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BUILD!NG. !NSPECTOR RECORD <br />Rev.08-07-2015 <br />SITE-WORK DATE ID/SIG.COMMENTS ()wNI.:R ttuil,l)uR t)1.:l.cARAl t()N <br />I hereby nffirnl under penalty of perjury that I arn excnrpt fronr the Contractos' l-icense [jw for thc following rcasn (Sec.7031.5 <br />llusincss and Prolcssion Codc)r Any Cily or Counly which requircs a lErmil to conslrucl, ahcr, irnprovc. dcmolish or repair any <br />stnrcture, pri(r &) its issuance. also re<Nires the rpplicnilt tbr such pernil lo fil€ a signed slatcmnl that he or she is licensd pursuanl <br />to thc pmvisions ol lfu'Contractor's l-iccnsed l,aw (Chaplcr 9, Comrncncing wilh Scction 7(I)0 ol l)ivision 3 ol thc llusincss and <br />ProfessioDsCotle)orthalheorshcisexempttherefrl)matrdthebasisfortheallegedexenrption. AnyviolattnlofSectionT03l.5hyany <br />rpplicxntlbrrpennitxubj.ctsthe applicantloncivilpenaltyofnotmorethrtrlivehundreddolhrs($5(xl). <br />_1. as owncr ol lhc proFny. or my employccs with wagcs as lhcir Fl. compcnsation, will do the work and thc (MW is mt <br />inrcrxled or oiTcrcd for ulc (s6.7(x4. Busincs5 .nd PNfessions Coder The Conlrachis Licensc Law d(rcs not apply to an owncr of <br />the pruFdy wl& lNilds or im0rows thcN[ and wlxr dGs such wo* hinrself or lrcrself or thrcugh his or hcr own employces, <br />providcd lhat such impNvermnts rc mt intcndcd or ollcrcd lor sle. ll. howcvcr, th! building or improvcmnt is sld withio one )rar <br />ofconrplelinr, thc Owner Builder will havc the burdcn ofprcviD8 llut lE or shc did not build or imprrrve thc prupcny for lhc purpose of <br />sale). <br />_1. as owner ofthe proncrly, am €xclusively conlrsclilg with licensd conlrnck)rs lo conllruct lhe prcject (Scc. ?(N4. Busincss <br />and PnrllssirrrCode:TheColtrilctor'sLicenseLawdoesnotapplyloanowneroIpropemywhohuildsorimproveslheaoil. <br />and rvho contracls for such projecls with a Conlmctor(s) liccnsed pursuml to thc Contraclor's Liccnsc [iw). <br />-IanrexemPlunderSectitrn-'B'&P,c,tbrthisrcason'n---. <br />woRKHRS', COt\IPUNSA1 l()N <br />DECLARATIoN <br />I hcrchy allirm undcr pcnaltyof pcrjury onc of lhc li'llowing (lcclarntions: <br />_lhaveildwill DaintainaCenitlcalcofCoDsenttoScl[-lnsurcforworkers'11)nrpeNation,as providedforhySeclionST00ofthe <br />hbor Cdlc, lbr thc pcrlorrurcc of thc work lilr ahich thc pcrmit i\ i\sucd. <br />X:;hy Sccrion 3700 oflhe bhorand will nlrirnain workes'K[ trtsurance, as Code, for the 1rcrfomrrce of <br />lir whrlr is canicr axl <br />o-i(.1 /=-ol)olicv 1/ <br />_l ccnity that in thc pcrtbrnunce of rhc work for which this pcrmit is issucd, I shull not cmploy aoy pcrson in {ny mmner <br />$astohccoDEsubjccttothcworkcrs'coilrpcnsllionlawso[CaliforDia,andagrcclhatiflstsuldbccorNsubjccltolhc <br />wodiers' con)pensxlion provisions of Section 1700 of the Labor Code, I slull, funhwilh comply wilh lhos provisions. <br />) <br />WARNING: Fililurc k) $curc workcrs' conrpnsation unlawful.shall m cmploycr to triminal peMhics , n(l <br />hccivil finer up to onc hundr.d thousand dollnrs (Sl(X).(Xxl).ir)n to darrrges rs provided fu <br />Section J076 ofthc inlerest and s <br />I hercby al-lifln undcr pcnalty ofperjury lhal I Arn un(lcr ol Chaplcr 9 (cornrrencing with Scction 7ff)0) of Division I <br />of the Busincsr and Profcssions Codc. el nrv liccnsc is in full fbrcc and clli'ct. <br />7z /7l-ic!'nse Classl <br />CONS'TRT]CTION I,I:NI)IN(; AGT:NCY <br />I heEby aftrnr under rtnalty of perjury rhal lh€re is ! conslruclion lendirg agency ti)r the perfomarEe ofrhe work tbr which this Jrmit is <br />issucd (Scc. -l(197. Ci!. C.). <br />knder's Nrilre: <br />lxndcr's A(ldress: <br />- <br />APPI,ICANT DECI,ARATI0N <br />I lxreby uflirnr unrler peralty of perjury one of the lollowiDg declarnt ions: <br />Den)olirion Pcrnrils-Ashe\los Ndification Fcderrl Reguhtio[s (Title.l0, Parl6) <br />_Required of Norili.illion <br />-I <br />that tlD federalrcgulatiofls EgarJing astEsbs rcmvrl are not applicable to this pmj*-(. <br />cenify thal I have rerd thi\ applicalion infornralior <br />nild Slrtc [-xws relilti,lg to <br />rtx,vc mcnlionc(l p(,pc(y tirr <br />Applicnnt or Agcnl <br />['rnilile( nanre <br />thnt rhe <br />attlrrrirc <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 />Framing <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />[Vasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Beport <br />Engineer Final Report <br />Flood Zone Certif. <br />//\ <br />FINAL 3-a-a Y.W16t) <br />Certificate of Occupancy <br />Notes, Remarks, Etc.