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BU!LDING. INSPECTOR RECORD SITE.WORK DATE !D/SIG.COMMENTS OWNER BUII-DER DEL('ARA'I'ION Je . I hreby affirrn under penally of pdjury that I m cxempt frem thc Conlraclo6' l-icsse Lau' for thc follorving reen (Sec.70-l1.5 Businss ud Profmion Code): Any Cily or Counly which requirs a tmnit lo comlruct. alte, improve. demolish or rcpair any structurq lrior (o its issuance. also requir6 the applicant for such pnnit to lile a signed statcmml thal he or she is licosed pursuanl lo thc provisions of lhe Contraclor's Licosed Larv (Chaptq 9. Commencing s ith Sation 7000 of Division 3 of thc Businas and Prcfesiens Code) or thal he or shc is excmpt thqeftom and the basis for lhe allegcd exernption. Any violation ofsection 703 I .5 by any applicant for a pcmit subj(ls lhe applicant to a civil pmahy o f nol more thm fitc hundrcd dollas ($500). _ _ l. as o\\'ner of the propert!'. or rny emplo)'ees $'ith $'ages as their sole cornpensation. u'ill do the s'ork and the structure is not intended or ofFered for sale (Sec.7044. Business and h'ofessions Code: '[he ('ontractor's l,icense l.arv does not apply to an orvner of the propmty s'ho builds or improves thereon. and rvho does such $'ort himself or herself or through his or her ou'n employees. provided that such irnprovorrents are not intended or offerc.d for sale. l[. hou'ever. the building or irnprovemenl is sold u'ithin one ]'ear of cornpletion. the Orvner Builder will have the burden of proving that he or she did not build or improve the propoly for the purFnse of sale). _ _1. as o\r'ner of the prop€rty. arn exclusively contracting s'ith licensed contractors to construct the project (Sec. 7044. Business and Pnrfession Code: 'fhe Contractor's License l-arv does not apply lo an owner of property rvho builds or inrproves lhereon. and who contracts for such projects rvith a Contractor{s) licensed pursuant to the Contractor's License Larv). l*4^ exempt under Section- . B. & P.c. for this reason. l)ale:_ Owner: \},ORKERS' (:O[I PENSATION DE(:I,ARA'tION hereby afftrm under penalty of pojury one of the follorving declarations:7' -l have md rvill maintsin a Cedificatc of Consnt lo Self-lnsure for sorkm' compmmtion. ro providcd for by S(lion -1700 of the Labor Codc. for the p€rfonnance ofthe $ort for shich rhc p@nil b issucd. \l ha*c and u,ill maintain lvorkm' comlENation iNurance. 6 rcqilirod by s(tion -1700 of the Labor ('odc. for thc pqfonnancc of the work for rvhich this pmnit is isucd. My workss' comlEnsation insurance cmis and policy numba rc:V*-6*rt \-ryr4- 5g 0-. 4.,*,*rpeag""oa.1r." - -;jl lzd,Z.-/\ - _l cedify that in the pqfonnancc of thc $ork for rvhich this pcnnit is issued. I shall not mploy any pcrmn in any mmno w u to bccorne subjet to the wo]tm' compcrsation laws of Califomia. and agre that if I should becomc subjet to thc uo*qs' compmmtion pre\'isions ofSation -1700 ofthc Labor Code. I shall. fonhrvith comply rvith tho* prorisions. WARNING: l:ailure lo secure n'orkcrs' civil fincs up lo one hundrctl thousand compensalion and shall sub.iect an employer lo crirninal poralties anrl dollars ($ I to the cost of contpensation. datnages as provicled for tlre Section the ('otle. interest and attonrey's 20 l)tt('1.,\R \,l'l()N I hereby affrrnr under penalty of per.iury that I arn license<l under provision of Chapter 9 (cornmencing rvith Section 7000) of l)ivision .1 of the Business and Professions Code. and rny license is in full force and effect. X e/;ll. - I / I hereby affirm under penalty of perjury that [:x*1:ft"io.:'' civ c ) tqq eB, Contrrctor:_L) / there is a construction lending agency for the perfonnance of the work for rvhich this pennit is Lender's Addrcss: _ A PPLICAN'I' DEC I,ARA'[ION I ltcreby affrnn under penalty of perjury one of the follow'ing dec'larations: Demolition Perrnits-Asbestos Notilication Federal Regulations (Title 40. Parl(r) _-_Required Letter of Notification -l cqriry thal the fcdaal rcgulatiom rcgrding ubctos rmold uc not applicablc to this prejcl. -l catify thsl I have red this applicstiog'snd natc that the aboye infomaion is corct. I agrc to comply rvith all City and County ordiqrncs and State taw relaling lo buijding yottsrctioa..ufficby ailhorizc rcprGotativG of lhh City ed tounty to ml6 upon lhc#;:::il:il"i:W _ _.*"g,hoJl1 _ 4.*.".",0.,";, Li\t 6@G^r,^^7- - - -----T--- 0 Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/Ve nUl n s u latio n Roof Sheathing lzt 'tt lt1 I *ttoat- *?? Shear Wall Framing I 2 N6p,v*tr lnsulation/Energy b*ria ll't? f (an-,tr6- -bA,.yp, Dfywall 2t DtW)€a *nl 4r, lO tf I nfrn /ffi Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif .l , FINAL t)hlto DfttA/ltv t,#T7 Certificate of _]!eteq, Rpmarkg, Etg.I I //il lltllq ilw /?'p{u J tfu I ,, z 1-L a I ,I J- \ ) /?a -Ext,7lnt. Lath I g I n l.L t*t I /t,. *\