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BUILDING- INSPECTOR RECORD SITE.WORK DATE !D/SIG.COMMENTS OWNER II UII,I)I]R DICI,CA RATION I hereby affirnr untler penalty of perjury that I am exempt from the Cbntractors' License [:w for the following reason (Sec.7031.5 IJusiness and Prolbssion Code): Any City or County which rcquires a pcrmit to construct. alter. irnprove, demolish or rcpair artry structurc, prior to its issuance. also requires the applicant for such pcrmit to fik a signed slaterpnt that he or she is licen.scd pursuant to the provisions of thc Contractor's Licensed hw (Chapter 9. Commencing with Section 7000 of Division 3 of the Business and Professions Code) or that hc or shc is exempt therefronr arxi thc basls ttrr the alleged cxemption. Any violation of Section 7031 .5 by any applicnnt for a 1rcnnit subjects the applicant to a civil penalty o[ not morc thiln five hundred dollars ($5U11. _1. as owncr ot'thc propcrty, or lny employees with wages as their solc compcnsation, will do the work and the stnrcturc is not intendetl or offerctl ftrr sale (Scc.7044, Business and Professiorrs Code: The Contractor's Licensc Law does not BPPIy lo an owner of the property who builds or improves thereon, and who does such work himself or lrerself or through his or her own employees, provided that such impnrvements are not intended or ollered for sale. Il. howcvcr, thc building or improvement is sold within onc year of conpletion, the Owner Builder will have the burden of provirrg lhat he or shc did not build or improve the properry for thc purporie of sale). fr. as owner of the propcrty. am exclusively contracring with licenscd conlraclors to conslruct rlrc project (Scc. 7044. Business arxl hotesskrn Code: The Contractor's License Law does not apply to an owner of proprty who builds or improves lhereon. and who conlracls for such projects with a Contracto(s) licenscd pursuant to the Contractor's License l-aw). _l amexempt under Section_, B. & P.C. for D^,",. 2llzl?:o2o I hcrcby aftirm unclcr pcnalty of pcrjury W( )RKFIRS' ('( )l\l I'ENs^A'l'l( )N DECLr\RATI()N onc of the tirlkrwing tlcclirrations: -l have and will nmintain a Certilicate of Consent to Self-lnsure for workers' compensation, as provided for by Sect ion 3700 of the Lahor Codc, for thc Jrcrformance of the work for which thc pcrmit is issucd. _l have and will maintain workers' compensalion insurance, as required by Section 3700 of the Labor Code, for lhe perfornrance of thc work fbr which this pcrmit is issucd. My workers' compcnsation insurancc carricr aml policy numbcr are: that in the Jrcrtbrmancc of the work for which this Jrcrnrit is Lssucd, I shall not employ any person in any manncr so astobecorncsuhjccttothcworkers'comlrcnsationlawsofCalifornia.andagrcethatiflshouldbecornesubjccttothc workers' conrlrcnsation provisions of Section 3700 of the Labor Cotle, I strall, forthwith comply with thosc provisions. WARNING: Failurc to sccurc workers'compensation coverdgc is unlawful, antl shall subject an employcr to criminal Srnalties antl civil fines up to one hundred thousand dollars ($100.UX), in addition to thc cost of damages as provided for the Section 3076 of the l-ahlr Cotle, interest and attorney's fees. ,r^r". - 2ll2.lZOzO I hcrcby allirm undcr pcnalty ol'pcrjury that I am licenscd under provision ol Chaptcr 9 (cornrnencing with Section 70m) o[ l)ivision 3 t of the Busincss and Pr<lfessions Codc, and nry liccnsc is in full tirrcc auxl clfect. Licensc Class: License Number: Dale: Contractor: CONSTRI.]CTION I,T.]NDING AG T:NCY I hercby atlirm under penalty of perjury that there is a constructiorr lentling agercy lbr the performance of the work fbr which this pcrmit is issued (Scc. 3O97, Civ. C.). Lendcr's Narnc: I-ender's Adtlrcss: APPLICANT DECLARATION I hereby affrm under penalty of perjury one of the following dec'larati<lns: Demolition Permits-Asbcstos Notification Federal Regulations (Title 40, Part6) _Required l*tter of Notification thls project. with all City and County and County to entcr u5rcn lhc atxlvc mcntioncd propcrly lirr inspcction purposes. Applicant or Agcnt Pt'nnilee nanlr I o^.,,- 2ll2l 70?b Set Backs \,a -r\/) ^?t l_ Forms/Stee!/Holdowns a r-l-4t ,\-a=- ('-t ( Erection Pads , UFER Ground SLAB Floor S u bf loo r/Ve nVI n su latio n Roof Sheathinq lrl ,, ' Zr)rZ C-2 4 Shear Wall ln(8-Q fLtt2 0 Framinq / /-i/^LA ffii lnsulation/Enerqv l/-r,r-A 2':l4J Drvwall //. /O'P flc Za Ext./dfitl=lD /1,|a ..2>0c U)k rlA -Z) fLc zF7 Brown Coat //.d'2()/?-c rf J\Iasonrv Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif -at L FINAL lDfttf-A ,Z Zts n/fus -2t7 Certificate of Occupancy Notes, Remarks, Etc. + Rev. 0B-07-2015