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INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BT'ILDER NELC dRATION <br />I hereby alTinn under penaltl, of periury that I arn exempt form the Contractors' I-icense Larv for the following reason (Sec.7031.5 Business <br />and Profession Code): Any' City or ('ounty u'hich requires a pennit to construcl. alter. improve. demolish or repair any struclure. prior to its <br />issuance. also requires the applicant for such pennit to file a signed statement that he or she is licensed pursuant to the provisions of the <br />Contractor's l.icensed Larv (Chapter 9. ('ommencing rvith Section 7000 of Division .1 of the Business and Professions Code) or that he or <br />she is exempt therefrom and the basis for the alleged exoxption Anv violation of Section 7031 .5 by any applicant for a pcrmit subiects the <br />applicant to a civil penalty of not more than fir'e hundred dollars ($-500) <br />No l. o. owner of the propeny. or rny employees rvith u,ages as their sole cornpensalion. rvill do lhe rvott and the stnrcturc is not intended <br />oloffered ftrr sale (Sec.7044. Ilusiness and Professions Code: The Contractor's [-icense [:w does not apply to an owner of the prop€rty <br />rvho huilcls or inrproves thereon. and s'ho dcres such rvork himself or herself or through his or her orvn employees. provided that such <br />impovonents are not intended or offered for sale. lf. horvo'er. the building or impovement is sold within orie year of complaion. the <br />Os,ner Builder s'ill have the htnden of gnoving that he cr she did not build or improve ttre propern* for the purpose of sale). <br />NO l. as ()\\,net'of the properly. anr exclusivelv conrracting rvith licensed cortractors to constnrcl the pro.iect (Sec. 7044. Business and <br />Pnrfc.ssion ('ode: 'l'he Contraclor's l.icense l-arv does not apply to an owner of property who builds or improves thereon. and <br />u,ho c()ntracts for such prrriects s,ith a Contmctorls) licensed pumuant to lhe Conlractor's License l-aw). <br />No t a,n exernpt under Section . I]. & P.C. for this reason. <br />WORKFRS' COMPENSATION NFCI ARA'IION <br />I hereby affirrn under penalty of perjury one of the follorving declarations: <br />rc I hr*'. and rvill maintain a (-ertificate of Consent to Self-lnsure for u,orkers' compensation. as provided for by Section -1700 of the <br />labor ('ode. for the performance of the rvork for u'hich the permit is issued. <br />YES <br />_lhaveandu'illmaintainrvorkers'compensationinsurance.as requiredbySection.lTffiofthelaborCode.forthepcrfonnanceofthe <br />rvork for rvhich this permit is issued. My workers' compensation insurance carrier and policy number are: <br />(.an-ier: New Har*rhirc llr co' <br />0383C1552 0710112022 <br />Policy Nurnher:_ Expires: <br />NO <br />I certify,that in the perfrrrrnance o[the rvork for s'hich this pennit is issued. I shall not ernplol'any person in any'manner so <br />as lo hec'onte sub.iect to the n,orkers' compensation las's of ('alifomia. and agree that if I should become subiect to the workers' <br />cornpensation provisions of Section .1700 of the l-ahor ('ode. I shall. forthrvith cornply with those provisions.. <br />\I'ARNIN(J: Failure to secure s'orkers'compensation coverag,e is unlawful. and shall subiect an employer to criminal penalties and civil <br />fines up to one hundred thousand dollars ($100.000). in addition to the cosl of compensation. damages as provided for the Section.1076 <br />of the l.abor ('ode. interest and attomey's fees. <br />LI('T'NSTN (:ONTRAC'I'OR NI.'CI .^ RATION <br />I lrerchy'alfirm under pcnaltl,of periury that I arn licensed under provision of Chapterg lcornnrencing rvith Section 7000) of I)ivision -l of <br />the llusincss and Professions ('odc. and rny license is in firll force and effect. <br />c36 <br />l.icense ('lass:OETEGO <br />l.icense Number <br />(.ONS'TRTICI'ION I FNNING dGFNCY <br />I herehy affrnn undel penalty of periury that tlrcre is a construction lending agency for the perfonnance of the work for which this permit is <br />issued (Sec. 1047. Cir'. ('.). <br />I.ender's Nanre: <br />iim.fracr lc@outlook.com <br />l.ender's A<ldress: ' <br />APPI I(:AN'T NTCI A.R{TION <br />I herelrv atlinrr under penalty of per.luw one of the frrllowrng dt'claratrons <br />l)enrolrtron Pernrrts-Ashestos Nottlication Federal Regulaltorts (Title 40. Pafl 6) <br />!!- Required l.etter of Notification <br />YEs I certify thar the federal regulations regarding asbestos removal are nor applicable to this pro.iect. <br />YES'-- I cerriI tlrat I have read this application and state that the atrove information is correct. I agree to cornply u,ith all City and County <br />ordinances and State l-au,s retating to building construction. and herebl authoriz.e representatives of this City and County to enter upon the <br />atrove mentioncd property for inspection purposes. <br />Reroof <br />Roof (Diaphragm Sheathing/Frame) <br />Structural Final <br />Plumbing <br />Under FIoor I Under Slab <br />Rough <br />Shower Pan / Tub Test <br />Water Service <br />Sewer / Sewer Cap <br />Gas Air Pressure Test 1-74t U^.{ {z <br />Plumbing Final Q-)-?t 9lrr,<40 ttZ <br />Electrical <br />Service (Meter I Panel) <br />Grounding / Bonding <br />Rough <br />Electrical Final <br />Mechanica! <br />Gas Air Pressure Test <br />Rough <br />Piping (HW,CW, etc.) <br />Exhaust Ducts <br />[/echanical Final <br />Notes, Remarks, Etc.