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BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/S!G.COMMENTS OWNER BUILDER DELCARATION . I hcrcby affirm under pcnalty of pcrjury that I am cxcmpt from the Contractors' Licensc law for the following reason (Sec.7031.5 Busirrcss aml Profcssion Code): Any City or Counry which requires a pennit lo consrruct. altcr. improve, &molish or rtpair any structure. prior to its issuancc, also requires the applicant for such ;rcrmit to filc a signed statcrnent thal he or she ls licensed pursuant to the fnovisions of thc Contractor's Licenscd Law (Chapter 9, Commencing with Section 7000 of Division 3 of thc Business and Profcssions Codc) or that he or she is exerrpt thcrcfrom and the basis for the allcged cxemption. Any violation of Section 7031.5 by any applicant for a permit subjccts thc applicant to a civil pcnalty of not morc than fivc hundred dollars ($5001. _1. as owncr of the fnoperty. or tny employccs with wagcs as thcir solc compcnsalion, will do the work and the structure is not inlcnded or offered for sale (Scrc.7044. Busincss and Professions Code: Thc Contractor's License [aw does not apply to an owner of the propcrty who builds or improves thercon and who does such work hirnself or hersclf or through his or her own employecs, providcd that such improvenrcnts arc not interrlod oroffcrod for sale. If. howerer, thc buiHing or inprovenrcnt is sold wilhin one )ryr of complctio[ the Owner Buildcr will have thc burden of proving that hc or she did not build or improve thc property for the purynse of salc). -1, as owncr of thc propcrty, am cxclusively contracting with licenscd contractors to construct the projct (Sec. 7044, Business and Profssion Code: Thc Contractor's Liccnse Law docs not apply to an owncr of propcrty who builds or improves thercrrn. and who contracts for such gnojccts with a C-ontracto(s) liccnsed pursuant to the Contractor's License l-aw). -IamexcmptundcrScction-,B.&P'C.forthisreason.Date:_Owner:-_ wonxg DECLARATION I hcreby affirm under pcnalty of grerjury one of the following dcrlarations: _l have and will maintain a Certificatc of Consent to Sclf-lnsure for workcrs' compcnsation, as providcd for by Section 3700 of thc [:bor Code, for thc pcrfornrance of the work for which thc pcrrnit ls issued. NR havc and will maintain workers' contpcnsation insurance. as rcquircd by Scctiott 37fi) of thc Labor Code. for thc lrcrformatrce of work this is issued. My workcrs' comgrcnsation insurarrce carricr and plicy numbcr arc: I Policy o \zl \\r,ccrlity that in the prforlrrancc o[thc work for which this pcrnrit is issued. I shall not cmpklyany pcrson in any nnnncr so as to bcconrc subject to thc workcrs'compcnsati<ln laws of Califomia. and agrcc that if I should bc'conre subjcct to the workers' conrpcnsation provisions of Section 3700 of thc hbor Codc. I shall. fbrthwith cornply with thosc provisions. WARNING: Failure to sccurc workcrs' compcnsation coveragc is unlawful. and shall subjecl an cmployer to criminal pcnaltics and civil fincs up to onc hundred thousand Scction 3076 of thc Labqr Code. intcrcst Date: lt lvlz-l: dollars ($to the cost of compensalion. danragcs as providcd ltlr tlrc and attorney's fecs. Applicant:_ I hcrcby affirrn undcr pcnalty of pcrjury that I arn liccnscd 9 (comnpncing with Scrtion 7000) of Division 3 of thc Busincss and Professions Code. and my liccnsc is in full forcc and eff'cct.qtbl 3b I Liccnsc c Nurtrbcr: \('onlructor:L W I hcrcby aflinn urdcr Fnalty of pcrjury thd thm is tr ongruction lcnding agcrcy for thc ftrforlmcc of thc work for which lhis fmii is issucd (Scc. 3097, Civ. C.). Lrnder's Name: Lrnder's Address: APPLICANT DECLARA'ryON I lrrcby affirm undcr pcnalty of pcrjury onc of the following declarations: Dcmolition Pcrmits-Asbcstos Notification Fedcral Rcgulations (Title 40. Part6) -Rcquircd lrtter of Notification _l ccrtify that lhc fcdcral rcgulations rcgarding asbcstos rcrnval arc nol applicablc to this projcrt. [S."nify that I havc read this statc that thc atnve infbrnurtion ordinanccs ancl ,Statc laws abovc rncnlioncd property for Applicant or Agent Pernritee nanle construction. and Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf loo r/VenVl ns u I atio n Roof Sheathing Shear Wall Framing lnsulation/Enerqv Drywall Ext./lnt. Lath Brown Coat J\Iasonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif It FINAL 11.I ?,0 DRV[1 Certificate of Occupancy Notes, Remarks, Etc. Rev. 08-07-201 5