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{BUILDING. INSPECTOR RECORD,. SITE.WORK DATE !D/SIG.COMMENTS .T OWNER BUTLDER DELCARATION I hocw affm unda pcnalty of pajury thar I m qâ‚¬mpt Gom thc ContrrctoE' Liccffi tsw for thc following tlen (Ss.7_031.5 Bwine and Prcfesion Codc): Any City or County which require a pamit to construct, altq, improvc, danolish or rcpai uy structuc. prior to its iswcq also requirB thc applicet for such pcnnit to filc I signcd stalmmt tha hc or slrc b limcd pwst to thc fovisioB of thâ‚¬ Cotrtmctor's Licmscd Law (Chapt6 9, Comcncing with Setion 7000 of Division 3 of thc BNinN ed Prcfsios Codc) or that hc or shc is ampt th6c&om ad thc b6sis for thc allcgcd cxmption. Any violation of Sctbn 7031.5 by uy ' applicmtforapcrmitsubjctsthc applimttoacivilpcnaltyofnotmorcthafive hundrcddollus(t500). ! _1, as owner ofthe property, or my employees with wages as their sole compensation. will do the work and the stnrture b not intendod or offâ‚¬red for sale (Sec.7M4, Business and Professions Code: The Contractor's Liccnsc l-aw does not apply to an owncr of the propo'ty who hrilds or improves thereon. and who does such work himself or hcrsclf or through his or hcr own employees. providd that such improvernents are not intendcd or offcred for salc. I(, howerrcr. the building or improveme,nt is sold within one ]â‚¬ar of cornplaiorL the Orvncr Builder will havc the hrden of pnoving tlra he or she did not build or irnprove the property for thc purposc of sale). L _1. as owner of thc propâ‚¬tty, am exclusively contracting with licensed contractors to construct the project (Sec. 7O44, Buincss ard Proftssion Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improves thereon. and who contracts for such projects with a Contraclo(s) licenscd pursuant to the Contractor's Licensc law). -l am excmpt under Section-, B. & P.C. for this reason. Jlo lo. WORJ(ER,S' CONT PEN SATIO N DECLARATION I hercby affirm under penalty of perjury one ofthe following declarations: by Section 3700 of the for the pcrfonnancc of t/ Policy 0 _l certi& that in the performance of the work for which this pcnnit is issued, I shall not employ any person in any manner so as to bccorne subject to the workers' compensation laws of California, and agree that if I should bccome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with those provisions. WARNING: Failure to secure workers' compansation coverage is unlawful, and shall subject an onployer to criminal ponlties and civil fines up to one hundred thousand dollars ($100,000). in addition to the cost of cornpensation, darnagcs as providcd for the<'"i ii::,: LICENSED CONTRACTOR DECI-ARATION I hcreby affirm under penalty of perjury that I am licenscd under provision of Chapter 9 (commorcing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. Num\:r: t W I hwby aI[m uda pcnalty of pojury that thG is a coEtruclbn knding agocy for thc pofo|]mcc of thc work fu which rhis pqmn b issucd (S*. 3097, Civ. C.). Lctrder's Name: a [-ender's Address: APPLICANT DECLARATTON I hodry affinn under penalty of perjury one of the following dcclarations: Dernolition Permits-Asbcstos Notification Fderal Regulations (Title 40, Pafl6) -Required l-ctter of Notification asbestos removal are not applicable to this project. the above infonnation is correct. I agree to cornply with all City and County represefltalives of this City and County to entcr above mentioned property for inspection zApplicant or Agent \rmitee 4-t-?/6-2 r"n" Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloorNe nUl ns u lation Roof Sheathing )-Z{-Zl.Erfrl ) Shear Wall Framinq lnsulation/Energy Drywall Ext./!nt. Lath Brown Coat Masonry Pool Fence V T-Bar Handicap Req. Deputv Final Report Enqineer Final Report Flood Zone Certif. FINAL 7--?-b?l har.<rq2 Gertificate of Occu pancy Notes, Remarks, Etc. \ / \ / Code, for the performance of the work for which the po'mit is issued. have and will maintain workers' work this permit is issued.and policy number arc: /,r/zr/2 c cati$ that I have read this application State [-aws relating