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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />S u bfloor/Ve nU I ns u latio n <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy l1 I r, <br />Drywall '^lqll'uln 'ti(ffi <br />Ext./lnt. Lath I I t <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />f,t <br />FINAL 5. 10'?070 0WAgtr <br />Certificate of Occupancy <br />AEtc. <br />lh/dcy IL 7 l <br />YIb/NfrO -,' <br />i her'eby affrrm undcr penalty cf perjury that I am exempt frorn the Contractors' License Law for the rottJ*ing rJi (Sec.703 1.5 <br />Buins and Profcsion Codc): Any City or County which rcquirc a pamit to coEtruct, alta. improvq dmolish or rcpair m! <br />struciuq prior to its iss@cq also rcquirG thc applicmt for such pcrrnit to fil€ a sigocd statmqt that he or shc b licofied pmuanr <br />to thc provisiom of the Codrrcror's Licenscd Law (Chaptq 9, Corruncncing with Sation 7000 of Division 3 ofthc Businru ui <br />Prcfcsions Codc) or thst h€ or she is cxmpt thscfrom ild thc basis for thc allcted erflption. Any violation of Setion 7031.5 by my <br />applicmtforapcnnitsubjetsthc applicuttoacivilpcrultyofnotmorcthdfivehun&cddollm($500). <br />_1. c ovr,q of thc proptny, or my cmployc with wagc c ttcir mlc cornpcruaion. will do thc wort ad thc srnrtw b nol <br />intodcd or olfqcd for sle (Se.7044. Buine ud Profsioro Codc: Thc Contractor's Lic€re taw doB not apply to m omq of <br />the prcpqry who builds or improvs th@n. ed who dc such wtk himself or hmclf or lhrough his or ho om mdoye, <br />providcd that such impmvmmts e rct intqrdcd or oflsed for sle. lf, howwq, thc hrilding or imprcmt is sld wilhin onc y6 <br />of complaioq thc Ovmq Buildq will havc the hrdo of poving that hc or she did mt build or imFovc lhc propqly for thc pruposof <br />el€). <br />_1. as owner of the prop€rty. arn exclusively contracting wrth liccrsed contractors to construcl the project (Sec. 7044. Buiness <br />and Pnofession Codc: The Contractor's License Law does not apply to an owner of propcrty who builds or improves thereon. <br />and who contracts for such projeos with a Contracto(s) licensed pursuant to the Contractor's License Law). <br />_l arn exempt under B. & P.C. for this reason. <br />Date:_-._owner'- <br />WORKERS' COMPENSATION <br />DECLARATIOh* <br />I hereby affrm under penalty of perjury one of the following declarations: <br />_l have and rvill maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section -1700 of the <br />Labor Code, for the performance of the work for which the pennit is issued. <br />and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. fbr the performance of <br />issued.compensation insurance carrier and policy number are: <br />c ce <br />Policy q t-Ao <br />_l certify that in the performanc.e of the work for which this permit is issued, I shall not ernploy any person in any manncr <br />so as to become subject to the rvorkers'compensation laws of California. and agree that if I should becorne subject to thc <br />workcrs' compcnsation provisions of Section 3700 of the Labor Code. I shall. foirhwilh comply rvith those provisions. <br />WARNINC: Farlurc to secure workers' compensation coveragie s unlarvful. a.nd shall subject an onployer to crirninal poraraes and <br />civrl fines up to one hundred thousand dollars ($100.000). in to the compcnsation. damages as provided for the <br />attorney's <br />hereby affirm under penalty of pcrjury that I arn provision of Chapter 9 (cornmencing with Section 7000) of Division 3 <br />the Business and Profc"ssions Code. and rny force and effect. <br />Number: <br />qqq7q3 €rebr <br />o <br />I hereby aflirm under penalty of perjury that thcrc is a <br />issued (Sec. 3097. Civ. C.). <br />agency tbr the pcrformance of the work for rvhich this perrnit is <br />Lender's Name: <br />[,cnder's Address: <br />APPLICANT DECLAITATION <br />I herd,)'ailfirm under penalty of perjury one of the following declarations: <br />l)ernolition Permits-Asbcstos Notification Fedcral Regulations (Tille 40, Part6) <br />-_ <br />Required l-rtter of Notification <br />.- __l cotifr that the federal regulations regarding asbestos removal are not applicable to this project <br />Irernritcc nilrrle <br />a <br />t a <br />work for <br />t <br />_Expires: <br />Section <br />-'A-t,