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PLUM BING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG I COMMENTS OWNER BUILDER DELCARATION <br />I hercby affirm under penrlty of perjury thrt I m crempt from thc ContrsctoF' Licen* [lw for the follouirg Esn (Ss.7031.5 <br />Busincss and Profcssion Codc): Any City or County which rcquircs I lmit lo snstruct. 8lts, imprcw, &mlish or rcJnir 6ny <br />structurc, pdrr to its issu!re, ds requircs lhe rpplicsnl for such tEmit to lilc 8 sigrcd sl8lcmnt thrt hc or shc is liensd pwanl <br />to thc provishns of thc Contrsctor's Lbenscd t w (Chrpter 9, Comreming with S6tbn 7m of Division 3 of thc Busircss md <br />Prcfcssions Code) or that hc or she is cxctrrpt thercfrom 8nd the basis for thc 8lhgcd cxemption. Any viohtion of S$tirn 703 1.5 by rtry <br />applicant for I lf,rmit subjcls lhc applicant to a civil penalty of not mrc than five hundrcd dollus ($500). <br />-1. <br />as owner of the pmpcrty, or my employces with wages ss their solc compensalion. will do the work and thc stnrturc is nol <br />intcndcd or offcred for sale (Scc.7044, Busincss and hofcssions Code: The Contraclor's Liccnse [-aw does not apply to an owner of <br />thc propcrly whcr builds or inpmves thereon. and who does such work himself or hersclf or through his or hcr own employees. <br />provided that such improvenrnts anc not intended or offered for sale. If. howcver. the building or improvenEnt is rcld within one )rear <br />of cornpletion. the Owncr Builder will have thc burden of proving thsl he or shc did not build or improve the propcrty for thc purlnsc of <br />sale). <br />-1. <br />tsowncrof thc propcrly. anrexclusivclyconlracting with liccrrscd conlracl()rs lo construcl lhe projccl (Scc. 71X4. Bttsiltcss <br />ard lhrlcssion Codc: 'Ihc Contraclor's Licensc l,aw tlocs nol apply to an owncr of propcrly who builds or itnprovcs lhcrcttn. <br />and who conlracts lirr such projccts with a Contractor(s) licensctl pursuant ltr lhc Contraclor's I.iccnsc l-aw;. <br />-lalltCxclIlptuntlerSection-.I].&P.C.lilrlhisrcastllt.l)ate: Owner: _ _ <br />lYORKERS' CO[I PENSA'I'ION <br />DECLARA'tION <br />I hcrchy al'l'irrn untlcr pcnalty of pcrjury onc ol'thc lblkrwing dcclarations: <br />_lhavcarxl u'ill rnairrtainaCcrtilrcateofConscntto.Scll-lnsurclirrrr'orkcrs'compcnsali()n.as providcrl fbrhyScction-17(X)ol'llrc <br />l-lbor Codc. lirr thc pcrforrruncc of thc work lirr which thc pcrrrrit is issucd. <br />ff#una*ilt nuintrinworkcrs'cotrrlrcnsalioninsurlncc.ns rcquircdhySccli('n-17([ofthcLaborCodc.forthcJrcrfonmnccof' ihc work for which this pcrnlit is issucd. My workcrs' conrpensatiotr insurancc c{fticr dd lnlicy numbcr m: <br />l'olic1' <br />q 1l 7(z Za <br />-l <br />ccrtify that in the pcrformance of thc work for which this perrnit is issued. I shall not enrploy any person in any mBnner <br />so as lo bccome subjcct to the workers'comlrcnsation laws of California. and agrc.c lhat if I should become subjoct to the <br />workcrs' compensation provisions of Section 37fi) of thc t-abor Code. I shall. forthwilh comply wilh tltosc provisions.. <br />WARNING: Failure to sccure workcrs' compensation coverege is unluwful. and shall subject an employer to criminal penaltics and <br />civil fines up lo one hundred thousand dollars ($l00.m0l. in addition to the cost of compensation. damages ss provided for the <br />Scction 3076 of lhc l-^abor Codc. interest and allorncy's fees. <br />1i-- <br />I hcreby affirm under pcnalty of perjury that I am liccnsed under provision of Chapter 9 (commencing with Section 7m0) of Division 3 <br />of the Busincss and Professions Code. and my license is in full force and effecl. <br />e$uv 1r <br />('ortl r:tclor: <br />W <br />I hcrcby ull'irm undcr Fn{lty of Frjury thilt thcrc is fl constructbn bnding agcncy lbr thc pcrli}rroncc of the work for which lhis <br />'tnnil <br />is <br />issucd (Scr. 3097. Civ. C.). <br />Lcndcr's Nanrc: <br />l.ender's Address: <br />APPLICANT DECLARATTON <br />I hcrcby affirm undcr pcnalty of pcrjury one of the following dcclarations: <br />Dcnrolition Pcrmits-Asbestos Notification Fcderal Rcgulations (Title 40. Part6) <br />-Required <br />[rtter of Notification <br />_l certify that thc fcderal rcgulations regarding asbcstos rcrrrovularc nol upplicablc to this projccl. <br />ccrlify lhat I have read this application and stale thal the atxrve informalion is corrcct. I agrcr to comply with all City and County <br />ordinailccs and Stotc llws rclating to building construction. &d herchy authorizc rcprcscnlllivcs ofthis City ond Counly lo cnls ulmn thc <br />atxlve nrcntioncd proprly for insJrcction <br />Agrpliurnt or Agent <br />Permitee nanre <br />,",". ct [ $l ? o <br />UNDER GROUND (\.s( <br />Waste & Vent I <br />Water-Under floor <br />Gas-Underf loor <br />Building Sewer <br />ArealStorm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT , <br />Waste & Vent zn - hL(-t/, <br />Water Pipinq q'ltolu)'-7r' b1444< <br />Gas Piping I I I I <br />Roof Drain I <br />Tub/Shower Test 1l trlltD 7 tl lL 'h) Dtr*9 <br />Rouqh Water Heater r- t I <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heaterlcas 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\N <br />FINAL \e\sil,lr \ <br />EtcRemarks \ <br />{q{t> Prt <br />a <br />DKA*7 I h'lLt <br />hlp*,v <br />Carricr:- <br />Exnircs: <br />Licensc Cfo.r, 9,",.,-QlS{-2o--License <br />Numbcr: