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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNIiR BU ILDER DI,:LCA RATION I hereby affirm under penalty of perjury that I am exempt fr<rm the Contractoru' License [-aw for the f<rllowing reason (Sec.7031.5 Ilusiness and Prolbssion Code): Any City or Countv which requires a permit to construct. alter. irnprove, demolish or rcpair any structure. prior to its issuance. also requires the applicant for such Jrcrnrit to file a signed statement that he or she is ]icenscd pursuant to thc provisions ol'thc. Contractor's Licensed l-aw (Chapter 9. Comrncncing with Section 7000 of Division 3 of the Business and Prof'essions Code) or that he or she is exempt theretionr and the basis for the alleged exenrption. Any violation of Section 7031.5 by any applicant for a 1rcrmit subjects thc applicant to a civil grcnalty of not more than five hundrcd dollars ($5001. _1, as owncr ol'the propeny, or my employees with wages as their sole comJrcnsation, willdo the work and the stnrcture is not interxled or offered for :iale (Sec.7B4. Business and Profcssions Ctxle: The Conlraclor's License l-aw does not apply to an owner of the property who builds or improws theruln, and wlxr dtrcs such work himself or herself or through his or her owrr employecs, providcd that such improverrcnts arc nol intcnded or ollered for sale. Il. howcver. the building or irrprovenrnt is sold within one year of conrpletion, thc Owner Buikler will havc thc bunlcn of pmving lhat hc or she did not build or improve ttre ptopetty for thc puqpose of sah). _1. as owner of the property, am cxclusivcly contracting with licensed contractors to conslruct thc projcct (Sec. 7044. Business and holession Code: The Contractor's License Law does not apply to an owner of property who builds or improves lhereon. and who contracts for such projccts with a Contractor(s) licenscd pursuant to the Contractor's License kw). -IamexemptunderSection-'B.&P.C'lbrthisreas<ln'I)ate: WORKI{)RS. COM PI.)NSA'TION DB]CLARATIoN I hcreby allirm undcr penalty of pcrjury one of thc lirllowing dcclarations: _[ have and will mainlain a Certiticate of Consent to Self'-lnsure for workers' compensation, as provided for hy Section 3700 of the Latnr Coclc, for thc performance of the work lor which thc permit is Lssued. _l have and will maintain workers'3700 of the [-abor Code, for the performan'ce of tlrc work t his is lxrlicy numhcr arc: Policy o o _l ccrtify that in thc pcrtbrmance of thc work for which this Jrcrmit is issuetl, I shall not cmploy any person in any manner so as to bccornc suhject to thc workers' conrpcnsation laws of Califonria, and agrce that if I should become subject to thc workers' conrlrcnsation provisions of Section 3700 of the Labor C'otle, I shall, forthwith comply with tlrost provisions. \, WARNING: Failurc to secure workers'compcnsation coverage is unlawful. and shall suhject an employer to criminal pcnalties and civil fines to one hundrcd thousand dollars in addition to thc cosl danragcs as provided for the Sectiolr interest and I hcrc'by of thc [,icensc, al'lirm undcr penalty of perjury that I am licenscd undcr Chaptcr 9 (comrnencing with Scction 7ffn) ol'Division 3 Business and Professi<lns Codc. B and my licensc is in full tbrcc arxl effcct. -l e L5'5 )o CONSTRI.'CTION I,tr]NDTNG AGITNCY I hercby aflirm under penalty of prjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097. Civ. C.). t-ender's Name: Lcntlcr's Addrcss: APPLICANT DECLARATION I trreby affurn under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) _Required lctter of Notification _l certify that the federal rcgulations regarding asbestos renpval are not applicable to this proi:ct. {rccrtify rhat I have rcad this application arxl statc thal thc above information is corrcc't. I agrce to comply with alt City arxl County ordirmnces and State Laws relating lo building hereby autlxrrize reproGntatives of thi.s City and County to enter upon the atxrve nrcntionc<l propcrty lbr inspcction ,t Applicrnt or Agent Prrnritee nanrc )qLo Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf loor/Ve nUl nsu latio n Roof Sheathinq Shear Wall I A. Framinq I (t 'w lnsulation/Enerov I A Drywall a Llr)'7/) Ext./lnt. Lath I \ Brown Coat [t/asonry Pool Fence T-Bar Handicap Req Deputv Final Reoort Enqineer Final Report Flood Zone Certif . I t, FINAL Ir u7 DT{T e Certificate of Occupancy t, Notes, Remarks, Etc./ ?-2 -- Rev. 08-07-2015 insurance, as camcr , I 4lIn