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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf loor/VenVl ns u Iation Roof Sheathinq Shear Wall Framinq lnsu lation/Enerqy Drvwall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Enqineer Final Report Flood Zone Certif I /t l;. FINAL iLlt?-'k r d)f '4Y6-l Certificate of Occupancy I Notes, Remarks, Etc. OWNER BUILDER DELCARATION I hcrchy attirm undcr pcnalty of Frjury that I am cxcmpt hom lhc Conlracbrs' Liccnsc kw li)r lhc litlktwing rcasrn (Ss.7031.5 Busincss atrd Profcssior Colc): Any City or Coutrty which rcquircs a Jrrmil to conslruct. altcr. impnrvc. dcmolish or rcpair any stmcturc, prior b its issuancc, also rcquircs lhc applicant lirr such Frmil lo I'llc a signed slatemnl that hc or shc is liccnkd lrursuant to thc pnrvisi()ns of thc Contractor's Liccnscd Law (Chaptcr 9, Commcncing with Scction 7U)O of Division .l of lhc Busitrcss and P(rlbssrcns Codc) (rr thal hc or shc is cxemlt thercfi()m and thc basis fbr thc allcScd cxcmption. Any vi(tlation of Setittn 703 I .5 by any applicant Ibr a Frmit subjccls th€ applicatrl k) a civil pcnalty of not morc lhan fivc hundrcd dollars ($500). _1. as owncr of thc property. or my cmployccs with wagcs as thcir solc comJrcnsalion, will do thc work and lhc structure is nol intcndcd oroll'crcd lirr sale (Scc.7044, Busincss and Prol'cssions Crxlc: Thc Contractor's Liccnsc Law dtrcs not apply lo an owncr o[ thc pnrpcrty who builds or improvcs thcrcun. aml who drrcs such work himsclf or hcrsclf or through his or hcr own cmployccs, prlvidcd that such improvcnrcnts arc mrt intcndcd or ollbrcd lirr salc. If, ltowcvcr, thc buikling or improvcrncnt is sokl within onc year of complction, thc Owncr Buildcr will havc thc burdcn o[pnlving that hc or shc did not build rlr improvc thc propcrty lirr thc purJxrrc ol' sah). _1. as owncr ol thc propcfly, am cxclusivcly contracting with liccnscd contractrtrs to conslruct thc pnljcct (Sec. 7044, Busincss and Pnttbssion Codc: Thc Contractor's Liccnsc Law tklcs not apply to an ()wncr of proJrcrty who builds or improvcs thcretln. and who contracts lirr such pro.iccts with a Contractor(s) liccnscd pursuant to thc Cuttlractor's Liccnsc Law). _l am cxcmpt undcr B. & P.C. lirr this rcason. Date:0wner: wonrcns'coltrums DECLARATION I hcrcby all'irm untlcr pnalty ol'Jrcr.iury onc of thc lirlkrwing dcclarations: _lhavcanrlwill maintainaCcrtiticatcofConscnttoSclt-lrrsurctirrwrtrkcrs'conrJrcnsation,as provirlcdtitrhyScctittn3T00ofthc Latxrr Crxlc', Iilr thc Jrcrlilrmance of thc work tirr which thc prmit is issucd. kr havc and Scction 3700 of thc Lahor Code, lilr thc lrcrfirrmancc of arxl Jxrlicy numbcr are:wrlrk lirr l'olicy _l ccrtify that in thc Jrcrlilrmance ol'the wrlrk tbr which this pcrmit is issucd, I shall not cmploy any lrcrs()n in any manncr so as to bcconrc subject to thc workcrs' compcnsation laws of Calililrnia, and agrce that if I stnuld bccomc subjcct to thc workcrs' comJrcnsation provisions of Scctkrn 37ffi of the Lahlr Codc, I shall. filrthwith c<lmply with thos:c pnrvisions. WARNTNG: I;ailurc to scurc workcrs'comgrcnsation covcragc is unlawlul, and shall suhjecl an employer to criminal Srcrraltics and civil lincs up lo onc huntlrcd thrtusand dollars in addition to thc c<tst of comJrcnsalittn,as pnrvidcd tirr thc Scction -]076 ol'thc Latxlr Ctxlc. irttcrcst and atkrrncy's DECLARATION I hercby aflrm undcr pcnalty o[ Jrcrjury that I am liccnscd undcr provision of Chaptcr 9 (commcncing with Scction 7U[) of Division 3 of thc Busincss and Prol'cssions Code, arxl my liccnsc is in ttll lirrcc arxl ctl'cct. Liccrrsc Nurnbcr:<- CONSTRUCTION LENDING AGENCY I hcrcby atftrm undcr lEnalty of lErjury that therc is s coNtruclion lcnding ogcrey tbr thc [rcrlbmcc of lhc uork for which lhis lEmit is issucd (Se. 3097, Civ. C.). l-cnrlcr's Namc: [-cndcr's Address: APPLICANT DECLARATION I lrcrcby atlirm undcr pcnalty of prjury one of thc lblkrwing declaralions: Dcmolition Permits-Asbcstos Notil'ication Fcdcral Rcgulations (Titlc 40, Part6) -Rcquirctl l,cttcr of Notilication _l ccrrily that thc t'cdcralrcgulations rcgarding ashcstos rcmoval arc nol applicablc to this pnrjcct. statc that thc abovc intirrmation is corrcct. I agrc.c to comply with all City and Cttuttty hcrchy authorizc rcprcscntativcs of this City and County lo cntcr uJxln thc atxrvc mcntioncd pnlpcrty for Applicant or Agent Pennitce n&nlc lo )o1 t o,,". 4(o/zo,?o