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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/S!G.COMMENTS OWNER BUILDER DELCARATION I hereby aflirrn under pcnalty of psjury that I m cxcmpt from thc Contracto6' t-icre Law for the following reen (Ss.7031.5 Busines ud Profsion Code): Any City or County which requirG a pcrrnil to coNIruct. altq. improvc. donolish or npoir oy structurq prior lo irs isuuse. also rcquirc lhc applicot for such pcmit to file a signcd $atm6t that hc or she b licoscd pumuanf to thc provisioru of the Contractor's Licensed Larv (Chaptq 9, Commencing with Sction 7000 of Division 3 of thc Buincs md Profcssions Codc) or that hc or shâ‚¬ is cxeinpt thqefrom ed the basis for the allcSed exmption. Any violation of S6tion 7031 .5 by any applicantforapmitsubjatsthe applicanltoscivilpenaltyofnolmorethufivehundteddollrs($500). Vj,. * oms of the prcpcrty. or my crnployrc with wag6 6 their sle composlion. rvill do thc wo* ild thc stnrluc b nol intodsd oroffded for slc (Ss.7044, Busin6s ild hofGsiom Codq'fhc Codractor's Licmc Law dos not spply to m owns of rhc prepety who builds or improvG th@n. ud who do6 such m* himself or hoself or through his or ha own cmployce. provid.d that such impf,ovqrmts e not intaded or offaql for gle. If. howoa. the boilding or improvmt is reld rvithin one ya ofcomplaion. the Owns Buildo sill have thc hrdn ofproving thd hc or shc did mt build or improvc lhc propqly for thc purlDs of sh). _ _1. as owner of the property. am exclusively contracting rvith licensed conlractors lo construct the project (Sec. 7M4. Business and Prloftsskln Code: The Contractor's License Larv does not apply to an owner of property rvho builds or improves thereon. and rvho conracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License [:rv). _l arn exernpt under Section-, B. & P.C. for this reason.,Jr &)6",.,-t1 l+4+\\'O RK ERS' ('(}I\I PENSA'I'IO N DECLARA'I'ION I hereby aflirm under penalty of perjury one of the following declarations: ___l have and will maintain a Certificate of Consent to Sclf-lnsure for u'orkers' compensation. as provided for by Section -i700 of the Labor Code. for the performance of the rvork fior which the pennit is issued. _l have and will rnaintain rvorkers' compensation insurance. as required by Section -i700 of the Labor Code. for the performance of the work for which this permit is issued. My u'orkers' compexsation insurance carrier and policy number are: Carrier:- Policv Number:Expires: )fIJ "."riry rr,"r in rhc pcrformance of the rvork for which this pmnit is issued. I shall not mploy any pcson in any mmno \rc u to become subj(t to thc rvo(tffi'@mpqsdion laws of Califomia, md agrc that if I should bccome subj(t to the work6' compenstion prcvisioro of Sation 3700 of the Labor Code. I shall. forthwilh comply with thoc prcvisiom. WARNING: Failurc to suc workm' ompensalion covmge is unlawful. and shall subjst m mploys lo qimiml pemltis md civil fins up to one hundrqt thosd dollm ($100.000). in addition to thc cost of compcmtion. darog* o prcr'idcd for the Section -1076 of the Labor Code. interest and attorney's fees. DECLARATION I hereby affinn under penalty of perjury that I arn licensed under provision of Chapter 9 (cornmencing rvith Section 7000) of Division 3 of the Business and Professions Code. and rny license Ls in full force and effect. License Class:_ Date: _License Number: ('onlraclor: CONSTRUCTION LENDING AGENCY I hucby affirm undo penalty of perjury that thqe is a construction lending agmcy for the prfommce of the rvork for s'hich this permit is issued (Sec. -i097, Civ. C.). Lender's Name: Lender's Address: AISJ.ICANLDECI.AEAIION I hothy affim unds penalty of pcrjury onc ofthc following deldations: Dcmolition Psmib-Asb6tos Notificstion Fcdqal Rcgulations (Titlc 40, Pil16) -Requircd trltq of Notifi cation -l cqliry that the fcdqsl regulaliom rcgrding rbctos rmoval re not applicablc to this prcj6r. {t cctiry tlat I have rmd rhis application od statethat the abovc infomation is corcct. I agr to comply with all Cityand County o?inance md Statc kws rclating to building constructio[ ild hqcby authorize reprMtdiv6 of this City ad County lo @tq uPon thc above mentioned property for inspection purposes. , Appticant or Agent rrrnr,J( #\g Permitee name,rOtf; --?uu Dt--PL tt. crq , Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/VenUl n s u latio n Roof Sheathinq Shear Wall I l Framing ////S// t Fu/,/d lnsulation/Enerqy I I Drywall tl/)A [/q rkJ/,1 iY Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zgne Certif. ll l>'ul fi flt,*fu lN,W I A FUJA ,ry, I tbr I FINAL / /blb L /OY Certif icdtd of Occu pa ncy Etc. tI