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BUILDING. !NSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDI:R DELCARATION 'I hrcby affim undo pcnalty of pcrjury that I m cxcmpt fiom the Contmc{o6' Licse Law for thc following rcen (56.7031.5 <br />Busin6s ild Profsion Code): Any City or County which rcquirs a psmit to coNtruct, altq. improvq dernolish or rcpair my <br />structuc. prior to its isuuce. also rcquirG the applicet for such permit to filc a sigtrcd slatmat thd hc or she is licsrd pwudil <br />to th€ prcvisions of Ihe Contraclor's Liccnsed Law (Chapter 9, Comencing with S(tion 7000 of Division 3 of thc Busine md <br />Prcfsions Codc) or that hc or shc is ercmpt th@ftom ad the basis for the allcgcd exm6ion. Any violation of Setion 7031.5 by my <br />applicant for a pmit subjects thc applicant to acivilpcnalty of not morc ths five hundrrcd dollrc ($500). <br />_1, as owner of the properly, or my employees with wages as their sole compensation. willdo the work and the structure is not <br />intcnded or offcred for sale (Sec.7044. Business and hofessions Code: The Contraclor's License Law does not apply to an owner of <br />the properry who builds or improves thermn. and who does such work hirnself or herself or through his or her own cmployees, <br />provided that such irnprovements are not intended or offered for salc. If. howe'/er. the hrilding or improvement is sold within one year <br />of complaion, the Orvner Builder will have the burden of proving tha he or she did not build or improve the propaty for the purposc of <br />sale). <br />-1. <br />as owner of the propefly. am exclusively contracting with licensed contractors to construct the project (Sec. 7M4, Busincss <br />and Pmfilssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. <br />and who contracts for such projects with a Contracto(s) licerued pursuant to the Contractor's License Law). <br />-IamexemptunderSection-.B.&P.C.forthisreason. <br />ll.rtrr' <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hereby affirm under pcnalty of perjury one of the following declarations: <br />-l <br />have and will maintain a Cerlificate of Consent to Self-lnsure for workers'compensation. as provided for by Section 3700 of the <br />I-.abor Code. for the performance of the work for which the po'rnit is issued. <br />_l have and -j700 of the tabor Code. for the pcrfonnance of <br />the work for and policy number are: <br />Policy Nr.r-k-.a)(^)tt2 -o7tfr _Expires:/o /r,t/t€ <br />_l certiff that in the performance of the work for which this pernrit is issued. I shall not enlploy any person in any manner <br />so as to becorne subject to the workers' compensation laws of California, and agrer that if I should become subject to the <br />u,orkers' comporsation provisions of Section 3700 of the l-abor Code. I shall. forthwith cornply with those provisions. <br />WARNING: Failure to socure workers' compensation coverage is unlawful, and shall subject an anployer to criminal penalties and <br />civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. darnages as provided for the <br />.Scction -i070 of the Labor Code. interest and attorney's fees. <br />DECI.ARATTON <br />I hereby affirm under penalty of perjury that I arn licensed under provision of Chapto 9 (comrnencing with Sr:clron '7000) of Division 3 <br />of the Business and Professions Code. and my license rs in full force and effe'ct. <br />Nurnber:{, <br />CONSTRUCTION LENDING ACENCY <br />I hqcby affm unds pcnahy of pcjury tha thc is a consruction lcnding agocy for thc pqfomcc of Ihc wrk for which this pqrnit b <br />issucd (S*. 3097. Civ. C.). <br />knds's Nmel <br />APIIJCANIJECI.AEAIIAN <br />I hqlby afm und6 pcnalty ofpsjury onc of the following dclaratioro: <br />Dcmolilion PmiteAsbetos Notificarion Fedqsl RcgulstioN (Titlc 40. Pan6) <br />-Required <br />lrtt6 of Notificatbn <br />-l <br />cgtiry that thc fcdtral rclulatioN rcgsdin8 sbctos rmoval ue not applicablc lo this prcjs{. <br />Af,cqtity **l havc rcad this application atd state that the above infomdion is corc1. I agrc to omply wirh all city 8nd County <br />ordinmcc md State lam rclaing to building construction and hmby authorirc rcpr*rtaive of this City md Coutrty to atq upon fic <br />2btve mentioned property for inspection <br />,rr", /2-J- / I <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bfloor/VenUI ns u Iation <br />Roof Sheathing <br />Shear Wall <br />Framing /1/lb-l <blrvl <br />lnsulation/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 />F!NAL q_2402 I /LLt Ct lffrg-zrJ <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />\ <br />/ <br />Owner: <br />conrracro ,, e /f(, ( <br />Lcnder's Address: