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SITE.WORK DATE ID/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloor/Ve nUl n s u Iatio 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 SouAr[L &T.A(A lb-nr7-l tlt> (d, \7 FINAL ,o-)^at 0-r^ ry1 Certificate of Occupancy Notes, Remarks, Etc. >OWNER BUILDER DELCARATION I hocby aflim undr penalty of perjury that I m qmpt from the ContBctoE' Licce t:w for thc following r@n (Se.7031.5 Bminss and Profcsion Codc): Any City or County which requira a pcmh to corutruct. alta. improvc, danolish or repair my structuq prior to its isuoca also rcquiG thc applicst for such pemit to filc a signcd stalmmt thd hc or shc b licascd plNant to thc provisiom of the Contractor's Liccnsed law (Chapto 9. Commcncing with Sction 7000 of Division 3 of thc Bwinw ud Prcfsions Code) or that he or shc is qempt thqcfrom od the b8is for the allegcd exmption. Any violation of S6lbn 7011.5 by any applicant for a pcrmit subjcts thc applicant to a civil pcaalty of nol morc the fivc hundrcd dollds ($500). -1. as owner of the property. or my employecs with wages as their sole compensation. will do the work and the structure is not intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of the property who builds or improves thereon. and who does such work himself or herself or through his or her own cmployees. provided that such irnprovonents are not intended or ofliered for sale. I[, howet/er. the btrilding or improveme'nt is sold within one )tzr of complaion, the Orvner Builder will havc the burden of proving that he or she did not build or improvc thc property for the purposc of sale). a -1. as o\rmer of the prop6ty, am exclusively contracting with licerued conlractors to construct the project (Sec. 7044, Business and Pnofession Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improvcs thereon, and who contracts for such projects with a Contracto(s) licerscd pursuant to the Contractor's License taw). -l am exempt under Section_, B. & P.C. for this reason. I)qtn'0wner:_ WORKERS' COIVIP'NSAT DECLARATION I hereby affirm under penalty of perjury onc of the following declarations: _-l have and will maintain a Certificate of Consent to Self-lnsure for work6s'compensation. as provided for by Section 3700 of thc Labor Code, for the pcrformance of the work for which the pcnnit is issued. yl n^r"and will maintain workcrs' compcnsation insurance. as required by Section 3700 of the Labor Code, for the performance of the work for rvhich this permit is issued. My workers' compensation insurance and policy number are: Policy l/z< -l cenifu that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' cornpensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall. forthwith comply with thosc provisions. WARNING: Failure lo secure workers' compensation coverage is unlawful. and shall subject an â‚¬mployer to criminal petrahies and civil {ines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damagcs as provided for the Section 3076 of the l-abor Code, interest and attorney's fees. Orr" DECLAR/ITION I hcreby affirm under penalty of perjury that I arn liccnscd under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Busincss and Professions Code, and my licensc is in full force and effect. License t0 b orr",o'l /A8 /Zo4 conrractor: C.O I CONSTRUCTION LENDING AGENCY there is a construction lending agency for the performance of the work for which this pennit b lrnder's Address: APPLICANT DECLARATION I her6y affinn under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notilication Federal Regulations (Title 40, Part6) -Required Letter of Notifrcation -l ccrti$, that the federal regulations regarding asbestos removal are not applicable to this project. V cerri6, that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances and State laws relating to building construction. and of this City and County to enter upon the above rncntioned propcrty for inspection Applicant or rtgent Pcrmitce namc S ,,r,8 /4/Zozl BUILDING. INSPECTOR RECORD cro 5 gbl t ft)tr _Expires: 9oi qtK 9olo.P lofc issued 3097, Civ. C.). Name: