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PLUM BING.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER I)ELC/IRATION <br />I hcrcby offrm undcr pcmlty of pcrjury that I m cxempt &om thc CoilrsdoB' Lic!trs lrw for the following rcen (S:cc.7031,5 <br />Business and Proftssion Code): Any City or County which rcquircs I Imit to @nstruct, sltcr, imprcre, demlish or rcpsir rny' <br />structre. [rbr to its issume, ds rcquircr thc applicml for sEh pcmit to tih r signcd ststcrcnt thrt lE or slE b licen$d pusunl <br />to thc lrcvisions of the Contrrctor's Lkensd trw (Chapter 9, Comming with Setion 7(m of Divisbr 3 of thc Busires ud <br />PrcfcssionsCodc)orthsthcorshcisexemptthrefmmandthcbasisforthcallcgcdcrcmptio[ Anyviol{tionofSstionT03l.5bysny <br />applicant for r tErmit subjcts thc rpplic8nt to r civil pcElty of rcl mrc lhu fivc hundrcd dollus (5500). <br />-1, <br />as owncr of the propcrty, or my employees with wagcs as thcir sole compensation. will do thc work and the stnrcturc is not <br />intendctl or offcrcd for salc (Sec.7044, Business and Professions Code: The Contractor's Licensc I-Bw does not apply to an owner of <br />thc propcrty who builds or improws thcreon. and who docs such work himself or hcrsclf or thmugh his or hcr own employees. <br />providcd that such improvcnrcnts arc not intcndcd or offcred for salc. If, howcver. thc building or improvcnrent is sold within onc )car <br />of comphtion, thc Owner Builder will have the burden of proving that he or shc did not build or improve the propeny for thc purpose of <br />sah). <br />-1, <br />as owncr of thc propcrty, am cxclusively contracting with liccnscd conlractors to construct thc projcct (Sec. 7M4. Busincss <br />and hofcssion Codc: The Contraclor's Licensc Law docs not apply lo an owner of proprty who builds or improves thercon. <br />and who contracts for such proicts with a Contracto(s) liccnsed pursuant to lhc Contractor's Licensc kw). <br />-IamcxcmptunderSection-'B.&P.C.forthLsrcason.Il., r ^. <br />WORKT' RS' COMPENSA TION <br />DECLAITATION <br />I hercby aff-um undcr pcnalty of perjury one of the following dcclarations: <br />-l <br />have and will maintain a Certificate of Consent to Sclf-Insurc for workers' com;rcnsation. as provided for by Sc.ction 37fi) of the <br />Labor Codc, for thc performance of thc work for which thc permit is iszucd. <br />-l <br />havc and will maintain workers' compensation insurarrce, as rcquired by Section 3700 of the l-abor Code, for the perfonnance of <br />the work for which this permit is issued. My workers' compcnsation insurarrce carrier and policy numhr are: <br />Policy Numbcr: Expires: <br />-l <br />certify that in thc grcrformancc of thc work for which this permit is issucd. I shall not cmploy any pcrson in any rmnncr <br />so as lo bccornc subpct to the workers'compensalion laws of California, and agrcre that if I shcluld becornc subict to the <br />workers' comlrcnsation provisions of Scction 3700 of the l",abor Code, t shall, forthwith comply with thosc provisions.. <br />WARNING: Failurc to sccurc workcrs'comFrensation covcragc is unlawful, and shall subict an cmploler to criminal pcnaltics and <br />civil lincs up to onc hundrcd thousand dollars thc cost damages as providcd fior the <br />Scclion 3076 of L:bor intcrcst and altorrrcy's <br />I hercby aflirm under penalty of perjury that I am licenscd under provision of Chaptcr 9 (comnrcncing with Sc'ction 7000) of Division 3 <br />of thc Busincss and Profcssions Codc, and rny licensc is in full forcc and effect. <br />Liccnsc <br />W <br />I lmby dFrm unds pcmly of Frjury that thsc is a @NIructbo lmding agmy for thc Frfotlffic of lhc wt br whi:h thb Fmt it <br />tusucd (56. 3097, Civ. C.). <br />lrndcr's Naurc: <br />Lrndcr's Addrcss: <br />APPLICANT DECI ARATION <br />I lrcrcby atlirm undcr pcnalty of pcrjury one of thc following declarations: <br />Dcmolition Pcrmits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Part6) <br />_Rcquircd lrttcr of Notifrcation <br />-l <br />ccrtify that the federal regulations rcgarding asbcstos renrcval are not applicable to this proi'ct. <br />_l ccrtily that I havc read this applicution and statc that thc infornution is corrcct. I agrcc to comply with all City and County <br />ordinances and State [:ws rclaling to authorizc reprcscntativcs of this City and County to cntcr ugnn thc <br />abovc nrcntioncd propcrty for <br />Applicant or Agent <br />Permitee <br />*r", 7,/, - /r <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line B-Q-zt t ll, <br />l\Iain Drain/Pool Pipinq 3-1-?Irzsn4 <br />Fill Line/Back Flow Z -Q -?l / <br />/-{a, <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary SewerlCao <br />Back Flow Device <br />Rough Plumbins <br />Final Gas Test <br />Meter Release <br />FINAL loa \-2,t 9-{' {+ <br />Notes, Remarks, Etc <br />Carricr:- <br />W