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PLU M BI NG.I NSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS OWNER AUILDER DET.CARATTON <br />I hscby affm undq pqralty of Fjury thd I m qmp from thc Cotrtretoc' Liccre trw for thc following rwn ($c.7031.5 <br />Buine and Profeion Co&): Aoy City or Coudy which rcquic a pamit to @Ntruct, alta. improve thnollsh or rtpair uy <br />stsuctwc, prbr to its issumcc. also rcquirc thc applicut for such pqmit to 6h a signcd stdqMt that hc or sh b licorscd pmant <br />to the provisiom of thc Conractor's Lhmcd Law (Chaptq 9, Comocing whh Sctioo 7000 of Division 3 of thc Buirc md <br />PrcfeioroCodc)orthsthcorslrciscxmptthac&om8rdthcbosisforthcElcgodcxmption. AnyviolationofsetiotrT03l.5bey <br />appli@tforap6nitsubjGtsthc applicuttoacivilpaalayofnotmorcthufivchundrcddollas($500). <br />_1, &s owner ofthe propc.rty. or my employees with wages as their sole compensation, will do the work and the structure is not <br />intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's Licease l-aw does not apply to an owner of <br />the properry who builds or improves thcron. and who does such work himself or herself or through his or her own employees. <br />providd that such improvanents are not intended or offercd for sale. I[, howelrer, the building or improvemcnt is sold within one y€ar <br />of complaior\ the Orrner Buildcr will have the burden of proving thd he or she did not build or improve the propoty for the purpose of <br />sale). <br />-1, <br />as owner of the property. am exclusively contracting with licenscd contractors to construct the project (Scc. 7044, Buiness <br />and hofessbn Code: Thc Contractor's License Law does not apply to an owner of property who builds or improves thereon, <br />and who contracts for such projeds with a Contractor(s) licascd pursuant to the Contractor's License taw). <br />-l <br />am exempt under Section-, B. & P.C. for this reason. <br />l)rto' <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hereby affrm under pcnalty of pojury one of the following declarations: <br />-I <br />hav€ od will mirtain a Cstifietc of CotMt to SdfJM for mrlo' ompmaiorq u Fovidcd for by Scrioa 3700 of thc <br />Labor Co& for thc pqfotrrec of thc rctt fu which thc psmit b issucd <br />?D-l hlvc ad will miotsi! rcrk6' @mpqsrtbo inwq a rcquircd by Setioo 37OO of thc L€bor Codc, for thc Ffm of <br />thc wrk fc which this panit is isocd My worto' ompasaion ire mkr ud policy omba rc: <br />tl irx.*{yy Ssltl 5.. r;4), l*. . <br />IoDO 1O cc ?ot lO.Ot - ?oDl <br />-l <br />certi& that in the pcrformance of the work for which this perrnit is issued. I shall not employ any person in any manner <br />so as to become subject to the workers' compensation laws of California. and agree that if I should becomc subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with thosc provisiors.. <br />WARNING: Failure to s€cure workers' <br />civil fines up to one hun&ed thousand <br />Section 3076 of the Labor Codc interesr <br />compensation coverage is unlawful, and shall subject an onployer to criminal pauhies and <br />dollars ($100.000). in addition to the cost of compmsation, damages as provided for the <br />and dtorney's fees. <br />a <br />0 <br />b' a4'3oa l f a*o<,e D, trlo' c'I <br />ILICENSED CONTRACTOR <br />DECII\RATION <br />I hereby affirm under penalty of perjury that I am licensed under p,rovision of Chapto 9 (commencing with Section 7000) of Division 3 <br />of the Business and Professions Code, and my license is in full force and effect. <br />License.,*, IirA License Nurnber: 75 tt lo <br />. tq - ?O2l fr*r, Drt"b-<t - lf,RS qs.tlt <br />W <br />I hEOy8ftDurdapoaltyofpajurythattftbaoE[lrctb! ladioggcy forthcpqforcofthcwort ftrvtichObpanit b <br />irsu€d (Se. 3097, Civ. C.). <br />lada's Nmc: <br />Lender's Address: <br />-l <br />cdiry thrt thc fod6d rrgulatioc ngarding cbctos moval rc not ap?licablc to thb prcjet. <br />t2t ccri& tha I luvc red this application ard $ar€ thst thc abovc infomation is conc1. I agc to omply with a[ City and Couty <br />ordimcc ed Ststc kw rclating to building construcliorr ard horby aurhorirc rclrstaivc of this Chy ud Couty to 6ts upoo thr <br />above mentioned property for <br />Applicant or Agent <br />Pernritee nrme <br />aI a,x lro-el <br />6-14 ru?.l <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ CIa rifier <br />TOP OUT <br />Waste & Vent <br />Water Pipins <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipinq <br />Fil! Line/Back Flow <br />Pool HeaterlGas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCap <br />Back Flow Device <br />Rough Plumbing <br />Final Gas Test <br />Meter Release I L <br />FINAL t0 l.t1?) A.,'YgY <br />INotes, Remarks, Etc. <br />I <br />flo to.Contrector:_ <br />APPLICANT DECLARATION <br />I her$r}, affirm under pcnalty of perjury one of the following declarations: <br />Dernolition Permits-Asbestos Notification Federal Regulations (Title 40. PaI16) <br />-Requircd <br />Lctter of Notification