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BUILDING. INSPECTOR RECORD SITE.WORK DATE lDEFI,COMMENTS) Set Backs u ti Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/VenUI n su Iatio n Roof Sheathing Shear Wall Framing Insu lation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T'-Bar Handicap Ree. Deputy Final Report Engineer Fina! Report Flood ZonqCertif /? \a,Utc- l/./il1^/2-/?t?Zc Al 7 FINAL /z-// -/ 7 /Z (-,e../F,rAg il)7, Certificate of Occupancy Notes, Remarks, Etc. OWNER BUILDER DEL(:ARA'I'ION I hoeby affirm unde pemlty of perjury lhat I an exempt from the Conlrsctom' I-icere t{w for thc follorving remn (Ss.7031.5 Busincs and Profssion Code): Any City or County which requira a pmnil lo coNtruct. alt6. i!trprovq dmolish or rcpair uy structue, prior to its isuuce, also requirs the a;rplicmt for such pennit to file a signed statmot thal hc or shc is licosed pmumt to the provisions of the Contmclor's Licenscd Law (Chapts 9. Commcncing with Sction 7000 of Division 3 of the Busins md Prof6sionsCodc)orthathcorshcisexemptthqefromildthcb6isfortheallcgcdcrqrpion. AnyviolationofSetiotrT03l.5byany applicant for a pmit subjcts thc applicant to a civil penalty of not more thil lil e hun&ed dollils ($500). I. as orvner of the property. or my employees rvith u'ages as their sole cornpensation. w'ill do the work and the structure is not intended or offered for sale (Sec.7044. Business and hofessions Code: The Contractor's [-icense La*'does not apply to an owner of the property rvho builds or improves therqrn. and rvho does such work himself or herself or through his or her orvn ernployees. provided that such improvonents are not intended or offererl for sale. Il. hos'ever. the building or inrprovemenl is sold w'ithin one ytrr of complaion. the Or*'ner Builder u'ill have the burden of proving that he or she did not build or improve the propoty for the purpose of sale). _ _1. as owner of the propoly. am exclusively contracting rvith licensed contractors to construct the project 1Sec. 7044. Business and Profession Code: The Contractor's License Larv does not apply lo an os'ner of property rvho builds or improves thereon. and u'ho contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's l-icense Larv). -lamexemptunderSection-.B.&P.C.forthisreason.I)ate: Owner:_ __ IVORKERS' COIII PENSAI'ION DECLARA'I'ION I hereby affirm under penalty of perjury one of the follorving declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for rvorkers' cornpensation. as provided for by Section -1700 of the Labor Code. for the perfonnance of the work for which the pennit is issued. .-_.1 have and rvill rnaintain rvorkers' compensation insurance. as required by Section .1700 of the Labor Code. for the po'flonnance of the rvork for which this permit is issued. My rvorkers' cotnpensation insurance carrier and policy number are: ('an'ier:___ l'olic't Nrrrrtller :!ixpircs: -- I cerril"y that in the perforrnance of the rvork for rvhich this pennit is isstrecl. I shall not ernploy any person in any rnanner so asto bec'omesubject tothervorkers'compensation larvsof California. and agrcethat if lshould beconresulrject tothe n'orkers' conrpensation provisions of Section -1700 of the l-abor Code. I shall. fiorths'ith complv rvith thosc WARNING: Failure to secure rvorkers' cornpensation coverage is unlaw'fiul. and shall sub.icct penalties and civil fines up to one hundred thousand dollars lll to the cost of as provided for the Section -3076 of the Labor Code. interest and Drte: I hercb."- affirrn under penalty of perjury that I under provisicrn of ('hapter 9 rvith Scctiun 7000) of l)ivision .1 of the llusiness and Professions Code. and is in full force and effect. c\t>Nunrhcr: ,,r" ,670*t \ lo1 lt q v I hercby affirm under pnalty of perjury that issued (Sec. -1097. Civ. C.). Lendcr's Nanre: lending agency for the of the rvork for rvhich this pennit is l.endcr's Address: APPLICANT DECLARA'TION I horby aflinn under penalty of perjury one of the follou,ing declarations: Dernolition Pennits-Asbestos Notification Federal Regulations ('l'itle 40. Part6) __Required Letter of Notification this llxr.icct. I agrer to cornply rvith all City and County and ('ounty to enter upon theof this ('ity LDare:tt, lo1 lf? w Frs ! colify that application and state thal the ahrve inltrrrnation is Lau's relating to building construction. and hcrcby aulhorizc llrovc propefly for o