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