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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hseby aflirm undo pcnalty ofpcrjury thal I m cxempt fipm thc Contractoc' Liccre taw for thc following r?ren (Sa.7031.5 Businss md Profsion Codc): Any City or County which requirc a po'mit to coctruct, alta, improvc, dcmolish or rtpoig oy structue, prior to its i$uece, also rcquire thc applicilt for such pâ‚¬mit to filc a signcd statmot that hc or shc is licoscd pwmt lo the provisioN of the Contrrctor's Licenscd Law (Chaptc 9, Commencing with Setion 7000 of Division 3 of the Busines md Prcfeions Codc) or that he or shc is umpt thaefrom ed the bosis for thc alleBcd cxmption. Any violation of Sdion 7031.5 by ily applicmtforapcrnitsubjetsthc applicmttoacivilpcnaltyofnotmorcthufrvchundrcddollm($500). -1. as owner of the property. or my employees with wages as their sole compcnsation. will do the work and the struoure is not intended or offered for sale (Sec.7044. Business and Professions Code: The Contraclor's License law does not apply to an ownâ‚¬r of the propcrty who builds or improves thermru and who does such work himself or herself or through his or her own employees, provided that such irnprovonents are not intended or offered for sale. If, however, the building or improvement is sold within one year of complaion. the Owncr Builder will have the hrden of proving that he or she did not build or improve the propo'ty for the purpose of sale). --1, as owncr of the propcrty, am exclusively contracting with licensed contractors to construct the project (Sec. 7M4, Bwiness and Profcssion Code: The Contractor's License Law does not apply lo an owner of property who builds or improves thereon. and who contracts for such projects wilh a Contracto(s) Iicersed pursuant to the Contraclor's Licensc Law). -l am excmpt undâ‚¬r Scction-, B. & P.C. for this reason. l)oto' WORKERS' COMPENSATION DECLARATION I hereby affrrm under penalty of perjury one of thc following declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for rvorkers' compcnsation, as provided for by Sectiort 3700 of the d,; for the performance of the work for which the permit is issued. will maintain workers' compensation insurance, as required by Section 3700 of the tabor Codc. for the performance of is compcnsation insurance carrier and policy number are: L7,l.7lPolicy -l certi& that in the performancc of the work for which this permit I shall not employ any person in any manner so as to becomc subject to the workers'compensation laws agree that if I should become subject to the u'orkers'of Section 3700 of the Labor shall. forrhu,ith those provisions. secure workers' compensation coveragc and shall to criminal penalties and civil thousand dollars ($100.000). in to the cost of damages as provided for the interest and 7 I hereby affinn under penalty of perjury that I arn licensed 9 (commencing with Section 7000) of Division 3 of the Business and Profcrssions Code, and my license effcct. Liccnse b I hereby affrnn under penalty of perjury that there is a issued (Sec. .3097. Civ. C.). lending agency for the of the rvork for whrcrr.$is neg8it is Lender's Name: 1,J- < Lender's Address: APPLICANT DECLARATION I hercb), affurn under penalty of perjury one of thc following declarations: Dernolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) _Required Letter of Notification _l certi& that the federalregulations rernoval iue not applicable to this project. that the above infonnation with all above mentioned property for inspection Applicant or Agent I't:rnritce nilnre and e and County to County Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloor/Ve nUl n su latio n Roof Sheathing Shear Wal! Framing lnsu Iation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif I - l 2/) FINAL L 74 / Certificate of Occupancy I / Notes, Remarks, Etc. Owner:_ Carrier:_ Io _l certiS that I have read ordinances and State Laws DTWY I