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INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNTR BTIILDER DELC^ RATION I hereby affirm under penalty of periury that I am exempt form the Contractors' License Law for the following reason (Sec.7031.5 Business and Profession Code): Any City or County which requires a permit to construct. alter. improve. demolish or repair any structure. prior to its issuance. also rcquires thc applicant for such permit to file a signed statement that hâ‚¬ or she is licensed pursuanl to thc provisions of th,' Contractor's I.icensed Law (Chapter'9. Commencing with Section 7000 of Division -i of the Business and Professions Code) or that htior she is exempt therefrom and the basis for the alleged eremption Any violation of Section 70-11 .5 by any applicant for a pcrmit subjects the applicant to a civil penalty of not more than fir'e hundred dollars ($500). 1=1. ,. owner of the propery*. or my employecs rvith wages as their sote compensation. rvitl do rhe r.t'ork and rhe stucture is nor intendod or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of the Fopeny u'ho builds or improves thereon. and who does such rvork himself or herself or through his or her own employees. provided that such improvanents are not intended or offered fcn sale, If. howeter. the building or imp'rovemext is sold within one ycar of complaion. the Orvner Builder rvill have the burden of proving that he or she drd not build or improve the propertv for the purpose of sale). No l. as owner of the property. am exclusively contracting with ticensed contractors to construct the project (Sec. 7044. Business and hofcssion Code: The Contractor's License Law does not apply lo an owner of property who builds or improves thereon. and who contracts for such projecs with a Contracto(s) licensed pursuant to the Conffactor's License Law). No I ., exempt under Section . B. & P.C. for this reason. WORKT'RS' COMPT'NSATION NF'C! AITATION I hereby affirm under penalty of perjurl,one of the following declarations: !t n"r'. and will maintain a Certificate of Consent ro Self-lnsure for rvorkers' compensation. as provided for by Section 3700 of the Labor Code. for the performance of the work for which the permit is issued. NO _l have and rvill maintain workers' compensation insurance. as required by Section .1700 of the Labor Code. for the performance of the work for rvhich this pennit is issued. My workers' compensation insurance carrier and policy number are: ('an'icr: Policy' Nurnber:__Expires: YES _ I cerrify that in the performance of the work for which this pennit is issued. I shall not employ any person in any manner so as lo become subject to the u,orkers'compâ‚¬nsation laws of California. and agree that if I should bocome subject to the worters' compensation provisions of Section 3700 of the L-abor Code. I shall. forthwilh comply wilh those provisions.. WARNIN(i: Failure to secure workers'compensation coverage is unlawful. and shall subiect an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section -1076 of the Labor Code. interest and attomey's fers. LI(' FN SI.'N CONTITACTOR NF'CI AIIATI()N I hercby afTirm under penalty of perjury that I arn licensed under provision of Chapter9 (cornmencing rvith Section 7000) of Division J of the Business and Professions Code. and my license is in full force and effect. [-icense (-lass:l.iccnse Nulnber CONSTRTICTION I F'NNING AGTNCY I hereby aflirm under penalty of perjury that there is a construction lending agency for the perfornunce of the rvork for rvhich this permit is issued (Sec. 3097. Civ. C.). Lender's Name: Lender's Address: APP! IC^NT DT'CI ^ITATION I herelry aflimr under penalty of per1ury one of the followrng declarations: Denulrtion Pernrits-Asbestos Notrfication Federal Regulatrons (Title 40, Part6) !!_ Required Letter of Noti fication YEs f certify that the federal regulations regarding asbestos removat are not applicable to this project. ttt I certiry that I have read this application and state thar the above infonnation is correct. I agree to compty wirh all City and County ordinances and State laws relating to building construction. and hereby authorize representatives of this City and County to enter upon the above mentioned property for inspection purposes. Reroof Roof (Diaphragm Sheathing/Frame)a-0.2t i ]atdtlZ 5/a. lh.ryoatr 6tr,**, Structural Final q/?or'?4 \*z*ils Plumbing 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) Grounding / Bonding Rough Electrical Final Mechanical Gas Air Pressure Test Rough Piping (HW, CW, etc.) Exhaust Ducts lVlechanical Final Notes, Remarks, Etc. I