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SITE.WORK DATE ID/SIG.COMMENTS OWNI.:R B U I I,DEII DIiT,CA RATION I hereby affirnr under penalty of perjury that I am exenrpt fronr the Contractoru' License Law for the following reason (Sec.7031.5 Busincss and Prol'ession Code): Any City or County which requircs a pcrmit lo conslruct, alter, irnprove, dermlish or rcpair any structure, prior to its issuance. also requires the applicant for such permit to file a signed slatemcnl that he or she is licensed pursuanl to the pmvisions of thc Contractor's l,icensed law (Chapter 9. Commcncing with Section 7(X[ of l)ivision 3 of the Business and Prufessions Code) or that he or she is exempt therefronr and the basis tbr the alleged exenrplion. Any violation of Section 7031 .5 by any applicant for a grcrmit subjects the applicant to a civilpcnaltyof not nrore than live hundred dollars ($StXl). _1. a.s owncr ol'thc propcrty, or my ctnployees with wages as their sole compcnsation, will do the work and the stnrcture is rnt intentletl or offered for salc (Scc.70a4. Business and Professions Ccxlc: The Contractor's Licensc Law docs not aPPly to an owner of the property wlxr builds or improrres thereon and who does such work himself or herself or througlt his or her own employees. providcd that such improvenrcnts are not intendcd orollered for sab. Il. however, ttrc building or furprovcnrcnt Ls soH within orc year of conpletioq the Owner Builder will have the burden of proving lhat he or shc did not build or improvc thc properry for tlrc purposeof sale). _1, as owner of thc propefly. am exclusively contracting with licensed conlraclors to conslrucl thc projcct (Sec. 7044, Business arrd Prolbssion Code: The Contractor's License Law does not apply lo an owner of property who builds or improves thereon. and who contracls lor such projccts with a Contractor(s) liccnsed pursuanl to lhc Contractor's Licen.se taw). _l anrexempt under Section-, B. & P.C. tbr this reasort. WORKICITS' COM PENSATION Ihcrebyaflirmunderpenaltyofperjuryoneofthe.,,o*',pffi .lEfn^"e and will maintain a Certificate of Consent to Self'-tnsure for workers' compensation, as provided for by Section 3700 of the l-ahor Code, for the Jrcrformance of ttre work for which thc permit is Lssued. _l have and will nraintain workers'Code, for lhe performarrce of thc work tbr which this is issucd.are: ?- /'2031 _l ccrtify that in thc pcrtbrmance nf the work for which this permit is issued, I shall not cmploy any person in any manncr so as to bccornc suhjcct to thc workcrs' conrpensation laws of Califonria. and agree that if I should beconp subject to thc workers' comtrcnsation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with thosc provisions. WARNING: Failure to securc workcrs'compcnsation coveragc is unlawful, ancl shall civil lines up to one hundred thousand dollars ($l00.tXltl;. in addition to the cosl o[ subjcct to criminal penahies and lhe Section 1076 of the latnr Ccxle, interest and attorney's fees. DECLARATION I hcreby all'irm under pcnalty of perjury that I arn licensed undcr provision ol'Chaptcr 9 (comrnencing with Secti<rn 7ffn) of l)ivision 3 of thc Busincss and Professions Code, arxl my license is in full forcc and elfcct. Numbcr: CONSTRI.'CTION I,T.:NDING AG ENCY I hereby atfirnr under Jrenalty of pcrjury tlut there is a construction lerxling agency for the lrcrformarrce of the work lbr which this permit is issucd (.Sec. 3097, Civ. C.). lrndcr's Nanrc: Lcnder's Address: APPLICANT DECLARATION I hereby uffirm under pnalty of perjury onc of the following declarations: Dcmolition Permits-Asbestos Notification Federal Regulations (Titlc 40, Part6) -Retluired lrtter of Notification _I certify that the federal regulations rcgarding asbestos rcnnval are not applicablc to this proJect. certify that I lrave read this application and state that information is .State Laws relating to tlre propcrty for or Agcnt and hereby authorize r,iru,/0'// -2Ofr Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf Ioor/Ve nVl nsu lation L\ Roof Sheathinq rzc*h wpat Shear Wall 7 [\J Framinq lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat I\/asonry Pool Fence T-Bar Handicap Req. Deputy Final Report Enqineer Final Report Flood Zone Certif. n FINAL Y-27-h klr-lDl Certificate of Occupancy \-/ Notes, Remarks, Etc. BUILDING. INSPECTOR RECORD I Rev. 08-07-2015 l)ale:Ormer: with all City and County