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PLUMBING-INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION I hcrcby alfim urdcr pcmlty of pcdury ihat I m cxcmpt fmm thâ‚¬ ContrlcloE' Licemc Lsw for rhc following @$n (5&.7031.5 . Bugines and Pmfcasion Codc): Any City or County which rcquircs a pcrmit to mNtnrct, altc, impmvq &mlish or rgrair Cn1 structurq prior lo its imare, alrc rcquircs thc applicant for ruh t,mit to lilc 8 signc{ statclmt that h or chc k liccnrd purguanr to lhc ltrovlrhN of thc Contnctq's Liccnsed Lsw (Chaptcr 9, Commcrcing with Sation 7fi)o of Division 3 of thc Businesr and Pmfcssions Codc) or thrt hâ‚¬ or shc fu excmpt thcG&om and the b&!is for thc allcgcd cxcmption. Any violation ofsction 703 1.5 by any applicant for a pcmil sbjcts th. alrplicant to 8 civil pcmltyof mt mrc than fivc hundrcd dollm (15fi)). -1, as owner of the proF,erty, or my employees with wages as their sole compensation, will do the work and the structure is not interded or ofFered for sale (Sec.7044, Busirrcss and Professions Code: 'l'he Contraclor's License l-aw does not apply to an ou'ner of the proyrcrty wtn builds or impmves thermn, and wlrl does such work himself or herself or through his or her own employees, provided that such improvernenls are not intended or offered for sale. l[, lrcwever. the building or improvement is sold within one ]â‚¬ar ofcompletionr the Owner Builder will have the burden of proving that he or she did rnt huild or inpmve the progrerty for the purJnseof sale). -1, asownerof the property, amexclusivelyconlracting u'ith licensed contraclorsto construct the pnrject (Sec. 7M4, Business and Pnrfesskrn Code: 'l'he Contractor's License Law does not apply lo an owner of property who builds or improves lhereon, and who conlracts for such projects with a Contractor(s) licensed pursuant lo the ('ontractor's License Law). _l am exempt under Section_, U. & P.C. lirr this reason. l)alc ( )u rrer' IVORKERS' CONI PENSATION DECLARATION I hereby alTirm under penalty of perjury one of the following declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for workers' conlpensation, as pnrvided for by Section 3700 of the Labor Code, for the performance of the work for which the permit ls issued. -l have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the perftlrmance of the work for which this permit is issued. My workers' compâ‚¬nsation insurance carrier and plicy number are: ,t-l A 0s tr. rsat\e)P>F (tr)Lfi L-\ \ rrd co j u>t st L k +o-Zol1Policy -l certify that in the performance of the work for which this permit is i.ssued, I shall not employ any person in any manncr so as lo become subject to the workers'compensation laws of California, and agree lhat if I stnuld trcorne subject to the workers' compensation provisions of Section 3700 of the Lahor Code, I shall, forthwith comply with those provisions.. WARNING: l;ailure lo secure workers'compensation coverage is unlawful, and an employer to penalties and civil fines up to one hundred thousand dollars (S100,000). in addition to the cost provided for tlre Section 3076 of the Labor Code, interest and attorney's fees. o^tu, ' 1'? 5-2 olert UUCLAn {.rrON I herc'by alfirrn under penaltyof perjury that I arn licensed under pmvision of Chapter 9 (commencing with Section 7000) of Division 3 of the Busincss and Pnrfessions Code, axl my license is in full force and eflect. a z3U 6 License n",.,' Lt-25-24? W I hercby aflirm undcr [tmlty of Frjury thst thft is 8 @ritruction lcnding agcrcy for the pcfomrce of thc m* ft,r which this lEmit ig isrucd (S@. 3097. Civ. C.). Lender's Name: Lender's Adclress: APPLICANT DECLARA'I'TON I hereby aflimr under penalty of perjury one of the ftrllowing cleclarations: Denxrlition Pernrits-Asbestos Notification l;ederal Regulations ('l'itle 40, Pnrt6) _Required [.ctter of Notification removalare nol applicable to this project. with all City and County and County to enter uynn the above nrentioned prnperty for Applicant or Agent Date: I L4 - LS_ 7 Qt1 l'ertnilee n:rrtr0 is UNDER GROUND Waste & Vent ql,a /r t hilrbt Water-Under floor .lit lt4 il,*lzrri Gas-Underfloor Building Sewer Area/Storm Drain I nterceptor/ Clarifier TOP OUT Waste & Vent Water Piping Gas Piping Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Piping Fill Line/Back FIow Pool Heaterlcas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary SewerlCap Back Flow Device Rough Plumbins Final Gas Test /b - l/-t g DC}r!? lo) Meter Release 7â‚¬8 zt ?L2r t l41A M_/ FINAL l'Z-?oU tLcte,)e,,n*Lt7 RemaNotes rks, Etc. -+ DDD^â‚¬D