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BUILDING- !NSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATTON <br />I hocby allim undo poalty of pqjury that I m cxempt from thc ContractoB' Licmw Law for thc following lffin (Ss.7031.5. <br />Businas ard Profesion Code): Any City or Counly which rcquiE a pcrnit lo coEtruct. alta. improvc. dcmolish or repair my <br />structure. prior to its issuuce, also rcquirc thc applicut for such pemit to filc a signcd statmmt thd hc or she b licmscd plmilt <br />to thc provisios of thc Contractor's t,iccnscd taw (Chapto 9. Comcncing with Setiotr 7000 of Division 3 of thc BNiocs ild <br />Profsions Code) or that hc or shc is cxcmpt thqcfrom ed thc basis for thc alleged exmplion. Any violation of Setiotr 7011.5 by an. <br />applicant forap6rit subjctsthc applicanl lo acivilp€naltyofnot morctho livchundrcddollus($500). <br />_,1, re oms of thc prcpc(y. or my cmployc with wagc c thcir slc mmpqsation. will do the wo* ald the structuc b not <br />intqdcd or offord for slc (Sc.7044. Buins ud Prcfcssioro Codc: Thc Contractor's Licry l:w doc not apply to m ownc of <br />rhc pmpdty who builds or infmvc thon. md who dm such wrt himsclf or h6clf or thrcugh hb or ha own cmploycc. <br />providcd that such improvqMts e not intqdcd or offqrd for sh. lf. how@q. thc buiHing or improvelmt is sld wilhin onc )ar <br />ofcomplaion, thc Ovm6 Build6 will havc thc hldo ofproving thd he or shc did mt build or improvc lhc plopqty for thc purpos of <br />slc). <br />-1. <br />re orvno of thc propqty, m exclusively contracting with licqscd contraclorc lo corutruct the projccl (S6. 7044. Bwins <br />od ProBsbn Codc: Thc Contractor's Licosc Law do6 nol apply to il owns ofpropcrty who builds or improvB th66n, <br />and who contracts for such pojets with a Contmcto(s) licorcd purewt to thc Contractor's Licm taw). <br />I m cxcmDt und6 Setion-. B. & P.C. for this rcen. <br />Drlc:_ O*rq:_ <br />YOB6E&LCOIAPTNSAIIAN <br />DECI.ABAUqN <br />I hqeby amm undo pcnaltyofperjury onc ofthe following delilatiom: <br />_l havc od rvill mintain a Ccrtificate of Comt to Sclf-Irourc for workm' compostion. r provided for by Sction 3700 of lhc <br />Labor Cod€. for thc pqfolmcr of thc work for which thc pqmit b i$ucd. <br />-l <br />havc and will maintain workm' compensation iEumncc. I rcquircd by Srtion -1700 of thc t bor Codq for thc pqfomilcc of <br />the u'ork for s'hich this My compensation insurance calTier and policy numkr are: <br />o <br />Policy lrrpircs:) <br />_l certifythat intheperfonnanceofthework forwhichthispermit is issued. I shall not employanyperson inanymanner <br />so as to become subject to the workers'compensation laws of California. and agrec that if I should become subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code. I shall. forthrvith comply with those provisions. <br />WARNING: Failure to secure workers' compensation coverage and subject an employer to criminal penalties and <br />civil fines up to one hundred thousand dollars ($100.000). in <br />Section 3076 of the Labor Code. interest and attorney's fees. <br />to the of damages as providd for the <br />b( <br />I <br />I hereby affirm under penalty of perjury that I aln licensed under 9 (cornrnencing rvith Section 7000) of l)ivision 3 <br />of the Business and Professions Code. and rny license is in full force and e ffect. <br />tLicense_l.icense <br />C <br />CONSTRUCTION LENDING AGENCY <br />I hrcby aflirm undo penalty of pojury that th6e is a construction lmding agocy for thc pqfonnuce of the work for which this pcrmit is <br />issued (Sec. -1097. Civ. C.). <br />Lender's Name: <br />Lender's Adclress: <br />APPLTCANT DECLARATION <br />I her,eby aflinn under penalty of perjury one of the following declarations: <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) <br />-Required <br />Letter of Notification <br />asbestos removalare not applicable to this project. <br />the above u'ith all City and County <br />and County to enter upon theatttl <br />above meartioned propeny for inspection <br />Applicnnt or Agcnl <br />Pernritee nttnre t <br />/r <br />is correct. I <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bfloor/VenUI ns u lation <br />Roof Sheathins <br />Shear Wall K\ <br />Framincr I -b-l-,uilJlhel <br />lnsulation/Energy il- C* l''v"\i@ <br />Drywall I -\.tW) <br />r'Ext//lnt. Lath I -5- lal tr-'$fu, <br />tsfown Coat \\ihf I )^,\[PY0 <br />Masonrv \,\-/ <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif. <br />A <br />FINAL €YN*}U <br />Certificate of Occu pancy \J <br />Notes, Remarks, Etc.t <br />J <br />.T <br />,r.",' l(- 4- (1 <br />a <br />,n", ' U- L{ - (7 <br />[\ul)v <br />| ) W\^n4{4/\