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SITE.WORK DATE ID/SIG.COMMENTS ()wN tiR B U I LI)1,:R t)1,:t.CA RATION <br />I hereby affirnr untler penalty of grcr;ury that I am exempt from the Conlracloni' License Law for the followinS reason (Sec.7031.5 <br />Busrn':ss and Prolbssion Codc): Any City or County which rcquircs a Jrcrrnit lo conslruct. altcr. irnprovc, dcrnolish or rcpalr any <br />.stnrcture. prior to its issuance. also requires the applicant lirr such pernril to lile a signed statement tltat lrc or slte is licensed pursuanl <br />to thc provisions of thc Contractor's l,icenscd Iaw (Chaptcr 9. Cornrncncing with Section 7(XX) ol'l)ivision 3 ol'thc Busincss and <br />Prol'essionsCtxle)orthatheorsheisexempttlrcrettomarrdtlrchasislirrtluullegedexenrption. AnyviolatirtnofSectionT03l.5hyany <br />lpplicant {br a lrrrnit subjects the applicant to t civil penrlty ol'not rnore lhu fivc hundred dollars ($5tXt1. <br />_l.as owncrol'thcpropcrty,ortnycrnployccswithwagcsasthcirsolccornpcnsation,willdothcworkandthestnrclureisrKlt <br />intended or offbred firr sale (Sec'.7(I14. Business and Professions Cotle: The Conlraclor's l-icense Law d()es nol npply to itn ou'ncr of <br />the pr)pctly wlxr builds or improves thereorl arxJ wlxr does such w<lrli hinrself or hrselt'or lhrouglt his or lter owrt enrployees, <br />providcd that such improvcmcnts arc not intcndcd or ollbrcd lirr salc. Il, howcvc'r, thc building or funprovcrncnt is sold within one ycar <br />of conpletion, the Owrrcr Builtler will lrave the burtlen o[proving llrat lu or shc tlid not build or inrprove the property for the purlxrse of <br />sale). <br />_1. as ()wner of the properly, am exclusively contracting with licensed conlructors to c()nslrucl tlrc prtrject (Sec. 7(X-1. Business <br />arxl l)nrlbssron(fode: 'l'heCorrtractor'sLicenseLawdtleslxrtapplytoanowuerofpropertywhobtriklsorintproveslltereon. <br />an<l who c()ntrilcls lbr such pro.iccls with a C()ntract()r(s) liccnscd pursuant to thc C()ntrilctor's Liccnsc Law). <br />-IantexemPtunderSection-'B.&P.C.forthisreasotr. <br />W( )RK I.IRS' (l( )Nl IDI :NSA'[I( )N <br />I)I]CI.ARATI0N <br />I hcrchy at'tirm untlcr pcnalty of pcrjury onc ol'thc tirlkrwing tlcclarations: <br />Lalxrr (ixlc, ftrr lhc pcrlirrmancc ol'the work lirr which thc pcnnit is issucd. <br />N9,t tl". <br />have and 3700 of lhe Labor Code, for the Jrerformarr"-e of <br />work arxl lxrlicy nunrbcr arc: <br />/t\\LO <br />that in thc lrcrtilrnuncc of thc work firr which tlris pcrnril i.s issucrl, I slrlll nol cnrploy any pcrs()n in any nlanncr <br />so,lslobc'colrcsuhjccttotheworkcrs'cornpcnsationlawsofCaliforrria.arrdagrccthatif lshouldhccolrcsubjccttothc <br />workcrs' conr;rnsatiorr provisions of Section 3700 of the Labor Cotle, I shall, forthwith contply with tlxrsc provisions. <br />IVARNING: Failurc to sccurc workcrs' conrJrcnsation covcrugc is unlawlirl. antl slrall subjcct an cntploycr lo crintinal pcnaltics and <br />civil lines up to one hundred thousand dollars ($l(X),(XX)). in addition to lhe cost ol'darnages it.s provided l'or the <br />DECLARATION <br />I hcrcby al'lirrn undcr pcnalty ol'pcrjury that I arn liccnscd unclcr provision ol'Chaptcr 9 (cornrncncing with Section 7([n) of l)ivision 3 <br />of thc Busincss antl Profcssions Codc. arxl nry liccnse is in tull tirrcc' arxl cllcct. <br />I-icr'nsc'c\0 4r 3156 <br />VIVt <br />CONSTR t I(--'T I ON I,I.]N I ) I NG AG I.]N (-'Y <br />I herehy alllrnr under penalty o f per.iury tlut tlrre is a const nrct ion lending agerry for t he performarre of the work lirr which this Jrcrnit is <br />issucd (Scc. 3097. Civ. C.). <br />Lcrrdcr's Narnc: <br />[-cntlcr's Arilrcss: <br />APPLICA NT DECI,ARATION <br />I hereby aflirnr untler penalty of perjury one of the following tleclarations: <br />Denrolit ion Pernrits-Asbcstos Notificat ion Federal Regulat ions (Title .t0, Part6) <br />-Retluired <br />Letter of Notification <br />_l cerlify that the t'ederal regulalions regarding asbeslos renxrvalare n()l applicable to this project. <br />S, cerrify rhat I have read this applicarion anrl srate thar the above infornration is correcl. I agrcc to conrply with all City antl Counry <br />this Corrrry lo errter ulxur tlle <br />blLt) <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/Ve nt/l nsu latio n <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulatio nlEnergy <br />Dlfwall <br />EfD/lnt. Lath lo21- 2o p4qLFt pd..,,,tPp fp^t\ <br />B76wn Coat <br />N/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputv Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />s,b <br />FINAL //,2o'D l2- c /1 N?bry,r1 <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />\ <br />BUILDING- INSPECTOR RECORD <br />t <br />I <br />ie,,,. 0B- 07 -2O15 <br />insurance, as <br />whiclr llris pcrnrit is issucd. <br />ordirr:rrrce.s und .Statc l-aws rehtirtg lo <br />rtbrlvc rrrcrtt ioncrl pnr;rcrly litr <br />Applicunt or Agcnl <br />Z Ll <br />I'rnrrilec nalue <br />cor)slnrction. arxl