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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS oWNERBUILDERDELCARATTON r I hqcby affm unde pcmlty of perjury thst I m cxcmpt from thc Contractom' Licere Law for the following rwn (5&.7031.5 Bsin6s and hofsion Codc): Any City or County which rcquirc a pcmit to sEIrucl. alte, improvc, dcmolish or rtpair my structw, prior to its i$umce, also rcquic the applicot for such pcrmit to 6le a sign€d statmat thd hc or she b licscd pwmt to thc pmvisioru of the Contretor's Licensed Law (Chapt6 9, Comnencing with Setion 7000 of Division J of the Busin$ od Prcfsions Code) or that hc or she is cxmpt thftfrom ild the basis for the alleged ermpion. Any violation of Sction 7031.5 by my applicantforaptrnitsubjatsthc applicanttoacivilpenaltyofnotmorcthsfivehundrcddollm($500). __1. as o\lner of the propert),. or my employees with wages as their sole compensation. will do the work and the structure is not interrded or offered for sale (Sec.7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property who builds or improves thereon. and who does such work himself or herself or through his or hcr own employees. provided that such improvoncnts are not intcnded or offered for sale. l[, howwer, the building or improvement is sold within one ]Ear of complaion, the Ourner Builder will have the burdcn of proving that he or she did not build or improve the propoty for the purpose of sale). _1. as owner of the propcrty. am exclusively contracting with licensed contractors to construct the projett (Sec. 7044, Business and Pnofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's Liccnse Law). _l am exempt under B. & P.C. for this reason. WORKER,S' COM PENSATIO N DECLARATION I hereby affirm under pcnalty of perjury onc of the following declarations: __lhavcurdwillmintahaCcrtificate ofcoMttoSelf-lNucforworkss'compwtion.c providedforbySction3T00ofthc tabor Codc, for thc pqfoIrmcc of thc wort for which thc pcrmit is isucd. VrZI have snd will maintain workm' cornpcmation imuruce, r rcquired by ss{ion 3?00 of thc Labor Codc, for thc pqfomoce of the work for which this Fnnit is issued My workm' ompcrrarion ireurucc wio and policy numba rc: a n'CG.-t ZtJf t( k 3 3 I6?oPolicy _l certify that in the performance of the work for which this perrnit is issued. I shall not employ any person in any manntr so as to become subject to the workers'compensation laws of California, and agree that if I should become subject to the _ rvorkers' compensation provisions of Section 3700 of the Labor Codc. I shall. forthwith comply with those provisions. WARNING: Failure to sccure workcrs' compensation coverage is unlawful. and shall subject an etnployer to criminal petralties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. darnages as provided for the Section 3076 of the Labor Code. interest and attorney's fees. a-k rf oir.t4i( ( Va DECI.ARATION I hereby affirm under penalty of pcrjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profcssions Code, and my license is in full force and effect. Licenseclr"r' ' C (O LicenseNumbcr: 3 cr"5 7 {a af)olp'2 -t/1^7 o2 c,('ontractor:* Vr v*t4 5 W I hrcby alfim undo pcnalty of pcjury that th6c is I @retrucliof, lcnding agmcy for thc pqfommcc of thc mrk for which this pqrnrt b isucd (Se. 3097, Civ. C.). Lender's Narne: Lcnder's Address: APPLICANT DECLARATION I hoeby aff:nn under pcnalty of perjury one of the followrng declarations: Dernolition Permits-Asbcstos Notification Federal Regulations (Title 40, Pan6) _Required l.€lter of Notification _l ccrti& that the federal regulations regarding asbestos rcmoval are not applicablc to this project. llv I ceflify that I have read this application and state that the above infonnation with all City and County and County to ent€r upon theordina-nces and State Laws relating to building construction. and -/al c Pcrmitee nlrnre t Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/VenUl ns u lation Roof Sheathing Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Jlqqd Zqne Certif I t\ k*lto V['.r I q Nco VVtrlv,(u6 I trt t Cr/ FINAL A/U/{-Ig7YI W )avu Certificate of Occupancy Notes, Remarks, Etc. Section Dete:_Owner:_ ffi::ff:ffi-i'