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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby alfirm undcr JEnalty of lErjury that I u crcmpt fr)n thc Contrack)F' LiccnE Law for the followin8 rcavtuscc.?0Jl.5 <br />Business and Profcs$ion Cillc): Any City or County which rcquircs a Jrrmit k) conslruct. altcr, improvc. dcmolish oi mlsir any - <br />strucIurc, Fior to its issuancc. also rcquircs thc applicmt f(rr such lx]trril b tilc a signcd statemnl lhal hc or shc is liccn$d pL'sat <br />k) thc pnlvisions of the Contractor's Liccn$d Law (Chaptcr 9, Commcncing with Sstion ?fix) of Divistrn 3 of thc Busincss ud <br />PnrlbssionsCodc)orthathcorshciscrcmptthsclirnrandthchasislorthcallcScdcxcmplion. AnyviolationofscctionT0-ll,5byany <br />applicant lirr a Frmil subjels lhc applicant to a civil pcnally of not m)rc lhm fivc hundrcd dollus (5500). <br />_1, as owner ol'thc propcrly, or my cmployces with wagcs as thcir solc compcnsation, will do thc work and the struclurc is not <br />intcrded or oft'crcd lilr salc (Sc.,c.7M4, Busincss and Pml'cssions Crxlc: 'l'hc Contractor's Liccnse l-aw docs not apply to an owncr of <br />thc prcpcrty who huilds or improves thcrcrrn. arxl who drrcs such work hinrsclf or hcrself or through his or her ttwn employecs, <br />pr()vidcd that such improvenrcnts arc mrt intcrrdcd oroll'crcrl lirr sale. It, lxrwcver, thc buiLling or impnrvcrnenl is sokl within onc ycar <br />ot'complction. thc Owncr Buiklcr will havc thc burdcn of proving that hc or shc drl mrt huihl or improvc thc pnrJrrty for lhc purJxrsc of <br />salc). <br />_1, as owncr of thc propcrty. am exclusivcly contracting with liccnscd conlraclors to conslruct the pnljcct (Sec. 7O44. Busincss <br />arxl Pnllcssion Cotlc: The Contraclor's Liccnsc Law docs not apply to an owner of proJrcfly who huilds or improves thereon, <br />and who contracts lilr such projccts with a Contraclor(s) liccnscd pursuant to thc Contractor's [.iccnse Law). <br />-Iamexcmr,tundcrSectitln-'B.&P.C.tbrlhisreasrln. <br />1 t.,. ^, <br />IVORKERS' COI\IPENSATION <br />DECLARATION <br />I hcreby all'irm undcr Jrcnalty of pcrjury one of the tirllowing dcclarations: <br />_l havc and will maintain a Ccrtilicatc ol'Consent to Sclt-lnsurc tirr workcrs' cotttpcnsation, as pnrvidcd fitr by Scction J700 of thc <br />Latxlr Ctxlc, lbr thc Jrcrtbrmance o[ the work tirr which lhc grcrmit ls issucd. <br />J7fi) of thc l-abor CorJc, tbr thc pcrtbrmance o[_l havc and will nraintain wrlrkers'conrJrcnsation insurancc, as rcquirctl byScction <br />thc work lirr which this Jrcrrnit is issucd. My workers' c()mpcnsalion insurancc carricr and nunrber arc: <br />1o <br />I)olicy a <br />_l certily that in the pcrlirrmancc ol'thc work lbr which this pcrmit is issucd, I shall not cmploy any lrcrson in any nlanncr <br />so as to bccomc suhjcct to thc workcrs' compcnsation laws of Calitbrnia, and a-trec that if I slrculd bcctlmc subject to thc <br />workers' compcnsation pnlvisions ol'scction -17fi) of lhc Lalxlr Codc, I shall, tilrthwith comply with thorc <br />WARNING: Failure to sccurc workcrs' comJrensation covcrage is unlawl'ul, antl shall subjcct an I tt Jrcnaltics and <br />civil tincs up to one hundrcd thousand dollars (S100.fiX)), in lhc ol'as providcd for thc <br />Scction 1076 of thc Labor intcrcst and atlrlrncy's t'ccs. <br />a2 <br />I,ICF]NS F]I) ('O N'tR,\CTO R <br />DI.t('t.ARATt(N <br />I hcrcby allirm undcr Jrcnalty of pcrjury that I anr liccnscd undcr pnrvision of Chaptcr 9 (commcncing with Scction 7firu) of Divi-'pr 3 <br />ol' thc llusurcss and Prol'cssions Crlrlc, ard nty liccnsc is in lull tirrce antl cttcct. <br />I-iccnse Nurnhcr:t $2e <br />e <br />CONSTRUCTION LENDING AGENCY <br />I hcreby aflirm undcr Fnalry of pcrjury thar thcrc is a q)nsrruction bndinS aSency lbr thc trcrlirmrec of llrc work for which this tEmil is <br />issucd (Scc. J097, Civ. C.). <br />kndcr's Namc: <br />APPLICANT DECLARATION <br />I hcrcby aflirm undcr penalty of pcrjury one of the tblkrwing dcclarations: <br />Demolition Permits-Asbestus Notification Fcdcral Rcgulations (Title 40, Part6) <br />_Requircd [*ttcr of Notilication <br />rcmovitl arc not applicable to this projcct. <br />atxlvc mentioned proprty lilr insgrcction <br />Applicant or <br />Pernritee nanre <br />atxlvc is <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/VenVl nsu lation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />Insu Iation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />/\ <br />FINAL s-z -7 Ylfvltt <br />Certificate of I <br />Notes, Remarks, Etc.I <br />\-/ <br />+ <br />, <br />- <br />to cornply with all City and <br />of this City and