Laserfiche WebLink
PLUMBING.INSPECTOR REGORD <br />APPROVALS DATE ID/S!G COMMENTS OWNER BUILDER IIEI.CARATION <br />I hqclry affm undq pcnalty of pqjury that I m qmpt from thc Cootracro6' Licw kw for thc following twn (Sc.703L5 <br />B6ins ard Prcfeion Codc): Any City or Couty which roquirc a pcmit to srlstruct, alta. improve <brclish or rpair uy <br />structrc, Fior to its ismcc, alm rcquirc thc spplicet for srch pcmit to filc a signcd stat@6t thd hc or shc b licascd pwutt <br />to thc FovisioN of thc Coilrrctor's Licqscd kw (Chapts 9, Commiag whh Ssliotr 7000 of Division 3 of thc Buim ud <br />Prcfsions Co&) or that hc or shc is qmpt thqcfrom md thc bssis for thc allcgcd cxmFion. Atry violsrion of Setior 7031 .5 by ey <br />applicmt for a pamit subjcts thc applicanr to a civil pmlty of not morc tha fivc hundrtd dollan ($500). <br />-1, <br />as owner of the prroperty, or my emplolcc with wages as their sole compensdion, will do the work and the stndure is not <br />intcndcd or offced for sale (Se.7044. Business and Profcsions Code: The Contractor's Licsosc l-aw does not apply to an owner of <br />thc propcrty who hrilds or irprove tlrenoru md who does such wort hirnself or hcrsclf or through his or her own ernployees. <br />providcd that such improverncnts are not intendod orofltr€d for sale. I[, howcvcr, the hrilding or improvement is sold within onc ]car <br />of conplaiou thc Owner Builds will have ttrc hrd€n of proving thd tE or shc did not build or impove the property for thc purposcof <br />sale). <br />-I, <br />as owncr of the propcrty. am exclusively contracting with liccnscd confiractors to construct the project (Scc. 7044, Busincss <br />and Proftssion Codc: The Contractor's Licensc Law does not apply to ar owner ofproperty who builds or funprovca thereon, <br />and who contracts for such F,ojects with a Conracto(s) liccnscd pursusnt to the Contractor's Liccnsc Law). <br />-l <br />am exempt under Section-, B. & P.C. for this reason. <br />On'ncr: <br />WORKERS' COMPEIISATION <br />DECIABAIIAN <br />I hrcby allim unda panalty of pajury onc of thc following deluatioro: <br />-t <br />havc ard will mintsitr I Cgtificstc of CoMt to SdfJBurc for rcrkc' omFnsation, r pmvidcd for by Sction 3700 of thc <br />Labor Codc. for thc pofomcc of thc rcrt for which thc pcntrit is issucd. <br />(LI havc ud will maintain wortm' compcrcstion irulmcq s rcquircd by Setion 3700 of the tJbor Codc, for thc psfomucc of <br />the work for which this pcnnit is isucd. My workq' ompcroation irouucc qiq aad plicy rumb6 ec <br />T <br />,/rr- oc- LL <br />_t ccrti& that in the performancc of the work for which this pcrnrit is issued, I shall not qnploy any person in any manner <br />so as to bccomc subjcct to the workers' compensation laws of Californiq and agrec that if I should become subject to thc <br />workcrs' compcosation provisions of Section 3700 of the labor Code I shall, forthwith comply with thosc provisions.. <br />WARNING: Failure to sccure workers' compc.nsation coverage is unlawful, and shall subject an anployer to siminal pcnalties and <br />civil fines up to one hundred thousand dollars ($100,000). in addition to the co$ of compensation. damages as providod for the <br />t <br />Section 3076 of the Labor Code, interest and attorney's fees. <br />oetez OQ -04 - 2 I <br />I hereby affrm under penalty of perjury that I am licensod 9 (commencing with Secrion 7000) of Division 3 <br />of the Business and Professions Code, and my license is in full force and effcrct. <br />License ct^u, b License Nurnber:t0070 <br />oarc: 4 -O4-21 Pr-o Ec*t h*c CouJffu/cnvlt) <br />W <br />I h@by slrm udtr pqElty of pqjury thd thqe is 8 onstructbn lcnding agacy for thc po'fomcc of thc mrk for $,hich this pqmit b <br />issucd (Se. 3097, Civ. C.). <br />tmdq's Namc: <br />Lcnder's Address: <br />APPLICANT DECLARATION <br />I herfu aftm under pcnalty of perjury one of the following declarations: <br />Demolition Pcrmits-Asbestos Notificaion Federal Rcgulations (Title 40, Part6) <br />-Requirod <br />lctter of Notification <br />Permitee nnme (urint):-THIEP Prttn,t <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarifier <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 />Main Drain/Pool Pipinq <br />Fill Line/Back FIow <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 t t It ,l / <br />FINAL \s\r?\7\DS.K,/ <br />Notes, Remarks, Etc.\\ <br />,**, l, GtlftfLf>