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owNI,lR Btilt,l)t]R t)Et,cARA'tloN <br />I hereby affirnr undcr penahy of pcrjury thal I am exempt from the ContracloB l-icense liw for th. followin8 rcason (Se.70J1.5 <br />llusincss and Proltssion Codc): Any City or County which rcqutcs a pcflnit to conslruct, !hcr. improve, dcrmlish or rcpair any <br />stnrcturc. prior k) its issuance. aLso requircs the applicant tbr such p€rnrit rc file a signed stxtercnl that lE or sh. is licensed put$ant <br />to lhc provisionr of thc Contractor's l,icensed lrw (Chapter 9. Commcncing with Seclion 7(XXl ol Division J ol lhe Business and <br />ProtcssionsCode)orrhatheorsheBcxempttherefiomaDdthehlsislbrtlpalle8edexemptiul. AnyviolalioilofSectionT03l.5byaily <br />rpplicinr for a fEnnit subjecrs the npplicant lo n civil penAlty of not rmre lhor five hundrcd dollars ($500). <br />_1, as owncr ol thc prolEny, or rny crnployccs wilh wagcs as lhcir $lc cornpcnsatiru. will do lhc work and thc strcturc is mt <br />irilended or offered for sAle (S{.7(X4, Business lnd PmfessioDs Code: TID CoDlraclor's Liccnse l-tw does nol apply lo an owner of <br />the ptr)pc!1y wh) builds or inrprows thersD, drd wln dNs such wrrk hinrselfor krsel[or through his or her own employees, <br />prr)\ idcd rhat such improvemils trc ml inlcnded or ollcre-'d lor sl('. II. however. rhc huildinS or irnprovcmnt is sld wirhin onc )far <br />ofcon{rlerbn. thc Owrrr Builddr will h{ve lhe hurdcn of pmvirS t[u{ lE or she did B{ buikl or irpmve the pmpcny for rhe purps. of <br />_1. ns owner ofthe properly, am exclusivcly contracting with licensed conlrnck)rs to conslrucl llr projecl (Scc. 7(X4, Busincss <br />arxt PrrllssknCode:ThcContrrctor'sLiceuscLuwdoesnotapplytoanowDerol'propef,ywhobuildsorinrproleslhercon. <br />and who contrncts for such proiccts with a Conrraclor(s) liccn$d pursumt to thc Contractofs Licc[ie ljw). <br />-IJnrexemPlutrdersccti()n-,B,&P.C,li)rthisreasoll, <br />itiur lo lhc (osl of <br />tv()RKt:Rs' ( r)l\tPENsA'il()N <br />l)ECI.ARi\TtON <br />hy Scc(ion 3700 oflhe <br />for thc pedornurrec of <br />(\zo <br />_l ccllify llHt in thc trcrtbrnfincc ol'lhe work Ii)r which (his l)cril)il is issuc(|, I slull not cnrt)l(,y {ny person in any nranner <br />so rs to hccoDrc subjcct to lhe workcrs'cotrlpctrsariotr law\ ol'Cnlilbnlia. and ilgrec lhnt il l should bccorrc suhjccl to thc <br />trorLcrs conrpcnsarionprovisionsofSection3TU)oftheLrbor(-(xle,lshill,fo(hwithcon)plywithllD*provisions. <br />IVARNING: Failurc o scure workcrs' compcnsati()n is unlawful. uml shall subject an k) oimindl FEuh s ud <br />civil llnes up h one hundred lhousilnd dollnrs ($l0l),{Xx)). <br />Secti()n 1076 of the l-atxrr Cotle, inerest and atl()rney s fees. <br />damtrgcs xs providcd foa lhe <br />I <br />-/no,u,? /LO|ZO l.l( llNsl:l) ( ()N'rR.\("f()R <br />I)t.t( t,,\R,\t toN <br />I hcrchy alliflnund.r pcnakyol pcrjury that I drn liccnsc'd under p(]vision ol Chnplcr 9 (conrmcncing with Scction 70(x)) ol l)ivisir)n l <br />ol thc Busincss ud Protlssions Co(lc. of,d nrv liccnsc is in full 1i)rco and cll'!'ct. <br />L Numlt r:"- 7\ <br />2--ztzo <br />CONSTRTICTION I,I]NI)IN(J AGENCY <br />I hcrehy nlilrnr undcr Fnahy of Frirrry thal lherc is r constmcttrn lc[diDg agcncy titr the perf()rnunce ot the work li)r which lhis pernlit Ls <br />issuc(l (Scc. 3097, Civ. C.). <br />l.trdcr's Niln1c: <br />hn(lcr's Addrcss: <br />APPLICANT DECLARATIoN <br />I hercby affm)uDder penalty of pcrjury one oflhc following declarations: <br />Denrlition Permirs-Asbcslos Ndification Federal ReSulalion5 (Tillc 40, Pan6) <br />-Rcquired <br />[ttter of Notification <br />i()ns regdding ashcstos rcnf,)val are not applicahlc to this proi*t. <br />and stitc thal the rbovc irfornMlion <br />1 <br />ulx)vc nrcnli()ne(l p()pcdy li)r <br />or Agctrt <br />naDl( <br />coNlrucli(n! ard herehy <br />i\ corecl. I aSree to comply <br />represeilalives of this Cily <br />with all Cily and County <br />and Counly to entcr uF)n lhc <br />z- -?-o ^z.o <br />SITE.WORK DATE ID/S!G.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsu lation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />[t/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputv Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />I <br />9l<l7o DkflCc L*nFINAL <br />Certificate of Occupancy ItI <br />Notes, Remarks, Etc. <br />Rev.0B-07-2015 <br />BUILDING. !NSPECTOR RECORD