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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCANATION <br />I hocby affum under petrdty of pcrjury thsr I u Excmpt ftom th€ Conrac{m' Licns trw for the following ren (56.7031.5 <br />Busincss and Prcfc$ion Codc): Any City or County whth rcquircs a pcmit to construct, rlter, imprcvc, demlish or rcprir uy <br />structre, Jrbr to its isswc. also rrquircs thc applket for-iEh pcmit to fib r sigEd slatcmnt tlul hc or slE b licnsd pu$sril <br />to thc pmvisions of thc Contrrctor's Licensd lrw (Chrpter 9, Comncing wilh S6tion 7000 of Division 3 of thc Busircss ud <br />PrcfcssionsCodc)orlhslhcorslEisexempttlusftomstdthcbalisforthcalhgcdcrmprion. AnyvblationofsclbnT03l.5bymy <br />spplicsnt for a permit subj$ts thc applicant to a civil pcnalty of not mrc the frvc hundrcd dollm ($500). <br />-1. <br />as owncr of the property, or my emplo)rces with wages as their sole comFrcnsation. will do thc work and thc stnrture is not <br />intcndcd or offcred for sale (Sec.7044, Business and hofessions Code: Thc Contractor's Licensc [:w does not &pply to an owner of <br />the propcrty who builds or improves thereon, and who docs such work himself or hersclf or through his or her own employecs, <br />provided that such improvcnrnts are not intcndcd or offcrcd for salc. lf. howcver, thc building or ir{novcnrnt is sold within one )rcar <br />of conphtion, the Owner BuiHcr will harrc the burden of Snoving that trc or she did not build or inqrrove the propoty for the purposcof <br />sale). <br />-1. <br />asowncrof thc propcrty. amcxclusivclycontracting with liccnscd contractorstoconslrucl thc projcct (Scc.7M1, Busincss <br />and Pnrfcssion Codc: Thc Contractor's License Law docs not apply to an owncr of proJrcrty who builds or improvcs thcrcon. <br />and who conlracls tbr such projccts with a C<lntractor(s) liccnscd pursuant to thc Contract<lr's Liccnsc Law). <br />-lamexcmptunderScction-.B.&P.C.forthisreason'n^a^. <br />WQETESETI}MPINSAtrON <br />DEII.ABAIIAN <br />I hcreby rffirm under pcmlty ofperjury onc ofthc fotlowing deluotions: <br />-l <br />haw ard will mintain a Ccnifrcatc of Conrcnt m Sclf-lnsurc for workcro' comlrcnsation. as prcvided for by Sation 3700 of the <br />tibor fuc, for thc pcrfomrcc of thc mrk for whhh thc 1Emil is issucd. <br />/l havc und will mintain workcrs' comrEnsation insuronce, as rcquircd by Setion 3700 of thc hbor Codc, for thc pcrformre of <br />thc work for which this Jrcrmit is i.ssucd. My workcrs' cornpcnsation insurance carricr and plicy numlxr arc: <br />a <br />Policy <br />D <br />-l <br />ccrtify that in thc prfornuncc of thc work for which this pcrmit is issucd. I shall not employ any pcrson in any manncr <br />so as to bccorne subject to ttrc workcrs' compcnsation laws of California, and agrec that if I should bccome subject lo the <br />workcrs' compcnsation provisions of Scction 3700 of thc Labor Codc, I shall, forthwith comply with those provisions.. <br />WARNING: Failurc to sccurc workcrs' compensation covcragc <br />civil fines up lo one hundred thousand dollars ($100.000). in <br />, is unlawful. and shall subjcct an cmploycr to criminal Frcnaltbs and <br />addition to the cost of compcnsation. damages as provided for ttrc <br />Section 3076 of thc l-atnr Codc. intcrcst and attorncy's fccs. <br />n.,a^. <br />I hcrcby allirm undcr pnalty of pcrjury that I arn liccnscd undcr (comrncncing with Sc.ction 7000) of Division 3 <br />of the Busincss and Professions Code, and my liccnse is in full forcc and cffcct. <br />Liccnse <br />Dale: <br />I hcrcby affirm under Jrcnalty of perjury that thcrc is a onstructbn lending agcrcy for thc Jrcrformncc of thc work for which rhis lnmit is <br />issucd (Scc. 3097. Civ. C.). <br />[rndcr's Namc: <br />knder's Address: <br />ATELIGANLDECI.ABAIIIIN <br />I Myaffimunder lrcnalty of perjury orc of thc following dccltrstions: <br />Dcmlition Permits-Asbcstos Notification Fcdcral Regulstions (Tide,l0, Pa(6) <br />-Rcquired <br />l-rncr of Ndifrcatbn <br />-l <br />ccrtify that thc fcdcBl rcgulatio$ rcgEding rsbcstos rcmval m not spplicablc to this prcjcrt. <br />_l ccnify rhat I hsw rcad this rpplication and ststc that lhc sborc inforEElion is coffit. I agE to @mply with all Cily ard Coutrty <br />ordimnccs and Statc [aws rclating to buiHing constructiort ild hcrcby suthorirc rcprcsnlotivcs of this Chy and County to cntcr uIDn thc <br />abovc mcntioncd prolrcrty for <br />Applicant or <br />Pernrilee <br />l )rrlr <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 t- l t,^a(Water Piping I lqlat arail 0tqffi <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />N/ain Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heaterlcas Line 4 <br />I <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCao <br />Back FIow Device <br />Roush Plumbinq <br />Final Gas Test <br />Meter Release I /lt 2 <br />FINAL t0////A/W/il(ru4ry <br />Notes, Remarks, Etc.( <br />Owner: <br />a