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BUILDING. INSPECTOR RECORD ! SITE.WORK DATE ID/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf loor/Ve nVl nsu latio n Roof Sheathinq Shear Wall Framinq lnsulation/Enerqy Drvwall Ext./lnt. Lath Brown Coat Jt/asonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif. ^ z*l FINAL J)rt\,,V4t ' I I 'l/)'tuv Certificate of Occupancy Notes, Remarks, Etc. ?d/<4 U / OWNIER B UII,I)IiR DIiI,CA RATTON I hereby affirm under penalty of perjury that I am exempt fronr the Contraclors' License Law for the following reason (Sec.7031.5 Business ard Profession Code): Any City or County which requires a permit to conslruct, alter. irnprove, dcmolish or rcpair any structure, prior to its issuancc. also requircs the applicarrt for such prermit to filc a signed staternent that hc or she is licensed pursuanl to the pmvisions of the Contractor's [.icensed law (Chapter 9. Commcncing with Section 7000 ol'Division 3 of the Business and Professions Code) or that hc or she is exempt therefuom arxl the basis tbr the alleged exemptiorr. Any violation of Section 7031.5 by any applicant for a grcnnit subjects the applicant to a civil penalty of not nrore than five hundred dollars ($5001. _1. as owner ol'the propcrty, or my employees with wagcs as their solc compcnsation, will do thc work and the structure is not interxlal or offcred for sale (Scc.7OCa, Business and Pmfessions Code: The Contractor's Liccnse [:w docs not apply to an owner of the proJrerty who builds or improrrcs thereon, and who does such work himself or hcrself or through his or her own employees, provided that such improvenrnts are rnt intcnded orollercd for sale. Il, howevcr. the buiHing or improvennnt is soH within one year of complction, thc Owrrcr BuikJer will hnve thc burdcn of proving that hc or she did not buikl or improvc thc propcrty for the puqposc of sale). _1, as owner of thc property, am cxclusively contracting with liccnrcd conlractors to conslruct the project (Scc, 7044, Business arxl Prrollssbn Code: The Contractor's License Law does not apply to an owner of progrerty who builds or improves thcreon. and who conlracts for such projects with a Contractor(s) licensed pursuant to thc Contractor's License Law). _l anr exempt under R. & P.C. ltrr this reason. I)ale: Owner: WORKI.:RS' COM PI.INSATION DECLARATION I hereby affirm under Jrcnahy of perjury onc of the following declarations: _[ have and will maintain a Certificate of Consent to Self-Insure for workers' compensation, as pmvided for by Section 3700 of thc Labor Code, for the perlormance o[ the work for which thc permit is issucd. _l have and thc work ttlr will maintain workers' compensation insurance, as by Section 3700 of the [:bor Code, for lhe performarrce of thi.s pcrnrit is issuctl. My carricr un<l prclicy number are: )<2os aS 6 2- '""s?*?)t:) Policy _I ccrtify that in thc prtbrmancc of the work for which this Jrcrmit is issued, I shall not employ any person in any manner so aslohccomcsubjecttothcworkers'cornpcnsationlawsofCalifomia.andagrccthatiflshouldbccorrcsubjecttothc worliers' comlrcnsation provisions of Section 3700 of the labor C'ode, I shall, forthwith conrply with thosc provisions. WARNING: Failure to secure workcrs'compensation covemgc is unlawful, and shall subjcct an cmployer to criminal penalties and civil fines up to one hundred thousand dollars (SIOO.UXD, in addition to thc cost of conrlrcn.sation. damages as provided for thc attorney's fees. I hcreby allirm under pnalty of perjury that I am liccnsed under provision ol'Chapter 9 (cornmencing with Scction 7000) of Division 3 of thc Busincss and Professions Code, arxl my license is in futl tbrce aml cffect. Licensc CONSTRI.'CTION I,I.:NDING AG}:NCY I hcrcby aflirnr under penalty of per.iury that there is a construction lending agency for the performance of the work tbr which this permit ls issucd (.Sec. 3097, Civ. C.). lrnder's Name: lrnder's Addrcss: APPLICANT DECLARATION I hcreby affrm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Rcgulations (Title 40, Part6) _Requ ired lrtter of Notification _l certify that the federal regulations regarding asbestos renroval are not applicable to this project. _l certify that I havc rcad this application and statc that thc above infornration is corrccl. I agrec to comply with all City and County onlinances and State [:ws relating to building constructior\ and hereby authorize reprcscntatives of this City and County to enter upon the abovc mcntionctl propcrty lbr inspcctir)n purp()scs. Applicant or Agcnt Permitee name 0B-07-2015 I a\