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Home My WebLink AboutBLG_Project_Declaration_051620Hawaiʻi County is an equal opportunity provider and employer Page 1 of 3 Project Declaration Last Updated: 5-1-2023 TMK Property Owner Name Permit Number Project Includes: ☐Building Work ☐Plumbing Work ☐4 bathrooms or more ☐Electrical Work ☐over 200 Amp service STATEMENT ACCOMPANYING PERMIT APPLICATION PURSUANT TO CHAPTER 444, H.R.S. (RELATING TO CONTRACTORS) SELECT BUILDING/GENERAL CONTRACTOR OR OWNER-BUILDER ☐BUILDING/GENERAL 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 or Sole Proprietor Date NOTE: RME (Responsible Managing Employee) or Sole Proprietor, is required to sign. Building/General Contractor License Name License # Lic. Expiration Date Phone# Business Address RME Full Name RME Work Phone RME Email Address RME Cell Phone ☐OWNER-BUILDER Section 5-1-5 Definition “Owner-builder” means owners or lessees of property who build or improve buildings or 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. Property Owner Name Property Owner Signature Date Hawaiʻi County is an equal opportunity provider and employer Page 2 of 3 TMK Property Owner Name Permit Number LIST ALL SUBCONTRACTORS Where electrical or plumbing work is included, applicant must identify all phases of such work to be covered and the contractor completing the phase. Refer to page 3 of this form for a reference list of all phases of electrical and plumbing work. Contractor License Name License # Lic. Expiration Date Work Phone Cell Phone Phase(s) – See reference lists on page 3 of this form. RME Full Name RME Work Phone RME Email Address RME Cell Phone Signature of RME or Sole Proprietor Date Contractor License Name License # Lic. Expiration Date Work Phone Cell Phone Phase(s) – See reference lists on page 3 of this form. RME Full Name RME Work Phone RME Email Address RME Cell Phone Signature of RME or Sole Proprietor Date Contractor Name License # Lic. Expiration Date Work Phone Cell Phone Phase(s) – See reference lists on page 3 of this form. RME Full Name RME Work Phone RME Email Address RME Cell Phone Signature of RME or Sole Proprietor Date Contractor Name License # Lic. Expiration Date Work Phone Cell Phone Phase(s) – See reference lists on page 3 of this form. RME Full Name RME Work Phone RME Email Address RME Cell Phone Signature of RME or Sole Proprietor Date Hawaiʻi County is an equal opportunity provider and employer Page 3 of 3 ELECTRICAL PHASES LIST IS FOR REFERENCE ONLY. WRITE PHASE(S) WITHIN SUBCONTRACTOR’S SECTION ON PAGE 2. PLUMBING PHASES LIST IS FOR REFERENCE ONLY. WRITE PHASE(S) WITHIN SUBCONTRACTOR’S SECTION ON PAGE 2. 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 Wiring Security System Wiring 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 P5c Standpipes P6a Fuel Gas Piping System and fittings P6b Gas Appliance Qty P7a Solar Water Heating System (Except Water Supply) P7b Solar Water Heater – Water Supply 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) P13 Gas Station Piping P14 As-Built