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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS owNER tlt,tLDER t)lil.cARA't'toN , <br />I hereby aflinn untler penalty of Jrerjury that I am exempl fnrm the Contractors' License Law frrr the following reas()n (Sec.7O3l..5 <br />Business and Profession Cotle): Any City or C)ounty which requires a permit to construct, alter, improve. denxrlish or repair any <br />struclure. prkrr to its issuance. also requires the applicant frrr such Jrrmit to file a signed statermnt that he or she is licensed pursuflnt <br />to the prrtvisions of the Contraclor's Licensed Law (Chapter 9, Conrmencing with .Section 7(XX) of Division 3 of the Business and <br />PnrfessionsCode)orthatheorsheisexempttherefromantl thebasisfirrtheallegedexemption. AnyviolationofSectionTO.ll.5byany <br />applicant for a permit suhjects the applicant (o a civil penalty of not nrrrre than five hundred dollars ($5(X)). <br />a <br />-1. <br />as ()wner of the pn)f,erty, or my empklyees with wages as their srle compensat ion. will do the work and the stnnure is mrt <br />interxled or offered frrr sale (Sec.7044. Business and hofessions Code: 'l'he Contractor's License Law does not apply to an owner of <br />the property whn builtls or impnlves therc<ln, antl who does such work himself or herself or through his or her own empkryees, <br />provided that such improvements are not intenrled orofferetl frrr sale. lf. hrwever. the huiltling or inprovenent is sold wilhin one year <br />of completion. the Owner Buikler will have the burden of pnrving thd he or she dkl rxrt buikl or impnrve the pnrperty forthe puryxrseof <br />sale). <br />-1. <br />asownerof the property. amexclusivetycontracting with licensetl c()ntractorsto construct tlr pro.iect (Sec.7044. Business <br />and Professirn Code: 'l'he Contraclor's License Law tloes not apply to an owner of property who huilds or improves thereon, <br />and who contracts frrr such projects with a Contracto(s) licensed pursuant to the Contract()r's l.icense l-aw). <br />-lamexemptunderSection-,[J.&P'C.frlrlhisreason.Date:___ Owner:___ <br />WORKERS' COMI'ENSAI'ION <br />DECLARATION <br />I herehy affirm under penalty of perjury one of the following declarations: <br />-lhaveandwill <br />maintainaCertifrcateofConsenttoSelf-lnsurefirrworkers' prnvirledfirrbySection.lT0Oofthe <br />Lahor Crxle, firr the perfrrrmance of the work for which the pennit is issued. <br />-lhaveandwill <br />maintainworkers' requiredhy.Section-ST[DoftheLahorCotle,frlrthe;rrfrrrmanceof <br />the work frrr which this permit is issuetl. My workers' compensation insurance carrier and Jnlicy number are: <br />Policy Numtrcr: Expires: <br />-l <br />certify that in the perforrnance of the work for which this permit is issued, I shall not ernph)y any person in any rnanner <br />s{) as to become subject to the workers'comJrensation laws of California, and agree that I shruld hecome to the <br />workers' compensation provisions of .Section -37(X) of the I shrll.with those <br />WARNIN(i: Failure to s€cure workers' compensation cover:Ige <br />civil fines up to one hundred thousantl dollars ($lU).(XX)).:in <br />t\I,shall :ln Irl criltrin:rl Jrnalties :rntl <br />lo the as provitled frrr the <br />atlOrney's fees. <br />I herehy affirm under Jrenalty of Jrcr.jury that I am licenserl untler of Chapter 9 (commencing with .Section 7UX)) of Division .1 <br />of the Business and Professions Cotle. and nry license is in full force antl effect. <br />License <br />u"t., Li oi1 C'ontractor: <br />c(tNS'l'RLj("t toN t.l.NDtNG A(;tiN('l <br />I hereby affirm under Jrnalty of perjury that there is a construction hnding agency firr the perfrrrmance of the <br />issued (Sec. 3097. Civ. C.). <br />Lender's Name: <br />which this Jrernrit is <br />l.ender's Atltlress: <br />APPLICANT DECLAR^TION <br />I hereby affnm under penalty of prjury one of the following declarations: <br />Demolition Permits-Asbestos Notification Fetleral Regulations (Title 4O, Part6) <br />_Required Letter of Ncxifrcation <br />-l <br />certify that the federalregulations regarding asbestos not applicahle to this project. <br />_l certify that I have read this application that the ahrve is correct. I to comply wilh all City antl County <br />rurdinances antl State Laws rclating to antl this City and County to enter upon the <br />o,r" vl -6 - ZollaLxlve rnentioned property for <br />Applicant or Agent <br />l'ermitee name tprintl: ILD Zr GOU D D <br />Set Backs <br />Forms/Steel/Holdowns l.l-3 rln VRloT fr Dv ah?o # <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf Ioor/VenUI nsu I ation llt t <br />Roof Sheathinq h*rg,m t?--?Ur-4q IDX*/tx <br />Shear Wall O--lt-l q\\^o <br />Framing .//trtb <br />lnsu lation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL 7-24-0U lLQln '€iat5.e7 <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />Flev. 08-07-201 5 <br />J <br />Carrier: <br />I