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BUI RECORD <br />SITE-WORK DATE !D/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />S u bf loor/Ve nVl ns u lation <br />Roof Sheathinq n <br />Shear Wall ^ /t\ <br />Framinq '--1 ^4 )-J1-14 <br />lnsu lation/Energy (J \r <br />Drywall l,11-7-k) <br />Ext./lnt. Lath fiao-7A Y')CrE( <br />Brown Coat c -25'.7o \ilryx1 <br />WJ{}'+rtlhr{asgnrv l0n *\L^f a '-1-h <br />Pool Fence Yl\ I <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif \/ <br />It \\ <br />FINAL )rWY\ <br />Certificate of <br />Notes, Remarks, Etc \, <br />)o I'v <br />OWNER BUILDER DEI,CARATION <br />I hcrcby aflirm undcr pcnalty of pcrjury that I am cxcmpt frnm thc ConlEclors' Liccnsc law for thc following rca$n (SN.70-!1.5 <br />Busincss and Protcssion Codc): Any City or County which rcquircs 0 [Ermil lo conslrucl. .llcr. imp]orc. dcmoli(i or rcpair any <br />structurc. pri)r to ils issuarce. also rcquircs the applicant for such Jrcrmil lo filc a signcd statcrrcnt that hc or she ir liccnscd frBuanl <br />to lhc pmvisions of thc Contrrctor's Lhcnscd hw (Choptcr 9. G)nnncncing wilh Sslion 7000 of Division 3 of thc Busircss ind <br />ProfcssionsCodc)orlhathcorsheircxcmptthscfromandthcbusisforlhcallcgcdcxcmplion. AtryviolalionofSationT0.3l.5byany <br />upplicanlforapcrmilsuhj$tslhe upplicnnlk)acivilpentrltyofnolmorclhanlivchurdrcddollars($5fi)). <br />-1. <br />as owncr of the proJrcrty. or my crnployccs with wages as thcir solc compcttsatiolt. willdo thc work and the structurc is not <br />intcndcd or olTcrcd for s.rte (Scr.7O44. Busincss and Professions Codc: Thc Contractor's Licensc l-aw docs not apply lo an ou'ncr of <br />thc prolrcrty who builds or improles thcrcrrn. and who docs such wort hirnsclf or herself or through his or hcr own cmployecs. <br />providcd that such inrprovenrcnts arc not inlcrrdcd orofl'crcd lirr salc. lf. howcver. thc building or irnproverrent is sold within onc year <br />of comphtion. thc Owncr Buikler will harc thc burden of proving that hc or shc did nol build or improve the propcrty for thc purynsc of <br />salc). <br />_1. as owncr of thc property. arncxclusivcly contracting with licenscd conlractors lo conslruct thc projcct (Scc. 7044. Business <br />and hofcssion Codc: Thc Contractor's l-iccnse Law does not apply to an owner of propcrty who huilds or itnproves thcreon. <br />arrd who contracts for such projccts with a Contracto(s) licenscd pursuanl to lhc Contractor's l-icensc Law). <br />-larnexclllplunderSection-.B.&P.C.forlhisrcason' <br />l ):rtc. ( )u ltt'r: <br />}V()RKF RS' C0I\ I P}'NSA'I'ION <br />I)IiCI,ARAI'I(}N <br />I hcrcby allirrn urrdcr pcnalty ol'perjury onc of lhe following declaralions: <br />_l havc and will maintain a Ccrtificate of Consent to Sclf-lnsure lirr workcrs' cotnpensation. as providcd for by Section 37fi) of thc <br />l-ahor Code. for the pcrfornrance of thc work lor which the Jrcrmit is issucd. <br />_l havc and will ntaintain workers'compensalion insurance. as rctluired hy Section 37(D of thc l-abor Code. for the Jrcrforltunce of <br />thc work frrr which this pcrrnit is issucd. My cornpcnsation insuraltcc carricr and Jxrlicy numbcr are: <br />Policy <br />_l ccrlily that in the pcrforrnance of thc work for which this pcrnrit is issued. I shall nol cntploy any pcrson in any munncr <br />so as to bcconrc subjcct to the workers' compcnsation laws of California. and agrce lhal if I should bcconrc subjcct to the <br />workcrs' corrrpensation provisions of Scction 37ff) of the Lalxrr Crxlc. I shall. lbrthwith corrrply with thosc provisions. <br />WARNING: Failurc to sccure workcrs' conrpcnsation covcrage is unlawful. and shall suhjecl an entployer to crirninal Jnnalties and <br />civil fincs up to one hundrcd thousand dollars (SlU).0rX)). in addition to lhe cost of cornpcnsation. damagcs as provided for the <br />Scction 3076 of the Lahrr Codc. intcrcst and allorney'lE.*.- nofuDate: <br />LICENSED CONTRACTOR <br />DECLARATION <br />t hcrchy atfirnr urrcler pcnalty of perjury that t anr liccnscd undcr provision ol'Chaptcr 9 (comnrcttcing with Section 7Un) of Division .3 <br />of thc Busincss and Professions Codc. and rny liccnsc is in l'ull f<rrcc and cfl'ect. <br />Liccrrsc I <br />Da6 b q <br />I hcrcby allirrn undcr pcrtalty ol'pcrjury lhal llrcre is a coltslruction <br />issucd (Scc. -1097. Civ. C.). <br />agcncy lirr thc ol'thc rvork for u'hich this prrnit is <br />l.cntlcr's Nalnc: <br />[,cndcr's Addrcss: <br />AI'PI ICANT DI.'CLARATION <br />I lrcrcby allirrn unclcr pcnalty of pc{ury one o[ lhc folkrwing dcclaralions: <br />Dcnrolition Pcrmits-Asbcstos Notillcalion Fcdcral Rcgulations (Titlc .10. Part6) <br />-Requircd <br />Lrttcr of Notification <br />_l ccrtify that the fcdcral rcgulations regarding asbcstos rcmovalare nol applicablc lo this project. <br />_l cerlity that I have rcad this application and state that the ahrve inlormatiott is correct. I agrce to comply with all City and County <br />0r <br />6 I* <br />orrlirranccs and Slatc Lau's rclating to construction. and hercby authorizc <br />ahovc rncrrlioncd propcrly for <br />Applicnnt or Agenl <br />cnter uJnn theIrqg <br />Pernritee nanre $ <br />1 <br />_\1