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PLUMBING.INSPECTOR RECORD APPROVALS DATE lD/slG-COMMENTS OWNER BUILDER DET,CARATTON I hacby affm undc pcralty of pcjuy that I m dmpt fiiom thc ContrscloB' LicoE [rw for thc following twtr (Sc.7o]l.i Buinas ard Profsion Codc): Any City or Couty which rcquirc a pcmit to snstrucl. altc. improvq damlish or rcpoir any structurq p(br to its is|req also rcquirG thc applicmt for such pqrnit to fih 8 sigtrcd stat@6t thr! hc or slrc b licqEcd plmet to thc Fovisiou of thc Contretor's Licmscd L:w (Chapts 9, Comcncing with Sctior 7000 of Division 3 of tb Bwiae ud Prcfcsions Codc) or that hc or sh. is qmp thqcfrom ed thc bosis for thc allqcd qmilion. Any violation of Sccrbtr 7031.5 by uy applicetforspmitsubjatstbe applicmttoacivilpcnaltyofuotmrcthulivchundreddollrs($500). -1. as owner of the p,roperty. or my employecs with wages as their sole compensation. will do the work and the structurc b not intendod or offered for sale (Sec.7044. Busincss and hofessions Code: The Contraclor's License Law does not apply to an owner of the property who builds or improves thermn. and who docs zuch work himself or hcrself or through his or her own employecs. providd that such improvonents are not intendod or offcrod for salc. l(, hower',er. the building or inrprovcmcnt is sold within one )â‚¬ar of complaion. thc Orvner Builder will have the burden of proving tlrru he or she did not build or impnove the propoty for the purposcof sale). _1. as owner of the propeny. am exclusively contracting with licensed contractors to construct the project (Sec. 7M4, Business and Profession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracls for such projects with a Contracto(s) licarsed pursuant to the Contractor's Licerse Law). -l am exempt undâ‚¬r Section-. B. & P.C. for this reason. f)o t o. WORKERS' COMPENSATTON DECII\RATTON I hereby affrm und6 penalty of pcrjury one of thc following declarations: -l have and will maintain a Certifrcate of Consent to Self-Insure for workers' comperuatioq as provided for by Section 3700 of the I-abor Code. for the pcrformance of the work for which the perrnit is issued. \( mvc ana wilt mairtsh work@' compcruarion imrmcq a rcquircd by Setion 37OO of thc kbor Codc, for thc pqforc of 'thFwrt for whhh tbir pmit ir isrcd My rcrta' onpasaiotr iaw ffiiq ud policy ruba rc: Policy Number: Expires: _l ccrti& that in the performancc of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workcrs'compensation laws of California, and agree that if I should bccorne subject to the workcrs' compensation provisions of Section 3700 of the Labor Codc. I shall, forthwilh comply with thosc provisions.. WARNING: Failurc to sccurc workcrs' compcnsation coverage is unlarvful. and shall subject an and civil fines to onc hundrcd thousand dollars ($100.000). in thc cost of the Section the intcrest and attorney's fees. I hereby affirm under penalty of perjury that I am licensed under 9 (commorcing with Sec-tion 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License CONSTRUCTTON LENDTNG AGENCY thcre is a construction lending agency for the pcrformance of the work for which this permit isI hereby aflirm under penalty of perjury that issued (Sec. 3097, Civ. C.). lrndcr's Name: l,cnder's Address: APPLICANT DECLARATION I hereb}/ affirm under penalty of pcrjury one of the following dcclarations: Demolition Permits-Asbcstos Notification Fcderal Rcgulations (Title 40. Part6) -Rcquired Letter of Notification -l certi$r that the federal regulations rcgarding asbestos removal are not applicable to this project. UNDER GROUND il A Waste & Vent ?-ZIL-A LilIbY,I Water-Under floor \) Gas-Underfloor Building Sewer ArealStorm Drain I nterceptor/ Cla rifier TOP OUT Waste & Vent Water Piping Gas Pipinq Roof Drain Tub/Shower Test Rouqh Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Piping Fil! Line/Back Flow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary Sewer/Cap Back FIow Device Rough Plumbing t,J\ Final Gas Test Rl lght rrJ (5y Meter Release lt , FINAL b4 lzr a-v (n Notes, Remarks, Etc.I - Owner: Carrier:. 4 above mcntioned property for inspection Applicent or Agent i Permitee nanre