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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG a CoMMENTS OWNER BUILDER DELCARATION I hqcby aflim undo pcnalty of perjury that I m cxmpt from thc Contmclo6' Licse liw for thc followitrg r@n (Sc.7031.5 Busines md Prcfesion Code): Any City or County which requira a pennit to coEtrucl, altq, improve, demolish or râ‚¬pait ey struduc. prior to its isuacc, also rcquirc thc applic@t for such Fmit to 6lc a sigtrod statm@t thd he or shc is licsEâ‚¬d p6uat to the provisioro of thc Contrrctor's Liccnsed taw (Chapl6 9, Commcncing with Sstion 7000 of Division 3 of thc Buins ud ProfsionsCode)orthatlrcorshciscxmptthqefromadthe basisforthcallegedexmpion. AnyviolationofSerionT03l.5byany applicant for a pmnit subjwts thc spplicut to s civil pemlty of not more the fivc hundred dollrs ($500). _1, as owner ofthe property. or my employees with wages as their solc compensation. willdo the work and the structure is not intended or offerd for sale (Se.7044. Business and Professions Code: The Contractor's License law does not apply to an owner of the properry rvho builds or improvcs therqrn, and who does such work himself or herself or through his or her own employees. provided that such improvonents are not intended or offerocl for sale. l[, horve\'â‚¬r. the building or improvement is sold within one year of complaion. the Orvner Builder will have the hrden of proving that he or she did not build or improve the propoty for the purposc of sale). _1, as owner of the property, arn exclusively contracting with licensed contractors to construct the project (Sec. 7M4, Business and Professbn Code: The Contractor's Licensc Law does not apply to an ownef, of property who builds or improves thereon, and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's Liccnsc Law). _l am exempt under B. & P.C. for this reason. WO RKE R^S' COM PENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: -l have and will maintain a Certificate of Consent to Sclf-lnsure fior workers' compensation, as provided for by Section 3700 of the I-abor 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 tabor Code, for the performance of the work for which this pennit is issued. My workers'carrier and policy number arc: tt a rav o a /-1 - AoAvPolicy _l certify that in the performance of the work for which this permit is issued. I shall not so as to become subject to the workers' compensation laws of California, and agree that if I employ any pemon in any manner should bocome subject to the those provisioru.rvorkers' compensation provisions of Section 3700 of the Labor Code. I shall. forthwilh comply with WARNING: Failure to sccure workers' compansation coverage is unlawful, and shall subjcct an to crirninal penalties and civil frnes up to onc hundred thousand dollars ($100.000). in addition to the cost of as provided for the Section 3076 of the kbor Code, interest and attorney's Ges. .-?/ DECI.ARATION I hereby affirm under penalty of perjury that I am licensod under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. t ' ?-L-.-7 (D 7 oLicenseNurnbcr: l.-L1-Z W I hftby affm unds pcnalty of pqjury th8t thft is a @nstruc1bo lcrding sg6cy for thc pqfomcc of thc wrk 6r which this psrnil b issucd (Se. 3097. Civ. C.). lrndq's Nmc: Lcnder's Address: APPLICANT DECLARATTON I hotby aflirm under penalty of perjury one of the following declarations: Dcmolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) _Required Letter of Notification _l ccrti& that the federal regulations regarding asbestos removal are not applicable to this project. state that the above information is correct. I above mentioned property for inspection Applicant or Pernritee name and hereby authorize ? "/-"/ Set Backs i/n/u I vI no Forms/Steel/Holdowns '6/n/a eo Erection Pads a t I \/' UFER Ground SLAB Floor Su bfloor/Ve nUl n s u Iatio n Roof Sheathing Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry 9,1*oh.t rAz" Pool Fence l{/v, T-Bar Handicap Req Deputv Final Report Enqineer Final Report Flood Zone Certif ^ FINAL qbhr \*?^ Certificate of Occu Notes, Remarks, Etc./I D ^L-I/v