, Civ. C.). <br />Lcnder's Namc: <br />l-cnder's Address: <br />A PPLICANT NE' CLA RA-.fION <br />I hercbyafFrnnunder pcnalty of perjury one of thc following declarations: <br />Dcmolition Permits-Asbestos Notification Federal Regulations (Title 4O, Part6) <br />-Rcquired <br />l.etter of Notifrcation <br />-l <br />ccrtify that the federal rcgulations rcgarding asbestos removal are not applicable lo this project.b <br />_l ccrtify that I havc rcad this application and statc that the abovc information is corrcct. I agree to comply <br />ordinanccs and State l-aws rclating to building construction, and hcreby authorizc rcprescnlatives of this City <br />with all City and County <br />above rncntioncd propcrty for inspcction <br />Applicanl or Agent <br />Permitee name <br />\ <br />'n <br />Y' <br />County to upn the <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildinq Sewer <br />ArealStorm Drain <br />I nterceptor/ CIarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />N/ain Drain/Pool Pipinq <br />Fill Line/Back FIow <br />Pool Heaterlcas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />LawruSnrlnkler_-flanitary6werlrffi /o-/l -u 2.L(g Jq1Oa> 2, I <br />Rough Plumbinq <br />Final Gas Test <br />Meter Release <br />FINAL /04V-A fLCl s aJet@, Vfl <br />Notes, Remarks, Etc. <br />4 u