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PLUMBING.INSPECTOR RECORD APPROVALS DATE !D/SIG.COMMENTS OWNEN BULDER DELCARATION I hcrcby affrm undcr Fnalty of pcrjury lhat I m crempt from the CoilrrcloE Lkrn$ kw for thc follouing rcNn (56.7031.5 Businms ard Profcssion Codc): Any City or Conty which rcquircs r pcmil to @Gtruct, dtr. imprcw. dcmlish or E?air uy structw, Ixbr to its issure, slso rcquim thc spplicmt for 3uch pcmit to filc I rigrcd strtcmnt thal lE or shr b liccnsd pIMr to rhâ‚¬ prcvisions of lhc Conrscrq's Licensed Law (Chapcr 9, Comrcing with S6aion 7000 of Divkion 3 of thc Busirc$ ed ProfcsskrnsCodc)orthalheorsheiseremptthercfiomsndthcbasisforthcsllcgcdercmpaion. AnyviolationofscclionT03l.5by.oy spplicsnl for s pcmil subjets thc spplicut to a civil peulty of nol mrc thrn fivc hundrcd dollus ($5fl)). _1. a.s owncr of the propcrty, or my employoes with wagcs as thcir soh compcnsation, will do thc work and the structurc b not intcndcd or offcrcd for salc (Sec.7(X4, Busirrcss and Professions Code: The Contractor's Licensc [^aw does not apply to an owner of thc propcrty who builds or iryrroves thcneon, and who does srch work himsclf or hcrself or through his or hcr own employees, providcd that such improvcnrcnts ane not interded or offered for sale. lf. howcver. the building or inprownrnt is sold within one )rcar of comphtion, thc Owrrcr Buildcr will have the burdcn of proving that he or shc did not buiH or inprorrc the property for the purpose of sah). -1. as owncr of the pro;rcrty. am exclusivcly contracting with licenscd contractors lo construct thc proict (Scc. 7W. Business and Profcssion Code: Thc Contraclor's License Law docs not apply to an owncr of property who builds or improvcs thereon. and who contracts for such projccts with a Contractor(s) licenscd pursuant to thc Contractor's Liccnse taw). _l arn cxcnrpt undcr B. & P.C. for this reason. Date: Owner: WORKERS' COM PF'NSATION DECLARATION I hcreby affrm under penalty of perjury one of the following declarations: -l havc and will maintain a Ccrtificate of Conscnt to Self-lnsure for workcrs' compcnsation. as provided for by Section 3700 of the I-abor Codc, for thc pcrformance of the work for which the pcrmit is issued. _l havc and will maintain as by Section 3700 of thc [-abor Code, for the ;rcrformance of lhc work for which carricr and policy number arc: e!l lD-l -21 _l certify that in thc pcrformarrce of thc work for which this permit is issucd, I shall not cmploy any pcrson in any rnnner so as to bcconrc subjcct to the workcrs'comgrcnsation laws of California. and agrce that if I should bcconrc subfct to the workers' compensation provisions of Section 3700 of the labor Code, I shall, forthwith comply with those provisions.. WARNING: Failurc to sccure workers' compensation covcrage is unlawful. and shall subjcct an employcr to criminal pcnalties and civil fincs to onc hundred thousand dollars ($100,0001, in addition to thc cost of com[rcnsation. damagcs as provided for the Scction ol'thc Codc, intcrcst "^:Y 4 FL- ItEiN5roTttninacrt.n DECL^RATION I hcreby affirm undcr penalty of perjury that I am licenscd under provision of Chaptcr 9 (commcncing with Scction 7m0) of Division 3 of thc Business and Profcssions Code, and my licensc is in full force and cffect. c] | 6r(Liccnsc L q. W I hcrcby Efffm under Fnally of perjury thd llm is a @nstruction lcnding agcrcy for lhc perforc of thc work for which this permn b isscd (56. 3097, Civ. C.). lrndcr's Nanrc: kndcr's Addrcss: APPLICANT DECI ARATION I hcrcby affrnn undcr penalty of pcrjury one of the following declarations: Dcnrclition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) _Rcqu ircd lrtter of Notification _l c$tify that the fcdcral regulations rcgarding asbcstos rcmoval arc not applicablc to this proict. _l certify that I havc read this application and state that thc abovc information is corrccl. I agrcc to comply with all City and County ordinances and Statc laws relating to building construction, and hereby authorizc rcprcscntativcs of this City und above mcntioncd property for inspection "rI Applicunt or Agent rF '(\ q,, cntcr upon tlrc UNDER GROUND Waste & Vent Water-Under floor Gas-Underf loor Buildinq Sewer ArealStorm Drain I nterceptor/ Clarif ier TOP OUT Waste & Vent Water Pipinq Gas Piping Roof Drain Tub/Shower Test Rouqh Water Heater POOL/SPA P-trap/Drain Line l\Iain Drain/Pool Pipinq Fill Line/Back Flow Pool Heaterlcas Line Miscellaneous Gas Service Water Service Lawn Sprinkler /t .t/),. Sanitary SewerlCao tv tg ?t l)tw2 7 Back FIow Device Rouqh Plumbinq Final Gas Test Meter Release I .-r L I rl^ FINAL 7 b 2 '4kfl,tr Notes, Remarks, Etc.t -= Policy Nurb"r, - O .Expires: _ Numbcr:t! Dale:_ Pernrilee name ( prinl ):_u I