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G RADI NG{ NSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS O*nq-Builds Dcclmtio I h6cby affim und6p6dty of pcdury thd I m cxmpt fm thc Cotrrcton'Limsc kw for thc followingreon (re.7031.5 Buin* ud Profdsio Codc): Any City or Couty which requirq a pfinit to cmstuct, altd, improvc, dmolish o rcpair my smdurq priq to its isswc, also rcquirc lhc Epplimt for such pcmit to filc I rigsad statcm@t thst hc 6 shc is lic@cd punwt to thc prcvisioN of thc Cmtr&tor's Lictrcd [;w (Chapts 9, Cm@cint with S@tion 7000 of Dvfuion 3 of thc Buincs ud Profcssim Codc) o thar hc or shc is cxmpt thacfrom ud thc buis frthc allcgcd cxmptim.Any violation of Scaion 7031.5 by uy applicmt ftr apcmit subjs$ rhc applicut to a civil pcnalty ofnot mm tho fivc hutr&cd dollm (S500). _I, u omcr of thc popcrty, or my mployce with wagc u thcir solc compasation, will do thc work qd thc structurc is rot intadrd or offacd fc salc ( 5*.7044, Buind ed Prcfsim Codc: Thc Cmtr&tor'J Limlc Law dc not apply to m mr of thc propcrqr who builds or impove thaon, md who dm such work hiruclf q hmclf a through his u ha m mployc, povidcd thrr ruch imprcvmaE e not intm&d or offcrcd for salc. If, hwcvd, rhc building or imprcvmot is sold within onc yo of ornplaion, thc Oma-Buildq will havc thc budcn of prcving that hc u shc not build or improvc for thc purposc ofsala). _1, a omc of the prcpaty, m cxcluivcly conracting with lifficd contrEtoB to msEuct thc Fojcct ( S€. 7044, Buinccs md Prcfsim Codc: Thc Contmcttr'r Liffic Law dc not eply to e M6 of prcpaty aho buil& q inprove thm , ud who cfftr&ts for sEh prcjds with s Cmtrelo(s) limscd puut to thc Contrrctor's Limc ljw.). {--" m exmpt for thisq\0 l+ I hocby ef6m uda pcnalty ofpojury onc I I hsvc md will minuin c Ctrtifiet of Coroat to Sclf-Iffm for wukm' mpsruation, s povi&d fc by Sction 3?00 of thc I Labs Codc, ftr thc pcrfmmcc of thc wqk for which thc pmit is issucd. _l havc od will mintain wqkm' ompaualio irolme, r rcquirc.d by Scction 3700 of thc L{btr Codc, for ttrc pcfomacc of thc work for which this pmit is isucd. My workm' compcmatio insumcc mia md policy numbo uc: Policy Nmbcr Expirs; lttrissction *l*;- I catify that in thc pafme of thc wo,rk f6 which thi! pqmit ir isuc4 I shsll not mploy ay pcrm in my mana !o a !o beamc rubjct to thc wortm ' ccrpcnratio lsws of Cilifmia, md agru thu if I rhould bcmc sbjet to thc wortm' composation ofScction 3700 ofthc Labq Codc,fonhwith thosc provisionr.. WARNING: Failwc to sccurc workcn' ompcnsation unlawful, od shall subjcct m mploya to ciminal pendtis md civil finc up to mc hmH thmd &tlm (3100,000),in additio !o thc c8t of mpaEEtim, dmagc u prcvidcd fa thc Scctio 3076 of thc Labor Cod!, intacct sd attomcy't f6, LICENSED CONTRACTORS DECLAAATION I hacby affim udo paslty of potjuy that I m lictrcd uda provirim of Chaptcr 9 (comacing with Scctioo 7OO0) of Dvisim 3 of thc Buins md Prcfeim Cod€, ed my lic@e ir in firll fmc md cffct. Limcclu- p- I hrcby afnm udr psrslty of pcrjry that thm i$ucd (Scc. 3097, Civ. C.). lads's Nmc: agacy fc thc pcrfomme of thc work for which thi6 pcmit i3 Lmdq's Addrdsl o A}PLICANT'S DECLARATION Dmolition Pmits-AsbBtos NotificadoD Fcdaal Rcgularions (Titlc 40, Pan 6) _ Rcquirrd Lett6 of Notificario _I ccfiiry that thc fcdaal rc8ulatiffi rcgrding Ebstor movd rc nor applicablc to this projccr. - I cstify that I hsvc rud this application ud stst6 that thc sbovc iofmatim is coftrt. I sgG !o comply wirh all City md Cmty ordinms md Stat Lsvt tclatin8 to buildinS constuotim, md h@by authoize rcprcmtativa of this City sd Comty to m&r upor thc abovc matimcd prcpcrty Applicut or agmt I Pmincc nmc (prinr)r Purpo66.q '0// y' Preliminary Soil Report Excauation Fills Sub Drains Buttresses Soils/Geology Report Contractors State of Comp. Compaction Report Flood Drainances Cert. Paving Sub Grade Aggragate Base Water Test & Seal Coat Asphalt Concrete Soils Eng. Cert. Rough Grading Release Final Civil Cert. FINAL 9-tz-tt JJ.d6{@D /p -fanrrr Notes, Remarks, Etc. \