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PLUM BING.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER EI'ILDER DELCARATION I hcrcby aIlirm undcr pcmlty of IHjury thst I m excnrpt friom thâ‚¬ Conlrsctm' Lbem [rw for thc following rceo (Scc.7031.5 Busincss ard Prcfcssion Codc): Any City or Couoty whbh rcquircs 8 JHmit to @nstrucl, 8lts, improw. demlish or rcpeir my struchre. prior to its issrc, also rcquircs tlrc applbilr for such pcmil lo lib a signcd ststemnl lhsl hc or slrc is lien$d pmuanl to the prcvisions of tlrc Contrrctor's Liccnrcd hw (Chapter 9, Comncing with Section 70fl) of Divisioo 3 of the Busimss and Prcfessions Codc) or thst hc or she is cxemlrt thcrcfrom and thc basis for lhc rllcgcd cxcmption. Any violstion of S$tion 703 1.5 by any appticilt for a pcmit subjects thc applicant to I civil penalty of mt mrc thsn fivc hundrcd dollrs ($500). -1, as owner of thc propcrty, or my employecs with wages as thcir solc compcnsBtion, will do the work ard thc stnrctune is not intendcd or offered for sale (Sec.7044, Business and Professions Code: The Contractor's License l-aw does not apply to an owner of the pmperty who builds or Lnpro\rcs thermru and wtp does srrch work himself or hcrsclf or through his or hcr own employees, providcd that such improvcnrcnts are not intendcd oroffcrcd for sab. If, howerrcr. thc building or improvenEnt is sold within one )car of complction, thc Owncr Builder will have thc burdcn of proving that hc or she did not buiH or improvc the propcrty for the purpose of sale). -1, as owner of the propcrty, am exclusivcly contractirrg with licensed contraclors lo construct thc proict (Sec. 7W, Business and Pmfessbn Codc: The Contractor's Licensc Law does not apply lo an owner of property who builds or improves thereon, and who contracts for such proicts with a Contracto(s) licensed pursu8nt to the Contractor's Licensc kw). -IamexemptundcrSection-'B.&P.C.forthisrcason. I ):rtc W0RKERS' CoMPENSATToN DECLARATION I hcrcby affirm undcr pcnalty of pcrjury one of thc following declarations: _l have and will maintain a Certil-rcate of Conscnt to Sclf-lnsure for workcrs'comFrcnsation. as provided for by Section 3700 of thc [:bor Codc. for the grcrformancc of thc work for which thc pcrmit is issued. -l have and will maintain workers' compensation insurance. as rcquired by Sc'ction 3700 of thc l-abor Codc. for thc performancc of thc work for which this Jrcrmit is issucd. My workers' comlrcnsation insurancc carricr and policy number are: Policy a -l ccrtify that in thc pcrformancc of the work for which this permit is issucd. I shall not cmploy any lrcrson in any masncr so as to bccomc subjcct to the workers' compcnsation laws of California, and agrcc that if I should bcconr subject to tlt workcrs' compensation provisions of Section 3700 of the l-abor Code. I shall. forthwith comply with thosc provisic14s.. WARNING: Failurc to sccurc workers' compcnsation covcrage is unlawt'ul. and shall subjcct an cmploycr to criminal pcnaltics and civil fines up lo one hundred thousand dollars ($100.000). in addition to thc cost of damagcs as providcd lbr thc Scction 3076 of thc Codc, intcrcst and o o I I hercby affirm under penalty of perjury that I am liccnscd under provision of Chaptcr 9 (commencing with Sectbn 7000) of Division 3 of the Business and Professions Code, and my licensc Ls in full force and cffcct. Liccnsc Nurnbcr: CONS'I'RUCTION I.IJNDIN( :,\( ; I.'NCY I hercby affrm undcr ,rcmlty of Frjury lhrl tlm is s @nstructbn lcnding rgcmy for the perfmc of lhc mrk for whbh lhis psmit b issued (Se. 3097, Civ. C.). lrnder's Namc: [-cnder's Address: APPI ICANT DECLAKITION I lrrcby alfirm undcr pcnalty of Jrcrjury onc of thc following dcclarations: Dcnxrlition Pcrrnits-Ashcslos Notification Fcdcral Rcgulations (Titlc 40, Part(r) _Rcquired Lcttcr of Notification -l ccrtify lhat thc t'cdcral rcgulations regnrdirrg asbcslt>s rcrnovalare not ap;llicablc to this projcct. ^>_l certify that I have rcad this application and statc thal thc above information is corrcct. I ordinances and Statc laws rclating to building construction. and hcreby abovc mcntioncd proprly for Applicant or Pernritee name UNDER GROUND Waste & Vent Water-Under floor Gas-Underf Ioor Building Sewer ArealStorm Drain I nterceptor/ Clarif ier TOP OUT t Waste & Vent q -l 7(T)il&V Water Pipinq Gas Pipinq Roof Drain Tub/Shower Test Rouqh Water Heater POOL/SPA P-trap/Drain Line lt/ain Drain/Pool Pipinq Fill Line/Back FIow Pool Heaterlcas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitarv SewerlCao Back Flow Device Rouqh Plumbinq Final Gas Test Meter Release t .l /tl FINAL DK\D I INotes, Remarks, Etc. fr.o Dale:_oqlor/21