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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DE1CARATION I haclry alfm undo pcnalty of pcrjury thal I m crcmpt 6pm thc Cotrtreton' Licere law for thc following twn (Se.7031.5 Buins srd Prof*ion Code): Any City or County which rcquire a po'rnit to @nstruct, aftc, imprcvq dmolish or rcpair oy structqq prior to its is@cc, also rcquL6 rhc eplicet for such p6mit to filc I signcd statoat that hc or shc is lic@scd pEmt to thc provisioa of thc Contrrctor's Licoscd Law (Chapts 9, Comocitrg with Sction 7000 of Division 3 of thc Bsins ed Prcfcsiom Code) or th&t hc or shâ‚¬ is qmpt thqcfrom 6d thc bosis for thc allcgcd amptior Ary violslion of S61iotr 7031.5 by my applicutforap6mitsubjctsthc applicmttoacivilp@llyofnotmorcthmfivchundrcddollm($500). -1. ds owner of the property, or my employee with wages as their sole compensation. will do the work and thc stnrcture is not intended or offered for sale (Se.7M4, Business and hofessions Code: The Contractor's License Law does not apply to an owner of the propcrty who builds or improvc thenor\ and who docs such work himself or herself or through his or hcr own employecs, provided that such improvernants are not intended or offered for sale. I(, howcver, thc bnrilding or improvement is sold within onc year of complaion, the Ovner Buildcr will havc the hrdcn of proving thd trc or she did not build or impnove the property for tlrc purpose of sale). -1. as owner of the property. arn exclusively contracting with liccnsed contracton to construct the project (Sec. 7M4, Business ard Professbn Code: The Contractor's License Law does not apply to an owncr of propcrty who builds or improve thereon, and who contracts for such projects with a Contracto(s) liccnscd pursuant to the Contraclor's License Law). -IamexemptundcrScction-,B.&P.C.forthisreason. f )o to. WORKERS' COMPENSATION DECL r IU{TION I hcreby affrm under penalty of perjury one of the following dcclarations: _I have and will maintain a Certificate of Conscnt to Self-lruure for workers' compensation, as provided for by Section 3700 of the Labor Codc, for the pcrformance of the work for which the permit is issued. _l have and the work for will rnaintain 3700 of the Labor Code, for the performance of and policy number are: ^L ) 0 -\-T- Policy -l ccrti& that in the pcrformance of the work for which this perrnit is issucd. I shall not so as to become subject to the workers'compensation laws of California, and agree that if I anploy any person in any manner should become subject to the workers' compensation provisions of Section 3700 of the l-abor Codq I shall. forthwith comply with thosc provisions. WARNING: Failure to secure workers' compcnsation coverage is unlawful, and shall subject an onployer to criminal penahics and civil fines to one hundred thousand dollars ($100.00q). in addition to*".y{e a jr the cost of compcnsation, damages as provided for the 4;,,rSectionCode. interest 2 LICENSED (ION'I'R,IC'TOR DECI,ARATION I hcreby affrm under pcnalty of pcrjury that I am licsrsod under provision of Chaptcr 9 (commcncing with Section 7000) of Division 3 of the Busincss and Professions Code, and my license is in full force and effect. Licensc ('1_1 tbc4- W I heby affm udr pcoalty of pojury thd th@ is a con$ructbn knding agocy for thc pqfotlmcc of thc mrt 6r which this pcrnit is issucd (Sa. 309?, Civ. C.). I-cnder's Name: Lender's Address: APPLICANT DECLARATION I herâ‚¬by affirm undcr poralty of perjury onc of thc following declarations: Demolition Permits-Asbestos Notilication Federal Regulations (Title 40, Part6) -Required lcttcr o f Notifi cation -l certi& that the federal regulations rcgarding asbestos removal are not applicable to this project. and County above mentioned property for Applicant or Agent Permitee name \4 enter upon the Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloorNe nUl n s u latio n Roof Sheathing Shear Wall Framing lnsulation/Enerqy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif. I l.sA FINAL bln Dff.fr'67 Certificate of Occupancy tt / Notes, Remarks, Etc. {) and state that t