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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION t hocf affrm und6 pcmlty of pdjury thar I m cxmpt from thc Contrac,tos' Licry law for thc following llen (Sc.7031.5 Buinas od Profwion Codc): Any City or County which rcquirc a pomit to coNtruct, alte, improvg dcrnolish or rcpair uy structue, prior to its iswcq also requiro thc applicut for such pcmit to file a signcd ststofft that he or drc is liccnscd pwuilt to thc provisioN of thc Contrrctor's Licensed law (Chapts 9. Commcncing with Setiotr 7000 of Division 3 of rhc Buincs ud PrcfsionsCodc)orthathcorsheisqmprthrcfrommdthcbasisfortheallegcdq@pion. AnyviolatiotrofSctiotrT03l,5byoy applicantforapcrmitsubjetsthc applicettoacivilpcnaltyofnotmorcthofrve hun&cddollars($500). _1. os owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec.7044, Business and hofessions Code: The Contractor's Licetuc law does not apply to an owner of the propcrty who builds or improvcs thereon, and who does such work himself or herself or through his or her own employecs. provided that such imp,rovonents are not intendod or offâ‚¬red for sale. I[, howerrcr, the building or improvement is sold within one ]ear- of completion. the Orvner Buildcr will have the burden of proving tha he or she did not build or improve the propcrty for the purpose of sale). -1. as owner of the property, am exclusively contracting with liccnsed contractors to construct the project (Sec. 7M4, Business and Rofession Code: The Contractor's License Law does not apply lo an owner of property who builds or improves thereon. and who contracts for such projecls with a Contracto(s) licansed pursuant to the Contractor's License Law). -l am exempr under Section-. B. & P.C. for this rcason. WO RI(ER,S' COM PENSATIO N DECLARATION I hercby affirm under penalty of perjury one of the following declarations: _l havc and will maintain a Cerrificate of Conscnt to Sclf-lnsurc for workers' compensation. as provided for by Section 3700 of the Labor Code, for the pcrformance of the work for which the perrnit is issued. -l have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code. for the performance of the work for which this permit is issued My workers' compensation insurance carrier and policy number are: Policv Numbcr: Exoires: _l certiS that in the perforrnance of the work for which this perrnit is issued. 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 subjcct to the and the Section 3076 of thc Labor Codc, interest and attorney's fees. D,r", ld/06/^/ I hereby affrrm under penalty of perjury that I arn licensed under provision 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License D,.", d,5/o6 / 2/ I hereby affrrm under penalty of perjury that there is a construction lending agency the performance of the work for which this pennit is Civ. C.). Lender's Address: _l ccrti& that thc federal rcgulations regarding asbcstos removal are not applicable to this project. _l coti$ that I havc read this application and statc that the above information is corrcct. I agrec to comply with all City and County ordinances and State Laws relating to and hereby authorize representatives of this City and County to enter upon the above mentioned property for Applicant or Ageht Permitee name f)o lo.06 /oo /et Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloor/Ve nUI n su latio n Roof Sheathinq Shear Wall Framing lnsu Iation/Enerqy Drywall Ext./lnt. Lath Brown Coat Masonrv Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif /.\ Sarxry nl\hdh[n-I G4-A yjy//u\ tVl FINAL 7'lt-zJ LJU4,fil Certificate of Notes, Remarks, Etc. Crrr4 APPLICANT DECLARATION I horby affirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notifrcation Federal Regulations (Title 40, Part6) -Required lrtter of Notification