HomeMy WebLinkAboutProject Declaration-v.4-6 9.3.21Hawaiʻi County is an equal opportunity provider and employer
Project Declaration
Last Updated: 9/3/2021
TMK Project Location Application#
Project Includes: (NOTE: Electrical drawings required for residential work involving > 200 Amp Service)
Building Work Plumbing Work
4 bathrooms or more
Electrical Work
>200 Amp service
Valuation of Building Work Valuation of Plumbing Work Valuation of Electrical Work
STATEMENT ACCOMPANYING PERMIT APPLICATION PURSUANT TO CHAPTER 444, H.R.S. (RELATING TO CONTRACTORS)
(SEC 444- HRS) (Select Contractor or Owner-Builder)
CONTRACTOR
I declare that I am licensed under the provisions of Chapter 444, HRS, of the Department of Commerce & Consumer Affairs,
State of Hawaii. My license# is in full force and in effect.
Signature of RME Date
NOTE: RME (Responsible Managing Employee) only to sign. Notarized authorization from RME required for designated
agents.
Building Contractor Name License #Lic. Expiration
Date
Phone#
Address
RME1 Full Name RME2 Full Name
RME1 Work Phone RME1 Cell Phone RME2 Work Phone RME2 Cell Phone
RME1 Email Address RME2 Email Address
OWNER-BUILDER
Section 5-1-5 Definition “Owner-builder” means owners or lessees of property who build or improve structures on their
property for their own use, or for use by their immediate family. This definition shall not preempt owner-builder by exemption
as defined by section 444-2.5, Hawai`i Revised Statutes
I declare an exemption under Sec. 444-2(7) for the following reasons:
1) This exemption allows me, as the owner or lessee of the property, to act as my own general contractor without
possessing a license
2) To supervise the construction myself
3) To hire licensed subcontractors
4) The building is for my personal use and not for the use or occupancy by the general public
5) Building will not be built for sale or lease within one (1) year after construction is complete.
Section 5-4 Definition “Owner-builder” means owners or lessees of property who build or improve structures on their
property for their own use, or for use by their immediate family. This definition shall not preempt owner-builder by exemption
as defined by section 444-2.5, Hawai`i Revised Statutes
Property Owner
Owner Name Owner Signature Date
Hawaiʻi County is an equal opportunity provider and employer
TMK Owner Name Application#
Where electrical or plumbing is included, applicant must identify all phases of such work to be covered and the contractor
completing the phase. Refer to back side of this form and mark all phases of electrical and/or plumbing work to be included.
Contractor
Name
License #Lic. Expiration Date
Work Phone Cell Phone Phase(s)
RME1
Full Name
RME2
Full Name
RME1 Work Phone RME1 Cell Phone RME2 Work Phone RME2 Cell Phone
RME1 Email Address RME2 Email Address
Signature of RME Date
Contractor
Name
License #Lic. Expiration Date
Work Phone Cell Phone Phase(s)
RME1
Full Name
RME2
Full Name
RME1 Work Phone RME1 Cell Phone RME2 Work Phone RME2 Cell Phone
RME1 Email Address RME2 Email Address
Signature of RME Date
Contractor
Name
License #Lic. Expiration Date
Work Phone Cell Phone Phase(s)
RME1
Full Name
RME2
Full Name
RME1 Work Phone RME1 Cell Phone RME2 Work Phone RME2 Cell Phone
RME1 Email Address RME2 Email Address
Signature of RME Date
Contractor
Name
License #Lic. Expiration Date
Work Phone Cell Phone Phase(s)
RME1
Full Name
RME2
Full Name
RME1 Work Phone RME1 Cell Phone RME2 Work Phone RME2 Cell Phone
RME1 Email Address RME2 Email Address
Signature of RME Date
ELECTRICAL PHASES
PLUMBING PHASES
E1 Temporary Installations
E2 Service Equipment HELCO
E3 Feeder Wiring
E4 Branch Circuit Wiring
E5 Electrical Equipment Installation
E6 Device and Fixture Installation
E7 Fire Alarm System
E8 Swimming Pool Wiring
E9 Solar Water Heater Wiring
E10 Landscape Lighting and Sprinkler Wiring
E11 Sign Installation Connection
E12 Alt. Energy Installation (PV/Wind/Generator)
E13 Low Voltage Wiring/Audio Visual/
Data Communication/Computer Wiring
E14 Air Conditioning/Refrigeration Control Wiring
E15 Motor Installation
E16 Street Lighting/Traffic Signal Installation
E17 Empty Conduit Installation
E18 Site Work Utilities Installation
E19 As Built/Work Started Without Permits
E20 Demolition Work
P1 Temporary Water
P2 Plumbing Fixtures, Equipment
P3a Sanitary Piping System (Interior)
P3b Sanitary Piping System (Exterior)
P3c Grey Water Waste System
P3d Sewer Lateral Connection
(Including Interceptors, Clarifiers)
P3e Private Individual Waste System
(Including Interceptors, Clarifiers)
P3f Private Wastewater Treatment Plants
P4a Water Distribution System (Interior)
P4b Building Supply (Outside Water Piping)
P4c Water Distribution Main (Subdivision, piping)
P4d Water Equipment – Backflow Preventer,
Pressure Regulator
P4e Water Tank – (Pump/Filter/Water Treatment)
P4f Non Potable Water Distribution
P5a Automatic Fire Sprinkler System (except water
supply)
P5b Water Supply for Fire Sprinkler System
(Cross Contamination)
P5c Standpipes
P6a Fuel Gas Piping System and fittings
P6b Gas Appliance
P7a Solar Water Heating System (Except Water
Supply)
P7b Solar Water Heater – Water Supply
P8 Irrigation Sprinkler System (Cross Contamination)
P9 Swimming Pool – Potable Water Supply,
Sanitary Drainage, Backflow
P10 Air Conditioning – Water Supply,
Including Backflow Preventer
P11 Alt. Energy (Heat Pumps, PV Hot Water)
P12 Medical Gas System
P13 Gas Station Piping
P14 As-Built