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