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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/S!G.COMMENTS ()\\'N l,.lt llt I I l,l)l,lll l) 1,.1.( "\ ll,\'l l( )N I hseby amrm unds poalty of Frjury that I m crsnpt fron thc Contracton' Licw lanv for thc follorving remn (Sec.7031.5 Businqs ud Profsion Codc): Any City or County which requirc a lmnh lo comtruct. altq. improvq demolish or repair my structurq prior to its isumce, also requir* the applicst for such pernit to filâ‚¬ a siSned statmmt that hc or she is licemcd pumarll to thc prcvisions of the Contractor's Licenscd Latr, (Chapter 9. Comnencing silh Selion 7000 of Division 3 of the Busins m1l Prcfessions Code) or that hc or she is ercmpt thqefrom and the basis for thc alleged exmption. Any violation ofsection 703 1.5 by 8n, applicantforapemitsubjetsthc epplicanttoacivilpenaltyofnotmorethmfivchundreddollm($500). __1. as owner of the properly, or my employees with wages as their sole compensation. rvilldo the work and the struclure is not intende<l or oflered for sale (Sec.7044. Business and Professions Code: T'he Contraclor's License Law cloes not apply to an orvner of the property s,ho buil<ls or improves thermn. and rvho does such $'ork himself or herself or through his or her orvn employees. provided that such irnprovonents are not intended or offered for sale. lf. hou'ever. thc building or itnprovetnent is sold within one year of cornplaion. the Orvner Builder rvill have the burden of proving that he or she did not build or irnprove the propoty for the pulpose of sale). - l. as owner of rhe propaly, am exclusively contracring rvirh licensed conlractors lo consrruct the project (Sec. T4l.Business e and Profession Code: The Contractor's License Law dcles not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a Contraoo(s) licensed pursuant to the Contractor's License Larv). -l arn exernpt under Section-. B. & P.C. for this reason. Date:-- owner:-- WORKERS' CONI PENSATION DECLARATION I hereby affrrm under penalty of perjury one of the follorving declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for rvorkers' cornpensation. ali provided for by Section .3700 of the labor Code. for the perfornrance of the s'ork for rvhich the po'rnit is issued. _t have and rvill ntaintain workers' compensation insurance. as required by Section 3700 of the Labor Code. fior the perfonnance of the work for which this permit is issued. My workers' compensation insurance calrier and policy number are: Carrier:- Policv Nurnber:Iixpires: -l cerrify that in the performance of the rvork for rvhich this perrnit is so .rs to become subject to the workers'compensation lan's of California. rvorkers' cornpâ‚¬nsation provisions of Section 3700 of the Labor Code. I any any manner : to the WARNTNG: liailure to secure rvorkers' colttpensation coveragc is to crirninal lnralties artd civil fines up to one hundred thousand dollars in as provided for the Section 3076 of the Labor Code.fees. I1.. .,,. Section 7000) of Division -3I hereby affirnt under pcnalty of pcrjury that I am licensed provision of Chapter. of the Business and Professions Code. and rny liccnse is in full fdrce and r, -3q o^r"t ft- ZO -/ V x2{ 383 I hereby affirm under penalty of perjury that there is a issued (Sec. -j097. Civ. C.). Lender's Name: lending agency ftrr perftrnnance of the rvork for u'hich this grrnit is APPLICAN'I' DECLAITATION I ho'elry affinn under penalty of perjury onc of the follos'ing declarations: Dernolition Perrnits-Asbestos Notilication Federal ('l'irle 40. Parr6) - Requirctl l.etter of Notificatiorr _l cerrify that regulations astrcstos project. read this I agree to cornply s'ith all City and Countl' of this City and County to cnter upon the abovc Applicartt or Agcttl I'errnilee relating to state ahrve are I)atc: t/- Zo -? Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subfloor/VenUlnsulation /I a Roof Sheathinq t llb,/fnl 0q Shear Wall I Framincr Insulation/Enerqy Drywall Ext./lnt. Lath Brown Coat l\Iasonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif tl t FINAL ?lt')lhlp lv(/,I q u"f Certificate of Occupancy Notes, Remarks, Etc. atttl