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BUILDING. INSPECTOR RECORD <br />flev. 08-07-20 1 5 <br />SITE.WORK DATE ID/SIG.COMMENTS oWNI.]R BI.'II,DI]R I)T]I,CARATIoN <br />I herehy affirnr under penalty ofpcrjury rhat I am exempt fronr the CbntractoB' l-icense Law for the followinS reasn (sec.7031.5 <br />Busincss and Prolession Codc): Any City or Counly which rcquires a fErmit lo construcl. altcr. irnprove. dcmlish or rupair any <br />stnlcturc,pri()rk)its issuance.aLsorequirestheapplicantli)rsuchpernriltofileasigledshlemeill lhatheorsheislicensd pursuanl <br />lo lhc previsions of thc Contractor's Liccnscd lrw (Chaptcr 9, Commcncing with .Scclion 7OD of I)ivision 3 ol-lhe Business and <br />ProlcssicusCorle)orthrttDorsheisexenpltherefrcmandthebasisfbrlheallegedexemption. AnyviolalionofSectionT0Sl.5hyany <br />rpplicant for a pcrrnit sub.jecrs lhe npplicrnl to a civil pen.lty of not rmre thatr fivc hundred dolinrs ($5{x)). <br />_1. a\ owncr ol thc profEnv, or my cmployecs with wagcs as lhcir solc cornpcnsation, will do thc work and thc stMlurc is ml <br />intenderl orofferedtorsale(Sa.7(X4,BusircssnndProfessionsC(xle:TheConlrac$isLicenseL{wdoesnolspplybanownerof <br />thepn)peny wlx)tnildsoritrprovcsth€Bnlilf,lwk)d(EssuchworthinNelforlErseltorthroughhisorherownemployees. <br />providcdlhalsuch improverrcntsecnotintendedorollcredlbrsalc.lllhowevcr.thehuildingorimprovemntissoldwithinoneycar <br />ofcompleli)n, (hc Owrer Buikler will have ltE burden of pmvirg thilt lE or she did mt build or inpn)ve the pmlE(y for ttu purlbs of <br />sule). <br />_1, is owncr of lhe pn)peily, am exclusivcly contrncting wilh ficetrsecl conlrack)rs h con\lnrcl lhc pm.ied (Sec. ?(X4. Business <br />ail I\rllrsirrrCorje:TheC(,nlracl.,r'sLicensel-awdoesnotapplyloanownerofProprnywhohuildsorin)provcsthere{n. <br />and who conrrds frrr such proi.cls wilh a Ci)nlrackr(s) liccnsc(l lursuint kr lhc Conlraclor's l-iccnsc l-aw). <br />-lamexemptundelseclion-'B.&P,c,lbrthisreason.n--... <br />W()RKllRS' ('()l\II'llNSA l l()N <br />I)}:CI,AR.\TI0N <br />t,f thc loll()winS (l(.clarnli(,ns:I hcrchy allirm undcr pcnahy of <br />_l hive an(l will a('enilicateolConserttoSelf:lnsurelirworlers'conlxnsatirn,as providedtbrhySecli()n:l700oflhe <br />l-atx'r Cotlc,oflhc work lor which thc pcrmil i\ issucd. <br />and rcquircd by Seclion 3?00 of th€ Labor Code. f(tr the perfomrec of <br />lhc work li,r insurancc crrricr anl Jxrlicry nutrrhcr iu'c: <br />/ttI'olicy i/t-[ '[ ' <br />_l ccnily thar in thc Nrtbrnuncc of lhc work li,r which this prnrit is issucd. I shilll not cnrploy any Frson in any nranncr <br />so as lo bccorrc suhjcct to thc work('rs' conrpcnsatiotr hws o[ Calilbrnia. rnd agrcc that if I stnuld bccorrc suhjcct to thc <br />worliers' (oilpensaiion prcvirions of Section 3700 of the Labor Code, I rlurll, fonhwith conrply with tlrc* provisions. <br />WARNINC: Failurc k) securc workcrs'c{,nrf[nsati(]n covcrrgc i\ unhwtul, rn(l shall subjr.ct an cmploycr k) rinrnal Fnaltics ud <br />civil fines up t) one hundrcd thousud dollnrs ($l(x).(XxD. in rddition to lhe gp\t of conrpcnsalion, damagcs as providcd for lh. <br />Scclit,n :1076 Lahrr <br />I hcrcby al lirm undcr r..nalty ol pcrjury rhrt I arn liccn$d undcr provision ol Chaplcr I lcornrrcncing with Secthn 7ilX)) ol l)ivision 3 <br />of thc Busincss and Professions Cotlc. mrl my licensc is in full t()rcc m(l clTcct. <br />I-iccn\('Nu n1&'r: <br />I heroby alllrm under ltDalty of periury tlut ihere is a con$ntction <br />issucd {Scc. .1097. Civ. C.). <br />l-endcr's Naille: <br />aSeNy tbr the perlirrnunce ofthe work fbr which this pernlit i\ <br />l-cn{lcr's A(ldrcs\: <br />APPI.ICANT DE('I,ARATI0N <br />I h.rebyaffmr under penalty of perjury one ofthe following declarations: <br />l)emolition Permits-Asbellos Notification Fetleral Regulatiorrs (Tirlc 40, Part6) <br />_Required ktter of NotilicatioD <br />_l cenily tlnl the li\leral re8uhti(rls reSrtrdinB ashcsbi re nx)vnl are nrn upplicxble k) this prqecr. <br />5r ren(l Lhi\ rpplicilioD ilrrd stile thill the ntbve inilrnrnlion i\ correcl. I n8r!e to complv with illl Cily ilnd (ounty <br />trws rehrrg to huillirrg construclrrrn.:-0propcny lirr inspection <br />Applicrnt <br />I'rnDilcr <br />Ag(Dt <br />aulif,)ria rcpreseDlalivcs ofthis City and <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor I <br />Subf loor/VenVl nsu lation t^l tl 4 <br />Roof Sheathinq Al'll'/{//u lMrfrt ,t$g <br />Shear Wall t- I <br />Framinq <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />ft/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif. <br />II Ar frh <br />F!NAL UWilTX qqlM <br />Certificate of Occupancy I , <br />Notes, Remarks, Etc. <br />I