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INSPECTOR RECORD { SITE-WORK DATE ID/SIG.COMMENTS O\TN['R BUILDER NEI CARATION I hereby affinn under penalty of periury that I am exempt fcrrm the Contractors' License [,aw for the following reason (Sec.7031..5 Business and Profession Code): Any ('ity or County rvhich requires a permit to corLstruct. alter. improve. demolish or repair any structure. prior to its issuance. also requires the applicant lor such permit to file a signed statement that he or shc is licensed pursuant to the provisions of the ('ontmctor's Licensed Law (Chapter 9. Commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the ba-sis for the alleged exonption Any violation of Section 7031 .5 by any applicant for a permit subjecs the applicant to a civil grcnalty of not more than five hundred dollars ($5001. No l. ,. o\\'ner of the property. or rny onployees rvith rvages as their sole compensation. rvill do the rvork and the suuctune is not inrended or offered for sale (Sec.7044. Business and Professions ('ode: The Contractor's License Law does not apply to an owncr of the fpâ‚¬rty rvho builds or improves thereon. and rvho does such wort himself or herself or through his or her own onployees, provided that such improvonents are not intendod or offered for sale. If. horvever. the building or imp,rovernent is sold within one year of cunplaion. the Orvner Builder rvill have the burden of p,roving that he or she did not build cn improve fie properW for the ptnpcc of sale). ]Et. ar owner of rhe property. am exctusively contracting rvirh licensed contractors to construct the project (Sec. 7044. Business and Pnrfession ('ode: The ('ontractor's l.icense [-arv does not apply lo an owner of property who builds or improves thereon. and wlro contracts for suclr projects with a Contracto(s) licensed pursuant to the Contractor's l,icense l-aw). !o I ., exempt under Secrion - B. & P.C. for this reason. WORKT'RS' COMPF'NSATION NF'('I ARATION I hereby alTinn under penalty of perjury one of the following declarations: N-o t hru. anct will rnaintain a Certificate of Consent to Self-lnsure for workem' compensation. as provided for by Section -j700 of the l-abor Code. for the performance of the work for which the permit is issued. YES _ I have and rvill maintain rvorkem' cornpensation insurance. as required by Section 3700 of the Labor Code. for the perfonnance of the rvork for u,hich this permit is issued. My workers' compensation insurance carrier and policy number are: FrankGrum('arrier:_ wct4-o&317-01l'olicr Nurrrhcr':Expires: 0610112022 NO I certify that in the performance of the rvork for rvhich this prmit is issued. I shall not employ any pefion in any manner so as lo become subiecl to the workers' compensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section .1700 of the L:bor Code. I shall. forthwith comply with those provisions.. WARNIN(i: Failure lo secure rvorkem'cornpensation coverage is unlarvful. and shall subject an employer to criminal penalties and civil fines up lo one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section -3076 of the Labor Code. interest and attomey's fecs. LI(' FN SF'T} ('ON'I'RACTOR NFC L.\RATION I hcreb5'alTirnr under penalty of perjury that I am licensed under provision of Chapter g (commencing rvith Section 7000) of Division -1 of the Rusiness and Professions Code. and my license is in ftrll force and effect. c30 l-icense ('lass:1007c45 License Number (.ONSTRIICI'ION I TNDING AGFNCY I hereby alTinn under penalty of per'fury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. .1097. Cir'. C.). l.errder's Narne: l.encler's Address: APPI ICANT NTCI A.RATION I heretry attnn under penalty of per1ury one of the followrng declarattons: l)ernolition Perrnits-Asbestos Notification Federal Regularons (Trtle 40. Part6) No_ Required Letterof Notification t11 t cenif)' that the lHeral regularions regarding asbestos removal are not applicable to rhis projecr. YES I cerrifo that I have read this application and state that the atxrve infornration is correct. I agree to comply with all City and Cc,unty orclinances ancl State l-arvs relating ro building construction. and hereby authorize representatives of rhis City and County to enter upon the above mentiord property for inspection purposes. Reroof l,//t Roof (Diaphragm Sheathing/Frame)-tfzqh,/41V\ Structural Final fitil4h,/-H-, PIum Under Floor I Under Slab Rough Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test Plumbing Final Electrical Service (Meter I Panel) Groundang / Bonding Rough Electrical Final Mechanical Gas Air Pressure Test Rough Piping (HW, CW, etc.) Exhaust Ducts Mechanical Final Notes, Remarks, Etc