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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS oWNERBUILDERDELCARATTON r <br />I hqcby affm unde pcmlty of perjury thst I m cxcmpt from thc Contractom' Licere Law for the following rwn (5&.7031.5 <br />Bsin6s and hofsion Codc): Any City or County which rcquirc a pcmit to sEIrucl. alte, improvc, dcmolish or rtpair my <br />structw, prior to its i$umce, also rcquic the applicot for such pcrmit to 6le a sign€d statmat thd hc or she b licscd pwmt <br />to thc pmvisioru of the Contretor's Licensed Law (Chapt6 9, Comnencing with Setion 7000 of Division J of the Busin$ od <br />Prcfsions Code) or that hc or she is cxmpt thftfrom ild the basis for the alleged ermpion. Any violation of Sction 7031.5 by my <br />applicantforaptrnitsubjatsthc applicanttoacivilpenaltyofnotmorcthsfivehundrcddollm($500). <br />__1. as o\lner of the propert),. or my employees with wages as their sole compensation. will do the work and the structure is not <br />interrded or offered for sale (Sec.7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of <br />the property who builds or improves thereon. and who does such work himself or herself or through his or hcr own employees. <br />provided that such improvoncnts are not intcnded or offered for sale. l[, howwer, the building or improvement is sold within one ]Ear <br />of complaion, the Ourner Builder will have the burdcn of proving that he or she did not build or improve the propoty for the purpose of <br />sale). <br />_1. as owner of the propcrty. am exclusively contracting with licensed contractors to construct the projett (Sec. 7044, Business <br />and Pnofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. <br />and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's Liccnse Law). <br />_l am exempt under B. & P.C. for this reason. <br />WORKER,S' COM PENSATIO N <br />DECLARATION <br />I hereby affirm under pcnalty of perjury onc of the following declarations: <br />__lhavcurdwillmintahaCcrtificate ofcoMttoSelf-lNucforworkss'compwtion.c providedforbySction3T00ofthc <br />tabor Codc, for thc pqfoIrmcc of thc wort for which thc pcrmit is isucd. <br />VrZI have snd will maintain workm' cornpcmation imuruce, r rcquired by ss{ion 3?00 of thc Labor Codc, for thc pqfomoce of <br />the work for which this Fnnit is issued My workm' ompcrrarion ireurucc wio and policy numba rc: <br />a n'CG.-t ZtJf t( k <br />3 3 <br />I6?oPolicy <br />_l certify that in the performance of the work for which this perrnit is issued. I shall not employ any person in any manntr <br />so as to become subject to the workers'compensation laws of California, and agree that if I should become subject to the _ <br />rvorkers' compensation provisions of Section 3700 of the Labor Codc. I shall. forthwith comply with those provisions. <br />WARNING: Failure to sccure workcrs' compensation coverage is unlawful. and shall subject an etnployer to criminal petralties and <br />civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. darnages as provided for the <br />Section 3076 of the Labor Code. interest and attorney's fees. <br />a-k rf oir.t4i( ( Va <br />DECI.ARATION <br />I hereby affirm under penalty of pcrjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 <br />of the Business and Profcssions Code, and my license is in full force and effect. <br />Licenseclr"r' ' C (O LicenseNumbcr: <br />3 cr"5 7 {a <br />af)olp'2 -t/1^7 o2 c,('ontractor:* Vr v*t4 5 <br />W <br />I hrcby alfim undo pcnalty of pcjury that th6c is I @retrucliof, lcnding agmcy for thc pqfommcc of thc mrk for which this pqrnrt b <br />isucd (Se. 3097, Civ. C.). <br />Lender's Narne: <br />Lcnder's Address: <br />APPLICANT DECLARATION <br />I hoeby aff:nn under pcnalty of perjury one of the followrng declarations: <br />Dernolition Permits-Asbcstos Notification Federal Regulations (Title 40, Pan6) <br />_Required l.€lter of Notification <br />_l ccrti& that the federal regulations regarding asbestos rcmoval are not applicablc to this project. <br />llv I ceflify that I have read this application and state that the above infonnation with all City and County <br />and County to ent€r upon theordina-nces and State Laws relating to building construction. and <br />-/al c <br />Pcrmitee nlrnre <br />t <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />S u bfloor/VenUl ns u lation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Jlqqd Zqne Certif I t\ <br />k*lto V['.r I q Nco VVtrlv,(u6 <br />I trt t Cr/ <br />FINAL A/U/{-Ig7YI W )avu <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />Section <br />Dete:_Owner:_ <br />ffi::ff:ffi-i'