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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DET,CARATION I hereby allim undr pcnalry of pcrjury thst I m excmpt from the ContractoB' Liceme l,arv for the folloning rc"*n fsc.zol 1.5 - ' Businss and Profssior Codc): Any City or County which rcquirs a pcnnit to construcl. altq. improvc. dmolish or rcpair ey structuq prior to its issuucc' also rrcquirc the applicmt for such lmit to file a signed slalement that he or she is liccnscd puEumt to the 1rovi$ions of the Contractor's Licensed law (Chaptq 9. Commencing rvith Selion 7000 of Division 3 of the llusinw md Prcfcsions Code) or lhat hc or shc is exmpt thscfrom md thc basis for the allcgcd crmption. Any violation of Setion 7031.5 by uy applicantforapcmitsubjctsthc applicanttoacivilpcnaltyofnotmorethalirchundreddollus($500). _1. &s owner of the propeny. or my employees with wages as their sole compensation. willdo the rvork and the structtre is not intended or offered for sale (Sec.7044. Business and hofessions Code: f'he Contractor's License [,arv does not apply to an orvner of the property rvho builds or improves thereon. and w,ho does such $'ork himself or herself or through his or her os'n emplo)'ees. provided that such irnprovonents are not intended or offerd for sale. l[, horvever. the building or improvement is sold rvithin one ]â‚¬ar of completion. lhe Owner Builder will have the burden of proving that he or she did not build or irnprove the propoty for the puryose of sale). _1. as owner of the propefly. arn exclusively contracting rvith licensed contractors to constnrct the pro.iect (Sec. 7M4. Rusiness and Profcssion Code: The Contractor's License Law does not apply to an owner of property u'ho builds or irnproves lhereon. and rvho contracts for such projects rvith a Contracto(s) licensed purstnnt to the Contractor's l-icense Las'). _l am exempt under Section_. B. & P.C. for this reason. Owner:_ WO RKERS' COI\T PENSATION DECLARATION I hereby alTirrn under penalty of perjury one of the follos'ing declarations: -l have and rvill maintain a Certificate of Consent to Self-lnsure for w'orkers' conrglensation. as provided for by Section .1700 of the I-abor Code. for the performance of the work for which the pennit is issued. )t have and will maintain workers' compensation insurance. as required by Section -1700 of the Labor Code. for the po'formance of the work for which this permit is issued. My workers' cornpensation insurance carrier and policy number at'e: ,*,,*,fr7: 4uter inn 9t 14 poricy *",,,*,,6p,^)&(00lEbA -Expires: Q' I :-l-7- _l certify that in the performance of the work for which this grrrnit is issued. I shall not onploy any person in any manner so as to become subject to the workers' compcnsation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section -1700 of the Labor Code. I shall. forthrvith comply rvith those provisions. WARNING: Failure to secure rvorkers' compensation coverage is unlarvful. and shall subject an anployer to crirninal Fnalties and civil frnes up to one hundred thousand dollars ($100.000). Section 3076 of the Labor Code, interest and attorney's fees. in cost of compensation. darrrages as provicled for the 0-L1 I hereby affinn under penalty of perjury that I arn license<l under provision of Chapto' 9 (cornmencing with Section 7000) of Division 3 of the Business and Professions Code. and rny license is in full force and effect. Licensc C?o 6?707/ Dere: fr to'27'lb I hrcby affum unda pcmlty of pcrjury that thqc is a comtruction hnding agmcy for thc pcrfonrilce of thâ‚¬ work for rvhich this psmit b issucd (56. 3097. Civ. C.). knder's Narne: Lender's Address: APPLICANT DECLARATION I hereb}, aflinn under penalty of perjury one of lhe follorving declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) -Required Letto of Notification -l cerrify that the lbderal regulations regarding asbestos removal are not applicable to this project. _l cerrify that I have read this application and state that the above infonnation is con'ect. I agree to comply rvith all City arrd County f this City and County to cnter upon theordinances and State Larvs relating to ard hereby authorize representatives o above rnentioned properly for inspection Applicnnt or Agent I'ernrilec nanre _Dil"10'7) - lb Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/Ve nUl n s u latio n Roof Sheathing Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif tt'-) I FINAL la I '.Q W<tb 4./Ci Y Certificate of Occupancy Notes, Remarks, Etc. w