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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hocby allirm undo penalty of pojury that I m cxcmpt ftom thc Contracto6' Licw law for thc following rcen (Ss.7031.5 Bsins and Profsion Codc): Any City or County which rcquirc a pornh to coctruct, altq. impIovq thnolish or npair uy struc{uq prior to its isumcq also rcquiG thc applicilt for such pemit to filc a signcd ststoot that hc or slrc is licqtscd pmuilt io thc prcvisios of thc Contractor's Liccnscd [aw (C.hapta 9. Commmcing with Sstion 7000 of Division 3 of thc Busins ad Prcfe$iorc Code) or that hc or shc is qcmpt thscfrom ild thc b6is for the allcged exmption. Aoy violation of Scrlion 7031,5 by oy applicantforapcf,nitsubjetsthe applicanttoacivilpcnaltyofnotmorethafivchundrcddollm($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 intended or offsrd for salc (Sec.7044, Business and hofessions Code: The Contractor's License law does not apply to an owner of the property who builds or improves therqln, and who does such work hirnself or herself or through his or her own employecs. provided that such improvanents arc not intended or offcred for sale. I[, horvever. the building or improvement is sold within one year of cornplaion, the Orvner Builder rvill have the hrden of proving tha he or she did not build or improvc the propoty for the purpose of sale). _1. as owner of thc properly, am cxclusively contracting with licenscd contractors to construct the project (Sec. 7U4, Bwincss and Pnofâ‚¬ssion Codc: The Contractor's License Law docs not apply to an owner of propcrty who builds or improvcs ther@n, and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's Liccnse taw). -l arn exempt under B. & P.C. for this reason. WORKER,S' COMPENSATION DECLARATION I hereby affrnn under penalty of perjury onc of thc following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as p,rovided for by Scction 3700 of the I-abor Code, for the performance of the work for which the perrnit is issued. _l have and rvill maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for the performance of the work for this pennit is compensation insurance carrier and policy number arc: a o Policy -l certify that in the performance of the work for which this pcrrnit is issued. I shall not ernploy any person in any manner should become subject to theso ils to become subject to the workers'compensation laws and agree that if I workers' compensation provisions of Section 3700 of the Labor I shall. fonhwith comply with those provisions. WARNINC:to secure workers' compensation unlawful. and shall subject and thecivil lines up to hunclred dollars ($100.000). and attorney's fecs. to the cost of Section a I hereby affirrn under of the Business and penalty of perjury that I arn 9 (commencing with Section 7000) of Division! Code, and rny license is in full effect. O License a Date: 1-/ I hereby affrrm under penalty of perjury that there is a issued (Sec. 3097, Civ. C.). lending the perfonnance of the work for which this pcrmit is Lender's Name: Lender's Address: APPLICANT DECLARATION I hotby affrrn under penalty of perjury one of the following declarations: Dernolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -_Required Letter of Notification -l cotify that the federal regulations asbestos removalare not applicable to this project. and County above mentioned propeay for inspcction (Applicant or Agent Signature: I'crnritee that lD entcr Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/Ve nUI n s u Iati o n Roof Sheathing Shear Wall Framinq Insu Iation/Energy Drywall Ext./!nt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputv Final Report Enqineer Final Report Flood Zone Certif rl /.t FINAL v ('lrl D{Vtf6 7 Certificate of Occu pancy -l I I Notes, Remarks, Etc. t - ,