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()\l NItR Irt jil,t)t.:tr <br />IhercbyrffirnrunderpeDulryofperjLrrythatInnrexenrptf()orthcContractors l-icetrsel-awforthefollowingreasoD(Sec.70Jl.5 <br />llusincss rnd Prolession Codc): Any City or County which rcquires a pcfinit lo conslnrcl. altcr, irnprove. dcmolish or re*pair any <br />stnrcnrre. pri{rr k) ils issurnce. rNo requires lhc applicant ti)r such Frnil k) file a si8ned slalemnl lhal IE or she is liccnsed pursuanl <br />to lhc pmviNions o[ the'Contraclor's l,iccnscd ltrw ichaptcr 9. Comnrcncing wilh Scction 7(Xn ol l)ivision 3 ol thc Busincss and <br />Proltsx)ns [irde) or that he or \he is crenrpl thcrcfionr arrd the hasrs lirr thc alleged cten)ptiul. Any vi(,lrti(nl ofSecti(n 703 L5 by any <br />rpplicrDtli)rrpcrmitsuhjcctsthe npplicanttoocivilpenrltyolnotnnrethilnllvchuDdrcddollilrs($5{}0). <br />_1. as own!'r ol'thc proFnv. or rny cmphyacs with wagcs as thcir sr)lc cornpe nsrlion, will do the work and thc structrtrr is not <br />irilekled oroflere(lforMle(S{.7(X4.BusirEssn0dPft)fessiorsCr{c;'l'heConlrnrlor's[-icenelawdrrcsnotrpplytosDo$rerof <br />thepr)pcny wlx)build\orinpnrvcstlErdnr.rrklwlx)dessuchworlhinrsellorhrrsclf(,rthroughhisorlErowtremployees, <br />pro!idtdlhnlsuch improvcnrnlsucmtinteftL'dordllaredldrsalc. II.howcver.lhct{i}lingorirnprrvcrmntir$Hwithinonc}trr <br />ofconlplctlrr. the Owner Builtlcr will hnve the burden of provir)g lhat lE or she diJ not build or rmp()ve thc p()pe(y for the purlhsc of <br />sale). <br />_1. ns owner ofthe property. rm crclusi\ ely conlrilctinS with liccn\cd c()nlrack)rs to conslrucl the projert (Sec. 7{X.1. Businerr <br />aril [\r)llssln) C(,dc: The Coltracttrr's License l-!w d(,es ilol apply lo xtr owner ()f DroJrny who huilds or inrproves thcreotr. <br />and who c(,nlncts for such proiccts with a C()ntrdc!)(s) liccns(l pur\uMt o llf,: (])ntrrdor's Liccnsc tjw). <br />WORKI.IRS' CONIPI:NSA'IION <br />DECI,i\RATI()N <br />I hcrcby xllirm undcr pcnxhy of pcrjury onc ol thc lollowing dcclarali(,ns: <br />Lala)r C(xlc. I'or lhc pcrfonrurncc ol'thc work litr which thc pcflnit ir issucd. <br />(;haverndwillnuinrainworkers conrpensatirrrinrurance,as requiredbySectir)n]TmoftheLaborG)de,fortheprtirrnurreeof <br />wrnk nn whi(h Ihis ir My wrtrkcrs'compcnslti()n uNurrncc canrcr anl yrhcy nunrhcr irc: <br />I'olicy <br />_l cciity lhrt in thc prrli)rnuncc r)l lhc work tir which this pcr rtil is rssucd, I shrll oot cnrploy any prson in any nrunncr <br />$ as to k(eo[r suhjcct to thc workcrs'conrpcilsrriotr law\ ol ('rlili)firir, nnd agrc. thrl i{ l should hcconr suhjcct to thc <br />workers'cotrllEilsntionprovisionsofSection3?00oftheLrthr(i)d.,lshnll,fbnhwilhcornplywithtlDel)rovisions. <br />WARNING: l:rilurc (] sccurc workcrs'conl)cnsrtron covcragc is unlawful, nn(l shrll subjcct an cnrl)k)ycr to oinrinrl l{niltics and <br />-Iilnlexenl|nunderSecritll-'B-&P,c'hlfthisreasotr, <br />civil lines up o one hundred lhousud dollrrs lo lhc <br />Sectrrn ('l rhe C(xle. irilerest and atk)rrey s <br />I hcrcby al lirrn undcr p('nalry ol pr'rjury thal I nm liccnscd <br />of rhc llusincss rnd Prolcssions Codc. ifrl nry liccnsc is in full lincc aftl ctftcl. <br />l-cn(lcr's A(kIcr\: <br />Applicailt or Agcnt <br />I'(rDrile( nunx. <br />dxnhges ns provided lbr lhe <br />Chint(r(, (cornrncncing with Sccrion 7(l(X)) ol l)irision 3 <br />LLicc'nsc <br />CONS'I'RTICTION T,]:NI)ING AG}:NCY <br />I herehy allirnl under Fnahy of perjury that lhere is a c(xrstnrcrr()n brxlirrg agcncy lirr thc perfomrrce of the work ,br which lhis FEmrit is <br />issuctl (Scc. .1097, Civ. C.). <br />Lcndcr's Nilnrc: <br />APPLICANT I)ECI,ARATI()N <br />I hcrcby rflirnr under penalty of perjury one of th€ followinS declilrat i(,trs: <br />Den)olition Peflnils-Asbe\tos Notification Firleral Regulatirns (Tille.l0. Pilft6) <br />-Re(luired <br />lf, lter of Notifiaaliu) <br />_l cerlity lhilt the t-edernlregulnti(n[ re8ardiIS ilsbcsk)s rcnxrr'rl urc not applicable to t[is proiect. <br />onlin!rrlcs rrxj Strle Lilws relrlirg to huildrnS iulilldherrhyaulhorizcreprescDlrlivesoflhisCilyundCounlylocnrcrulx[llr <br />rh)\c rrntir)nc(l proplnv lil <br />,,,",$llql'1,6m <br />COMMENTSS!TE.WORK DATE !D/SIG. <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/VenVl nsu lation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Enerqv <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lttlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />nqb< k,FINAL UD ./1/b 'ht ) <br />Certificate of Occupahcy 1J -) <br />-v <br />Notes, Remarks, Etc. <br />Rev. 0B-07-201 5 <br />BUILD!NG. INSPECTOR RECORD .<