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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII,DER DELCARATION I hoeby alfirrn unda penalty of perjury that I m exmpt frem the ContractoE' Licqse law for the following reen (56.7031.5 Busin6s ard Profsion Code): Any City or County which requirs a pennil to conslruct, altc. improvc. demolish or repar uy slruclurq prior to its isuace, also requirc thc applicot for such IErnit to fi|. a signed stalmot thal hc or she is licmscd pmuilt to the provisioG of the Contraclor's Licmscd trrv (Chapt6 9, Commflcing rvith Setion 7000 of Division -l'of thc Busincs ild Prcfeisions Codc) or that hâ‚¬ or shc is cxqnpt thqcfrom ud the bssis for the alleged exmption. Any violation ols6don 7011.54y any applicant for a pennit subjâ‚¬ts thc applicat to a civil penalty of not morc thil five hundcd dollils ($500). _1. as ou'ner of the property. or my employeâ‚¬ with wages as their sole cornpensation. rvilldo the rvork and the structure is not intcnded or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Larv does not apply to an o\\'ner of the propeny who br,rilds or inlp,roves thereon. and who does such work himself or herself or through his or her own employees. provided that such irnprovanents are not intended or ofFered for sale. l[ however. the building or improvement is sold within one year of cornplaion, the (Jrvner Builder rvill have the burden of proving tha he or she did not build or irnprove the propoty for the purposc of sale). _ I. as owner of the property. am exclusively contracting rvith licensed contractors to construct the project (Sec. 7044, Busins"ss and t'rofession Code: 'l'he Contractor's License Law does not apply lo an owner of property who builds or improves thereon. and who conlracls for such projects with a licensed pursuant to the Contractor's License Larv). & P.C. for this reason.I an exempt under Section--_. B. Date:_ I hercby affirm under penalty of thc declarations: -l have and rvill maintain a Certificate of Conscnt to Self-lnsure for workers' compensation. as provided for by Section 3700 of the Labor Code. for the pâ‚¬rfonnance of the work for which the pennit is issued. _ I have and u,ill nraintain workers' compensation insurance. as required by Section -i700 of the labor Code. for the perfonnance of the rvork for which this pennit is issued. My rvorkers' compensation insurance ciurier and policy number .re: ('arier:_ Policy Number:Expires: __-l cerrifythat in the performance of the work for rvhich this perrnit is issued. I shall not ernploy any person in any manncr so as to becorne subject to the rvorkcrs'compensation larvs of California. and agrcc that s'orkcrs' cornpensation provisions of Section 3700 of the Labor ('ode. I shall. forthw'ith if I shoultl become subject to the provisions.rvitlr WARNING: Failure lo secure n'orkers' civil fines up to one hundred thousand coverage is unlau'ful.shall to crirninal penalties and in addition to ion. damages as provided for the aSection 3076 of the interest 's fees. I hcreby aflirm under penalty of perjury that I am licensed under provision 9 (cornrnencing w'ith Section 7000) of Division 3 of the Business ancl Professions Code. and rny license is in lull lbrce and effect. [.icense Class: l)nle: I hereby affrnn under penalty of perjury that there is a construction lending issued (Sec. 3097. Civ. C.). for the performance of the s'ork for rvhich this pennit is Lender's Name: Lender's Address: APPLICANT DECLARAI'ION I lrcrefu affnrn under penalty of perjury one of the follorving declarations: Demolition Permits-Asbestos Notification Federal Regulations ('l'itle 40. Part6) -Required Lctter of Notification to this project. I Set Backs t-a Forms/Steel/Holdowns r 7{ Erection Pads UFER Ground SLAB Floor S u bfloo r/Ve nUl ns u lation Roof Sheathinq ?Arr,on -arrffr"JA tl*LrCrgs tl -2K-tQ Shear Wal!I-3*rt' I aa el+ A L*:xt2 tlr< Framing OGI 4, râ‚¬ lnsulation/Enerqy Drywall Ext./lnt. Lath Brown Coat Masonry Poo! Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif rl FINAL t2ltl t1 l}wl{/6L #7o1 Certificate of Occu pancy I Notqs, Bemarks, Etc. k1* l. Usnrtzr'lrrt/u read this application and state that all City and County ordinances l-arvs relating to t atxlve Agent inspection Va enlcr'