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BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION I hocby affm unda pcnalty of pejury that I m cxcmpt from the ContmcloB' Licro Law for thc following |wn (Se.7031.5 Busincs and Profsion Codc): Any City or County which requirG a pqrnit to costruct, alto, improvq danolish or rcpair uy structuq prior to its issuacc, also requirs thc applicmt for such pcrmit to filc a signcd statmot that hc or shc b licqEcd pulswt to thc Fovisioc of thc Contrrctor's Licenscd Law (Chaptc 9, Commcnchg with Setion 7000 of Division 3 of thc Buins ud ProfmionsCode)orthathcorshe isexilptthtrfromildthebsisfortheallcgcdcxmption. AnyviolationofsclionT03l.5bya{iD applicat for a pennit subjcts the applicant to a civil pcnalty ofnot more tha fivc hundred dollus ($500). _1. as owner of the property, or my employees with wages as their sole compensation. will do the work and the structure is not intendod or offered for sale (Sec.7044, Business and hofessions Code: Thc Contractor's License Law does not apply to an owner of the properry who builds or itnproves thereon. and who does such work himsclf or herself or through his or her own employees, provided that such improvonents are not intended or offered for sale. II. however. the building or improvement is sold within one year of complction, the Ourner Builder will have the hrden of proving tha he or she did not build or improve the property for the purposc of sale). a -1. as owner of the propeny, am exclusively contracling with liccrued contractors to construct the project (Sec. 7044, Business and Profisssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projeds with a Contracto(s) licensed pursuant to the Contractor's Licerue taw). -l am exempt under Section-, B. & P.C. for this reason. Date: !&BtsEESSAMEENIAIIAN DECT.ARATION I hseby aIfim undo poulty ofpojury onc ofthc following detaratiom: / {-l Uvc aa witl maintain 8 Ccf,ificstc of Coltgt to Sclf-lmuc for mrkc' ompâ‚¬rEation. I Fovidcd for by Setion 37OO of thc L8bor Codc. for thc pqfoIrucc ofthc work for which the pantrit b issucd. (t havc md will maintain workm' compcrcation ircurecq 6 rcquircd by Setion 37OO of thc kbor Code. for thc pqfomecc of - the work for which this pqmit is isuod. My workc' compcrualion iruumcc tri6 and policy numba rc: '=[rr\t- F.]^c\q-n-7\ _l certi& that in thc performance of the work for which this pcrmit is issucd, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' cornpensation provisions of Section 3700 of the Labor Code. I shall. forthwilh comply wilh those provisions. WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an onployer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of cornpensation, darnages ts provided for the Section 3076 of the Labor Code, interest and attorney's fbes. LICENSED CONTRAC'I'OR DECLARATION I hcreby affirm under penalty of perjury that I am licensed under provision of Chaptcr 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License _{_\ Nunrber: I W I hcby affm unda penalty of pcrjury that thqc is a comtruction lcnding agmcy for thc pqfollmcc of thc work for which this psmh b issucd (Se. 3097, Civ. C.). lsrds's Nmc: Lender's Address: APIIJCANI.DECI.ABAIION I hadry atrrm unds poalty of psjury one of the foUowing deluatiom: Dmolition PmiteAsb6tos Notification Fcdfial Rcgulations (Titlc 40, P{r6) -Rcquired Lctr6 of Notificalion -l cdiry thst thc fedGal rcgulatiore rcguding rbctos rooval uc not .pplicablc to this prcjet. -$J cotifo rha I havc @d this application and ststc thd thc abovc information is coEE1 I agr to @mply with 8ll City ud Courty -ririlimcc od Statc L:ws rchting to buitditrg colgructioD, ed haeby uthorire rcpmtativB of this City sd CoEty to 6t6 upotr tlrc above mentioned property for inspection \,Applicant or Agent Permitee nflnle o,,", 0[ lcl / ll Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloorNenul nsu latio n I , Roof Sheathing Y DA.W Shear Wall / Framing lnsulation/Enerqy Drynruall Ext./lnt. Lath Brown Coat Masonry Pool Fence 1 T-Bar \ Handicap Req Deputv Final Report Enqineer Final Report Flood Zone Certif t\I t-?// F!NAL U L\Vtl}Wc / Certificate of Occupancy t Notes, Remarks, Etc \ / g2rr']\Exoires: ft 'lac