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BUILDING. !NSPECTOR RECORD <br />flev. 0B-07-201 5 <br />SITE.WORK DATE ID/SIG.COMMENTS ()wNt:,R lrtJtt,l)t:l{ t)t),cAl{Al toN <br />I hereby affirnr under penulty of perjury rhat I am exenrpt fronr the (]ontractoB' l-icense Law for the following rcason (5*.?031.5 <br />lJusiness and Prolbssion Codc): Any City or County which rcquires a lrcnnil to construct. allcr, improvc, dermlish or rcpair any <br />stnrcture.pri()r!)its issuance.alsorequirestheapplicantti)rsuchpenDiltolileasi8nedslaterenl thallEorshcislicet€d pursuanl <br />to the f,mvisions of lhc Contractor's Liccnscd [,aw (Chaptcr 9. Comrncncing wilh Scction 700{) ol l)ivision .] ol thc Business and <br />Protts\ions Code ) or thrt he or she is exenrpt lherclrcm ard thc basis fi)r tlE alleSed erenrpliur. Any violatior'lt ,. ti^n 703 1.5 by any <br />ilpplicnnrforapcrrnitsubjeclsthc 0pplicailrtoncivilpenrkyofnot,mrelhxnfivehundreddolhrs($5(xl). <br />_1. as owncr o, thc prolEny, or rny cmployees with wagcs as their elc compnsalion. will do thc work ard the stmluc i\ ml <br />irlentlcd or offererj for ulc (Sc.7o4,{. Busines\ and Pmfassions Cftle: The Conlrilctor's Licensc Law docs nol npply to an owner of <br />thc pruFny wlD hoilds or improves llErNn, md wlD does such work hinlself or herself or lhrough his or lEr own enrpl()yecs, <br />providcd that such improvqrcnls trc ml inlendcd or olTercd lor salc. ll. howcvcr, thc buildiog or improvemnt is sold within one year <br />ofconrpletion, thc Owncr Builddr will hale the burdcn of pmvi[8 lhi[ lE or she diLI nd build or impreve th€ pmpeny for thc purF)s of <br />sale). <br />_1, as owncr ofthc p()pcf,y, am cxclusivcly conlr6cling with licen€d conlraclors to construct lhc projcct (Scc. ?044. Busincss <br />ard hortssiilCode:TheContrlclor'sLicenseLawdr*snotapplytoailownerofpropertywhohrildsoriDprovesthcreon. <br />and who conlracts lor such projccls with a Contraclor(s) liccn$d pursuMt lo the Codraclor's License [aw). <br />-Iamexemptundersecti()n-.B,&P,C,tilrthisreason.I)nle:- <br />WoRKERS' ('0NIP}:NSA'I'IoN <br />I)E('l_ARATION <br />(,nc of thc k)llowing (lcclirrlrurs:I hcrcby atllrm undcr <br />_l have nraintainaCenilicateofConscntt)Sclllnsurefrrrworkers'contpensati<rn,as pnrvidcdfrrrbySeotionJT00oftbe <br />l-rh('r thc performancc ol lhc work lirr which lhc pcrmil is issue(|. <br />thc w{rrk <br />and will maintain workc6' conrpcnsalion inrurance, as required by Sccliol 37m oflhe bkrr Codc, for the pcrfomun-e of <br />lbr which this Frmit is issucd. My workcrs' compcnslrion insurancc caricr anl plicy number uc: <br />CtA TE t-u{o <br />l)olic!2-o?P <br />,z-1 ccrrili thilr ln rhc l-_rfoflunc('()l'lllc work for which this Nrnlil is issucri. I shrll not cmploy any l--rson in any manner <br />so astobcconriubjectlothcworkcrs'conlpcnsalionlaw\ofCrlilbnria,andagrcclhatiflshouldhccortusuhjccttothc <br />&orlicrs' compen\rtion provi\ions ofSection 3700 ofthe hbor Code, I shilll, fonhwith conrply with thos provisioDs. <br />WARNIN(;: I;rilurc !) securc wolkcrs' cr)nrpcnsrtxrn is unlnwfut. an(l sh0ll suhjcct nn rnrt)l()yrr kr (rimrnal lrcnnkics md <br />civil llnes up to one hundred thousand dollnrs (Sl <br />/tu/\ <br />of conrpensatiotr. datrtSes ns provided for th€ <br />Sccli{xr 10?6 t-ahrr iileresl and Vt(L n"su: <br />I hcr!.by allirnr undcr penrlty ol ocrjury lhal I liccnscd undcr prcvision ol'Chxplcr 9 (cornmcncing wilh Scdion 7(XX)) oll)ivision 3 <br />of thc Bu$inoss an(l Prolcssions Codc. axl nrv license is in full li)re and elftct. <br />[-iccnsc <br />_j1 <br />Nu rnbcr:co ,3'(f <br />FLO .4<t b <br />I heEby atlirm under Filallyof perjury thal theE is a constructtnr lerdtl8 agerey for the perfomree of thc work lbr wkqh this Fmit is <br />issucd (Sec. 1097, Civ. C.). <br />l-endcr's Nanrc: <br />lrndcr's A,idrcss: <br />APPI,TCANT DECLARATION <br />I lrrcby affmr undcr penalty ofperjury on. ofthe followi[8 declardtioDs: <br />Dcnrclition Permits-Asbcstos Notification Federal Rcgulations (Title 40, Pa(6) <br />-Requted <br />lf,tter of Notificntion <br />_l .enily lhrt the I'ederal regulatitrrs regudiilS asbcsbr renrcvnl are not npplicrble t, this p(,pct <br />rhrr I this ion and stnte thnl with all Cily.nd County <br />rellrtirg lo eilrer uFn tlE <br />rtxrvc rm'ntioncd <br />r\pplicttrt or <br />Prrmiler nanre <br />lirr <br />tZ-r <br />aild <br />Z/., <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/Vent/l nsu lation t. <br />Roof Sheathinq <br />Shear Wall ./ - 'tJ <br />Framinq <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lt/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />FINAL vllq k7^2 'a^-At.Jr^{zn ) <br />Certificate of Occupancy a DI <br />Notes, Remarks, Etc. <br />z /lz/zt2 -