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BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS 0WNI'R B U I I,I)I.]R I)I.]I,CA RA'I'ION I hereby affirm under penalty of perjury that I am exempt from the Contractoni' License Law for the following reason (Sec.7031.5 Business and Prol'cssion Code): Any City or County which requires a permit to construcl, alter. irnprove, demolish or rcpair any structure. prior to its issuance. also requires the applicant tbr such pcrnrit to file a signed staternenl that lre or she is licensed pursuanl to the pmvisions of thc Contractor's Liccnsed law (Chaptcr 9, Comrnencing with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is exentpt thereltom and the basis lbr the alleged exenrption. Any violation of Section 703 1.5 by any applicant for a pcnnit subjects thc applicant to a civil penirlty of not more than five hundrcd dollars ($Sfn). _1, as owncr ol'thc property. or my employees with wages as their solc compcnsation, will do thc work and thc slructure is not interxlcd or offeretl for sale (Soc'.7&+. Business and Profcssiorrs Ccxle: The Contractor's Licensc Law docs not apply to an owner o[ thc property who builds or improves thereon, arxl who does such work hinrself or lrerself or through his or her owrt employees. provided that such improvemcnts are not intendcd or ol'fercd lirr salc. Il, howcvcr, thc building or improvcment is sold within one year of conrpletkrn. the Owner Buikler will havc the burtlen of pmving tlut hc or shc did not build or improve tlrc poopctty for lhc purposc of yab). -1, as owner of thc propcrtyt am exclusively contracting with licenscd contraclors to conslruct the project (Sec. 7044, Busincss and hotbssbn Code: The Contractor's License Law does not apply to an owner of property who builds or improves lhereon. and who conlracts for such projects with a Contracto(s) licensed pursuant to lhe Contractor's License l-aw). _I am cxcmpt under Section_, B. & P.C. tirr this reason. Date: WORKI.:RS' COM PI.:NSATION DECLARATION I hereby aftirm undcr pnalty of grcrjury one of the following declaration.s: / lLn^ve and wilt maintain a Certifrcatc of Consent to Sctf:-lnsure for workers' compensation, as pruvided for by Section 3700 of the l-abor Codc, for lhe Jrerforrnance of the work for which the permit is issued. _I Seclion 3700 of the Labor Code, for the performance of sarricr anl Jnlicy numhcr are:thc -cn, '1P?l'1r0 that in thc prcrlbrnuncc of thc work frrr which this pcrmit is issucd, I shall not cnrploy any pcrson in uny manncr so a.s to bccornc subject to thc workers' conrlrcn.sation laws of Califonria, and agrce that if I should bccorrc subject to the wodters' compensation provisions of Section 3700 of the Labor Cotle, I shall, forthwith comply with thosc provisions. WARNING: Failurc to securc workcrs' compcnsation covcrugc civil lines up to one hundrcd thousand dollars ($100.fiD). in is unlawful, and shall subjcct an enrployer to criminal Jrcnalties and to the cost of conlpcnsation. damages as provided for the Seclion 3076 of the Code, interest and attorney's DECLARATION I hereby al-lirm under penalty of perjury that I am licensed under provision of Chaptcr 9 (cornmcncing with Section 7000) ol'Division 3 of thc Business and Professions Codc, arxl my license is in full forcc and etfect. c15 rb$q s (Ji CONSTRT.'CTION I,T:NDING AGT:NCY I hereby atl-rm under Jrnalty <lf 5rcrjury that there is a construction hnrling agency fbr the Srerformarrce of the work tbr which this perntil is issued (.Scc. 3097, Civ. C.). kndcr's Name: lrnder's Address: APPLTCANT DECLARATION I hercby affrnr under pnalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) _Requ ired lrtter of Notification with all City and County and county to enter upon thc atxrvc rncnti()ncd propcrry tbr Applicant or Agent \Permitee nnme *,",s/tb/4D Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf loor/Ve nUI n su I atio n Roof Sheathinq Shear Wall Framinq lnsulation/Enerqy Drywal! Ext./lnt. Lath Brown Coat Jt/asonrv Pool Fence ( T-Bar Handicap Req Deputy Fina! Report Engineer Final Report Flood Zone Certif i n\ FINAL l)-Z-fl)x I T Certificate of Occupancv \ Notes, Remarks, Etc.\-/ Rev. 08-07-2015 a a /\ I