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BUILDING. !NSPECTOR RECORD I SITE.WORK DATE ID/SIG COMMENTS OWT,EtTt!UILDER DELCARATION I hoeby aflim undq pemlty of perjury that I m cxempt fto-m the ContrrctoE' Licsc tsw for the following rcen (Se.?031f Busines and Profcssion Codc): Any City or County which requiG a psrnit to coNtruc{. altq, improvq doolish or rcpair my structre. prior to its isswce. also requirc the applicst for such pcmit to file a signed statmmt that hc or slrc b licGcd plNsd to the provisiom of the Contmctor's Licensed Law (Chapt6 9, Commcncing with Strtion 7000 of Division 3 of thc Busile ud ProfcssionsCodc)orthathcorshe isexcmptthEefromildtheb8isforthcallegcdcxmption. AnyviolatiotrofSelionT03l.5byrgy applicantforapmitsubjetsthc applicanttoacivilpcnaltyofnotmorcthefivchundrcddollm($500). _1. as owncr of the property. or my etnployees with wages as thcir sole compensation. will do the work and the structure is not intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's [,icense Law does not apply to an owner of the property who builds or improvâ‚¬s theron, and who does such work himself or he'rself or through his or her own employees, provided that such improvancnts are not intended or offered for sale. If. however. the building or improvement is sold within one year of cornplaion, the Orvner Builder will have the hrden of proving that he or she did not build or improve the propo'ty for the purf)se of sale). _1. as owner of the property. arn exclusively contracting with licensed contractors to construct the proje'ct (Sec. 7044. Bwiness and Prrofcssion Code: The Contractor's Liccnsc Law does not apply to an owner of property who builds or improves thereon. and rvho contracls for such projects with a Contractor(s) licensed pursuant to the Contractor's Licerue Law). -IamexetnptunderSection-,B.&P.C.forthisreason. l)oLr. WORKER,S' COMPENSATION DECLARATTON I hereby allirm under penalty of perjury onc of the following declarations: _l have and will maintain a Ccrtilicate of Consent to Self-lnsure for workers' cornpensation, as provided for by Section 3700 of thc {ffi; for the performancc of the work for which the permit is issued. Section 3700 of the Labor Code. for the performance of carrier and policy number are: Policy t _l certi$ that in the perfonnance of the work for which this perrnit is issuctl. I shall not employ any person in any manner so ils to become subject to the work6s' compensation larvs of California. and agree that if I should becolne subject to the rvorkers' cornpcnsation provisions of Section 3700 of the Labor Code. I shall. forthwith comply rvith those provisions. WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an onploycr to criminal pcnalties and civil fines up to one hundred thousand dollars (S100.000). in addition to the cost of cornpensation. datnages as provided for the Section of the Code, interest and attorney's fees. DI'CI,ARA'I'I(IN I hereby alTirm under pcnalty of perjury that I arn licensed under p,rovision of Chapter 9 (commencing with Section 7000) of Division 3 of the Busincss and Professions Code. and rny license is in full force and effect. License Number: W I hrcby aflirm undr pcnalty of pqjury thar thqc is a consrucrion lcndhg agocy for thc po fomacc of thc work for which this pomit b issued (Se. 3097, Civ. C.). Lender's Narne: lrnder's Address: APPLICANT DECLAR/TTION I hcrcby aflirm under poralty of perjury one of the following declarations: to this project. I agrec to comply with all City and County ordinances and State Laws relating to building construction, and represefltatives of this City and County to elrter upon the above ment ioned property Applicant rrr Agent Pernritee nanle Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/Ve nUl ns u latio n Roof Sheathing Shear Wall Framinq lnsu !ation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif Soa Av Atpr''ft l0 6-zl t-o6)t\/ FINAL Certificate of Occupancy Notes, Remarks, Etc. Letter of Notification that I have read this application and state that the above ,^,",APof>l