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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS oTVNER BUILDI]R DELCA RA'TION <br />I hcrchy rlllrnr undcr pcoillly ol pcrjury lhat I ilm cxcrnpl fronr thc Conlrack)r\' Liccnsc lrw lirr tltc folhwing rca\on (Scc.7031.5 <br />Businuss and []rottssion Codc): Aily Cily or Counly which rcquircs il pcrnlil lo construcl. nltcr. inrprovc. dcnlolish or rcpair dny <br />\lruclure. pri(tr lo ils issuancc. xlso rcquircs lhc applicant li)r such Frnlil k) Iilc n rigncd slnlcmDl lhrl hc or shc is liccnscd pursuant <br />lo thc provisions of thc Conlrtrck)r's l-icenscd [,nw (Chaplcr 9. Conrncncing with Scclk)n ?0(X) ol Division .] of thc Busincsr and <br />Prolts\ion\Codc)orlhathcorshciscxcnrnllhcrcfromilndlhcbilsisli)rlhcxllcgcdexcrnption. AnyviolationofScctionT0.ll.5hyany <br />npplicanllbrapcnnilsubjcctslhc applicunlloacivilpcnollyofnottrtr)rcthuilfivchundrcddollrr$(S5(X)). <br />-1. <br />us owner of lhe pmfEny. or my cmpk,yces with wa8cs as lltcir solc conrpensalior, will do thc work ilrd thc slMtw is nol <br />intcn(lcd orolltrcdforsalc(S(.7(X4.BusincssandProlessionsCodc:lheContractor'sLiccnscl,awdocsnolapplytotrnowncrol' <br />thcpxlfEny whohuildsoriDrprorcsllrcrmn.andwhod(Essuchworkhinrsclforht'rsclforlhroughhisorhcrownenrployccs. <br />providcdlhalsuch i[provcnrnlsarcnoliilcndcdorolltrcdli)rsillc.ll.howcvcr.thchuilclingorimprovcnrntissoldwilhinonc]rar <br />ofconrplction. lhc Owncr Builder will halc lhc burdcn ot previrrg thal hc or shc (lid not build or iilrprovc the fmfrfly for thc purfFs of <br />ulc). <br />-1. <br />os owncr ol'lhc propcrly. atrt cxclusivcly conlrrcli[8 wilh liccnscd conlrilclors to construct thc proilcl (Sec. 7044, Bu\incs\ <br />and l)rofcssxil Codc: l-hc Conlraclor's Liccnsc Law docs not apply to rn owncr ()l prolrrty who huilds or ihprovcs thcrcon. <br />und who c(nrlracls lbr such prrjccts with a Corllrack)r(s) liccnscd pursurnl lo thc Conlrlck)r's Liccnsc Inw). <br />-lamcxcntpundcrseclion-.B,&P'C,forlhisrcason'l)alo:()Nncr <br />lVOllKttRS', C()NIt't,lNSA'il0N <br />I)ECI,r\RAI'I0N <br />l hcrchy al'lirnrrrrlcr pcnnltyof pcrjuryonc of thc lblk)wing (lcchrttion\: <br />-l <br />hrveilndwill ilrainlainilCcrlillcrlcolConscnlloSclf-lnsurcli)rw(trkcrs coilrpensalknl.!s frovidcdl'orbyScclion-17(X)oflhc <br />Latxrr Cmlc. fbr thc pcrlortr[rcc (,fthc work for which thc pcriltit is issucd. <br />thc work lirr which this pennit is issucd. My workcrs' compcnsali()n in\uraltcc canicr and policy rrunrher lrc: <br />Policy Nurnbcr: Expircs: <br />-l <br />ccnily lhat in thc pcrli)rnuncc of thc work li)r which this pcrnlit is issucd. I shall nol cnlploy any pcrson in any manncr <br />so as lo bccomc subjccl to lhc workers'conrpcnsillhn ldws ol Calitirrnia. and agrcc thal il l should hcconrc suhicct k) lhc <br />workcr\'compcn\alionpmvisionsofScction3T(X)ofthcLxtx)rC{xlc.lshall.tbnhwilhcomplywiththorcprovisions. <br />WARNING: Failurc lo sccure workcrs'conlpensiltion coverage is unhwful. and shall suhjcct an cmpk)ycr lo criminal Fnallics nnd <br />civil lincs up to onc hundrcd lhousdnd dolles (Sl(X).(XX)). in rddition lo lhe cost olcomlrcnsnlion, dnmilgcs as providcd for thc <br />Scclion -1076 of lhc Lrbor Codc. intcrcsl and rttorncv's fccs. <br />Applitarrl: <br />LICFNSED CONTRACTOR <br />DECLARATION <br />I hcrchy afl'irm undcr pcnally of pcrjury lhal I am liccilscd undcr provision oIChaptcr 9 (comtrEncing wilh Section 7UX)) of Division .] <br />of thc Busincss lnd Proltssions Codc. and mv licen\c is ir full forcc nnd cllccl <br />L-iccnsc Class:_Liccnsc Nrmbcr: <br />I)ale:___ Contraclor:_ <br />CONS'I'RUCTION I ENDING AGENCY <br />I hcrcby allinn rmlcr lrcnally of pcrjury lhal therc is a cotrslruclbn lcndirrg sScncy ti)r lhc perlbrmancc of the work for which this pcrillit is <br />issucd (Scc. 1097. Civ. C. ). <br />lrnrlcr's \untc: <br />l.cndcr's Atldrcss: <br />APPLICANT D}'CI.ARATION <br />I luthy allirrn undcr Pcnally of pcrjury onc of lhc lollowing dcclartlionri <br />Dcmolition Pcrmils-Ashcslos Nolitlcalion Fcdcrnl Rcgulalions ('I itlc ,l0. Pan6) <br />_Rcquired Lcltcr ()l' Notificrtiur <br />_l ccrlily thrl thc l'cderill rcSulatk)ns rcgffdinS ashcslos rctnovdlilrc trot nfl)licxhle k) this ft)jcct. <br />ahovc nrcnti(nlcd ptr)pcdy for inspcction furfoscs. <br />Applicililt or /\Brill Sigtrilturr:l)ille <br />Itrrilrilee nilnre {prinl ): <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsu lation <br />Roof Sheathinq <br />Shear Wall <br />Framrno <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />JVasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />,I <br />FINAL 7/27/tar -) <br />Certificate of Occupancy ( <br />Notes, Remarks, Etc.