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BUILDING. !NSPECTOR RECORD SITE.WORK DATE ID/SIG COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subfloor/VenUlnsul Roof Sheathing Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif EXPII TED FINAL ITIAII I I zu16 Certificate of Occupancy SAMC 843 29ft sie eaz Notes, Remarks, Etc. Orvner-Builder Declaralion '-'- I hereby afftrnt under penalty of perjury that I anr exenrpt form the Contracbrs' License Law for the folbwing reason (sec 703 I .5 Buiness and Profdsion Codc): Any ('ity or County which rcquircs a permit lo conslrucl. alter. improvc. dcmolish or repair any structure. prior to its issuance. also rcquird thc applicaot fot such pennit lo filc a signed slatement thal hc or she is licemed pureuant to the previsions ofthc ( ontraclor's l-rcensed Law (Chapter 9, Commencing wilh Seclion 7000 of Divrsion 3 of the Ilusiness 6nd Professions Codc) or thal he or she is exeilrpl lhcrcfrorn and thc bmis for the allcged exemplion .Any violation of Scction 701 L5 by atry applicant for a pennit subjccls thc applicant to a civil pcnalty ofnol morc than fivc hundrcd dollare ($500). __1. as owncr oflhe prcpe(y. or my ernployces wilh wages as their sole compensation, will do the rvork and lhc structure is nol inlended or offered for sle ( Sec ?044. Business and Prolessions Code The Contractor's License Law does nol .pply to an owner ofthe propc(y rvho builds or tnproves thereon. and who docs such rvork himselfor herselfor through his or hcr own etnployees, provided lhat such inrprovemenls are nol intended or offcrcd for salc. If. however. the building or improvement is sold wilhi! one ycar ofcomplction, lhc Owner-Builder u ill have lhc burdcn ofproving that hc or she nol build or ilnprove for lhe purpose ofsalc)_ I I. as owncr ofthc propcdy. 8m exclusively cotrtracting wilh liccrucd contractors lo coulruct the projccl ( Scc. 7044. Busincss ud I Prcfcssion Code. The Controclor's License law doe not apply to En owner ofpropeny who builds or improvs thereon , and who conlracls for such proltrts wrlh a Contractor(s) Icensed pursuant to the Contractor's Ltcense [rw.). I ;],""*"' undcrs'crion & P.C. for lhis reason. ()$Der: WORKERS COMPENSATION DECLARATION I hcrcby amrm undcr pcnalty ofperjury one ofthe followinS decltratios: lhavcsndwillmaintainaCcnific8tcofCoNcnttoSclr:lnsureforworkers conrpenetion,as providedforbySslionlT00ofthe Labor Codc. for thc pcrfomancc of thc work for which thc p€mit is issued. !have and will maintain workers' compenstion insurance, as requted by Section 3700 of the Labor Code. for the perfornunce of lhc work for whrch thrs permit is issued My workers'conpensation insurance carier and policy numbe[ arc: Policy N ,-rr,,",ll'l-41 $1001 or lcss)(T}lis seclion need nol be ifthe pennil is for One huf,drcd dollars I f,l cenify rtrat in becanre subtect to the perfornrance ofthe rvork for this perrnit is issucd. I shall nol empby any person in any manner so as to rfornia. and agree thal if I should become sublect to lhe workers'!he worlers cornpensalion provisions ofSection -1700 of Code.comply h thosc pror'isions. WARNING Farlure to secure workers' fincs up lo one hundred thousand dollars is unlawful. and shall subject nn employer to crilninal penalties aild civil addilion lo lhe cosl ofcompensation. damages c providcd for the Seclion -1076 of the tabor Code, interest and attorney s fees LICENSED ('ONTRACTORS DECLARATION I hercby afljnn under penalty ofperjury lhat I sm Iiccnscd undcr provision of Chaplcr 9 (commcncing with S(tion 7000) of Division -1 of the Busincss and Profcssions Codc. and mv license is in lirll force and effect Nunlber ,,r,c lO-tg- t4 I hercby aflim undcr penalty ofpcr.jury issucd (Sec. -1097, Civ. C.). Lender's Name: a lcndiog agcncy for thc pcrfomancc ofthe work for which this pcrmit is l,ender's Address: APPLICANT'S DECLARATION Dcrnolition Permits-Asbestos Notification Federal Regulations (1 itle 40. Pan 6) Required Letler of Nolillcation Icffify lhat regulations rcgarding asbestos removal are not applicable lo this project. have read this application and slate lhat lhe abovc informalion is corcd. I agrcc lo conlply wilh all Cily and Counly State lrws relating lo building construction. and hcreby aulhorize reprsentalivcs ofthis City and Counly to cnler upon the property Ibrabove or agenl ): purI)oses. ,^,,, /OE4- r.iccnse(.rrss: C4O Cto