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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/S!G COMMENTS OWNER BUIT,I)ER DELCARATION } t <br />I hcrcby rffirm under prnalty of lrcrjury lhill I dn cxcmpl fmm thc Coilruclors' Liccnrc kw for lhe following rcamn (Scc.70.11.5 <br />Business arl Pmfessi$ Codc): Any City or Coutrty which rcquircs u 1rcrmit lo snslruct. allcr. improvc. dcmlish or rcpair any <br />structurc. prior to its issuancc. also requircs lhc ilpplicant lbr such Frcrmit to lilc a signcd slnlcrmnt that hc or shc is licenscd pu.suant <br />to thc pmvisions of tlrc Contrnctor's Liccnscd law (Chaplcr 9. Commcrcing wilh Scclion ?(fi) of Division .J of the Busincss and <br />ProfessionsCodc)orthathcorshciscxcmptlhcrcfromandlhcbasisforthcallcgcdcxcmplion. AnyviolationofscctionT03l.5byany <br />applicanl for a pcrmit subjccts the applicant to a civil pclally of nol morc th0n livc hundrcd dollurs ($500). <br />_l.as ownerofthcproprty.ortnyentployceswithwagcsastheirsolecornpcnsalion.willdothcworkandlhestructurcisnot <br />intcndcd or ofl'crcd for salc (.Sc.c.7014. Busincss and hof'essions Codc: Thc Contractor's Liccnsc l-aw does not apply to an ow'ncr of <br />the prcpcrty who builds or inlproves thcrcrn. aml who dcrcs such work himscll'or hcrself or through his or hcr own emPloyces. <br />providcd that such intpnrvcnrnts arc not intctxlcd or offcred for salc. l[. howcvcr. thc building or improvcnrnt is solcl within onc ycar <br />of conrpletion. thc Owner Buildcr will have thc burdcn of proving thal hc or shc did not build or improvc the proJrcrty for the purynscof <br />sale). <br />_1. as owner of thc propcrty. am exclusively contracting with liccnsed conlractors to construct thc project (Sec. 7(44. Business <br />and Profcssion Codc: Thc Contractor's Licensc Law docs not apply lo an owncr of propcrty who builds or improves thereon. <br />and who contracts for such projects with a Conlract<l(s) liccnscd pursuant lo lhc Contraclor's License Law). <br />I arn excrnnt undcr Scction . B. & P.C. tbr this rcason. <br />I)ate:( )rr rrer. <br />WORKEKS' COTVIPENSATION <br />DECLARATION <br />I hereby aflirnr undcr penalty of pcrjury onc of lhe t'ollowing dcclarations: <br />_l have and will maintain a Certificatc of Conscnt to Self-lnsurc for workcrs' compcnsation. as provided for by Section 37fi) of thc <br />l^abor Codc. for the perfornurncc of thc work for which thc Jrcrmit is issued. <br />_lhaveandwill maintainworkcrs'compcnsationinsurancc.as requiredbyScclion3Tfi)oflhcLaborCodc.forlheperformanccof <br />thc work lbr which this pcrmit is issued. My workcrs' corrrpcnsation insurancc carricr and Jxrlicy numbcr arc: <br />Policy Numbcr: Expires: <br />_l ccrtily that in thc pcrlirrrrmtrcc of thc work lilr which this;lcnnit is issucd. I shall not etnploy any pcrson in any manncr <br />so as to beconrc subjcct to thc workcrs'cornpcnsation laws of Califrrrniu. attcl agrcc that if I should hcconrc suhjccl to lhc <br />workcrs' conlpensation provisions of Section 37fi) of thc Lahrr Code. I shall. lirrthwith cornply with thosc provisions. <br />WARNING: Faiturc to sccurc workers' c<lrnpcnsation covcragc is unlawl'ul. and shall sub.iccl an employcr lo crirninal pcnaltics and <br />civil fincs up lo onc hundred thousand dollars ($lU0.ffiOl. in addition to thc cost of comJrcnsalion. danragcs as provided for thc <br />Scction .307(r ol'lhc Lalxrr Crxlc. interest and allorncy's fl'cs. <br />Applicant:_ <br />I hcrcby all'irrn under pcnalty of pcrjury that I ant liccnscd undcr of Chapter 9 (cotttnrcncing with Scction 7Un) of Division 3 <br />of thc Busirrcss and Prol'cssions Codc. an<l rrty liccnsc is'irt l'ull t'orce arrd cl'f'cct. <br />Liccnsc , <br />Date:_Conlractor:-I RC <br />W <br />I hcrcby affirm under Fnahy of pcrjury rhBr rhere is a construction bnding agcncy for Ihe performrcc ofthc work for whhh this Jrrmit is <br />issucd (Scc. .1097. Civ. C.). <br />[-endcr's Nantc: <br />Lender's Addrcss: <br />APPLIC ANT DECLARATI(IN <br />I hcrcby afl'inn undcr pcnalty of pcrjury one of thc following dcclarations: <br />Dcmolition Pcrrnits-Asbcstos Notification Fedcral Rcgulations (Titlc 40. Part6) <br />-Rcquircd <br />Lcttcr of Notification <br />_l ccrtifythat thc l'cderalregulations rcgarding asbcstosrcnxrvalare nol applicablc to lhis projcct. <br />-l <br />ccrlily lhul I havc rcatl this applicatiott atttl that thc ahrvc inlbrnrnlion is corrccl. I agrcc to cotttply with al! City and Coultty <br />ordinanccs and State Laws rclating to and hcrcby authorizc rcprcscntalivcs of this City and County to enlcr u;nn lhc <br />abovc mcntioncd proprty for <br />Applicant or Agenl Signalure: <br />I)ernritee lrurne ( <br />Date:- <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />S u bf loor/Vent/l n s u lation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />Insu Iation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Jt/asonry <br />Poo! Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif. <br />-4 I . r . -C7 <br />FINAL q t^L\40 bfYln^l 'qrD /rl I ICertificate of Occupancv <br />Notes, Bemarks, Etc.,.-6L <br />I <br />Q. z+fiRcI)ale: