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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCANATION <br />I hcrcby sffrm under penalty of perjury that I m cxempt from thc ContretoB' Licens lrw for the following msn (Sc.7031.5 <br />Busincss rtd Profcssion Code): Any City or Courty which requircs 8 pqnit lo onstnrct, sltq, itrprow, &mlish or qrt uy <br />stnrcorc, Fk r to its issrc, alro rcquires the spplicmt for such pemit to fih a signcd st.remnl lhst hc or she is lkrnsd plltsua <br />to thc prcvisions of thc Conretor's Licemcd Law (CtEptcr 9, Comrcing with Serion 7000 of Division 3 of the Busircss ud <br />PrcfcssioN fue) or thsr hc or shc is €xcmpa thercfrom ed thc bssis for thc dlcgcd excmption. Any violalioo of Setbo 703L5 bl sny <br />spplicrnt for 8 permil subjcts th€ spplicsnt lo I civil pcElty of mt mrc thsn five hundrcd dollus ($500). <br />-1, <br />as owncr of thc propcrty, or my cmployccs with wages &s thcir solc compensation. will do the work and the struclure ls not <br />intended or offcred for sale (Sec.7044, Busincss and Professions Code: The Contractor's Liccnse LBw docs not apply lo an owner of <br />the propcrty who builds or inprorrcs thercon, and who docs such work himself or hcrself or through his or hcr own employecs, <br />providcd that such improvenrcnts arc not intcnded or offcrcd for salc. If. howcver, the building or improvcnrent is sold within onc )t.sr <br />of completion. the Owner Builder will harrc the burdcn of proving that hc or shc dkl not btrild or inprove thc propoty for thc purJnsc of <br />sah). <br />-1. <br />as owncr of thc pmpcrty. am exclusively contracting with licenscd conlractors to conslruct thc project (Sec. 7044. Busincss <br />and Pncfcssion Code: Thc Contractor's License Law does not apply to an owner of propcrty who builds or improves lhercon, <br />and who contracts for such projccts with a Contractorls) liccnscd pursuanl to thc Contraclor's Liccnse kw). <br />_l am cxempt undcr ';tufrr o.I 1.. t,, .n -.3o - zl <br />I hcrcby affirm undcr penalty of pcrjury onc of thc following <br />-lhavcandwill <br />rnaintainaCcrtificateofConscnttoSclf-lnsurcforworkcrs'c<lnrgrcnsation.as providedforbySection3T00ofthc <br />labor Codc. lbr lhc lrcrformancc of thc work for which thc pcrmit is issucd. <br />-l <br />havc and will nraintain workcrs' conrpcnsation insurancc. as rcquircd by Sect ion 3700 of thc labor Code. for thc pcrformancc of <br />thc work for which this pcrmit is issucd. My workcrs' cotnpcnsation insurancc carricr and plicy numbcr arc: <br />Carricr: <br />Policv Numbcr: Exnircs: <br />-l <br />certify that in thc pcrformancc of the work for which this permit is issucd, I shall not employ any person in any manncr <br />so as to bccome subjcct Io the workcrs' compcnsation laws of California, and agrce that if I should become subject to thc <br />workcrs' compcnsation provisions of Section 3700 of thc Labor Code. I shall. forthwith comply with those provisions.. <br />WARNING: Failurc to sccurc workers'comlrcnsation cover.rgc is unlawful. and shall subjcct an employcr to c-rirninal pcnaltics and <br />civil fincs up to onc hundrcd lhousand dollars ($100.000). in addit ion to the cost of compensation.damagcs as provided for thc <br />Scction 3076 of thc laklr Code. intcrest and altorncy's <br />oror 4-3o-Zl Q, <br />I hcrcby affirm under penalty of perjury that I am licensod under provision of Chapter 9 (comnrencing with Section 7000) of Division 3 <br />of the Business and Professions Code, ard my license is in fuU force and effcct. <br />Liccnse <br />Dale: <br />Nunrbcr: <br />W <br />I hcrcby aflrm undcr pcmlty of pcrjury Ihat Ihcrc is ! onslructbn hnding agcncy for lhe pcafommc of lhc work for which this Ismit is <br />issucd (Sa. 3097. Civ. C.). <br />lrndcr's Nam: <br />Lrnder's Address: <br />ABUCANIJECI.AMIION <br />I Myafnmundcr Fnalty of pcrjury orc of thc following delarations: <br />Dcmlition Pcrmits-Asbcslos Notification Fcdcral Rcgulations (Title 40, Part6) <br />_Requircd kttq of Notifrcation <br />-l <br />cmify thal thc fedcBl rcgulations rcgading asbcslos rcmval rc not applicsblc lo this prcjct. <br />_l ertify that I harc rc8d this application ild statc that thc abovc informalion is comcl. I agre to comply wilh sll City and Counly <br />ordimrccs and Slltc laws rchting lo buiHing construcliotr ud hercby authorizc rcprcsnlativcs ofthis Cily 8rd County to cnts uJDn thc <br />abovc rncnlioned propcrty for O,WApplicant or <br />l't rnritee ben'f EA <br />o""'?40-7"1 <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildinq Sewer <br />ArealStorm Drain <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 />N/ain 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 SewerlCao <br />Back Flow Device <br />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release <br />FINAL lD{/-2 lOCrE ntfffiU <br />Notes, Remarks, Etc. <br />Contractor: