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INSPECTOR RECORD SITE.WORK DATE ID/S!G.COMMENTS OWNER BUILDFR DT'I CARA'TION I hereby aflirm under penalty of periury that I am exempt form the Contractors' License Law for the following reason (Sec.703 I .5 Business and Profession Code): Any City or County rvhich requires a permit lo construct. alter. imp,rove. demolish or repair any structure. prior to its issuance. also rcquires the applicant for such pennit to file a signed statement that he or she is licensed pursuanl to the provisions of the Contractor's l.icensed l-arv (Chapter g. Commencing rvith Section 7ffX) of Division ]l of the Busincss and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 70-l I .5 by any applicant for a pcrmit subjects the applicant to a civil penalty of not more lhan five hundred dollars ($500). !1f . r. owner of the propetty. or my enrployees with rvages as their sole compensarion. rvill do the wort and rhe stnrcturc is nor intended or oflered for sale (Sec.7044. Business and Professions (.ode: The Contractor's License Larv does not apply to an owner of the property u,ho builcls or inrproves thereon. and rvho does such rvork himself or herself or through his or her orvn employees. providcd that such imprcvonents are not intended or offeted for sale. lf. horvwer. the building or improvement is sold within one year of complaion. the (hvner Builder s,ill have the burden of p,roving that he or she did not build cr improve the propertv for the purpose of sale). !!i. ,-r owner of the property. am exclusively conffacting with licensed conhactors to conshuct the p,roject (Sec. 7044. Business and hofession Code: The Contractor's License Larv does not apply lo an owner of property u,ho builds or improves thereon. and rvho contracts for suclr pro.jects rvith a Contracto(s) licensed pursuant to the Contractor's License Law). !!l .rn exempt under Secrion B. & P.C. for this reason. WORKT'RS' ('OMPFNSATION NF'CI ^ RATION I hereby affinn under penalty of perjury one of the follorving declarations: *! t n.*," and rvill maintain a Certificate of Consent to Self-lnsure for rvorkers' compensation. as provided for by Section 3700 of the l-abor C'ode. for the performance of the rvork for u'hich the permit is issued. YES ._ I have and u'ill maintain rvorkers' compensation insurance. as required by Section 17fi) of the Labor Code. for the performarrce of the work for which this pennit is issued. My u'orkcrs' compensation insurance carrier and policy number are: . Everort Premlor lnrurance Company Carrier: 7C0017CC.1211 l0lll0112022 Policy Nurnber: Expires: NO _l cerrifu that in the perfonnance of the rvork for rvhich this permit is issued. I shall not employ any pâ‚¬rson in any manner so as to become sub.iect to the rvorkers'compensation larvs of California. and agree that if I should become subject to the rvorkers' compensation provisions of Section 3700 of the Labor ('ode. I shall. forthrvith cornply with those provisions.. WARNING: [;ailure to secure rvorkers'cotnpensation coverage is unlarvful. and shall subjecl an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compâ‚¬nsation. damages as provided for the Section -3076 of the l.abor ('cxle. intetest and attomev's fees. LICFNS['N CONTITACTOR NT('I AR A'TION I hereby'affinn under penalty of per.iurl'that I am licensed under provision of Chapter 9 (commencing rvith Section 70m) of Division .1 of the Business and Professions Code. and mv license is in full force and effect. c-10 l.icensc ('lass:042023 [,icense Number CONSTRIICTION I TNNING AGFNCY I hereby aflinn under penalty of per.iury that there is a construction lending agency for the perfonnance of the rvork for which this permit is issued (Sec. 3097. Civ. C.). I-endcr's Narne: l.cnder's Addrcss: APPI ICINT NFCI ARATION I herehr allimr under pe.nalty of perluw one of the followrng declarations [)enrolrlron Perrnrts-Asbestos Notrficalron Federal Regulatrons (Trtle 40, Part6) N! Require<l I-etter of Notification ttt , cerlify rhat the federal regulations regar<ling asbestos removal are not applicable to rhis project. YEs I ceflib that I have reacl this application and state thar the above information is correct. I agree to cornply with all City and County ordinances and State l-au's relating to building constnrclion. and hereby authorize representatives of this City and County to enter upon the above mentioned property for inspection purposes. Reroof Roof (Diaphragm Sheathing/Frame) Structural Final Plumbing Under FIoor I Under SIab Rough Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test Plumbing Final Electrical 0 Service (Meter I Panel)q- lul ' /r \c Grounding / Bonding g-t'l'tr{\r Rough 1-l{ -l (La'\v Electrical Final 9-14 -l\- t ,/ Mechanica! Gas Air Pressure Test Rough Piping (HW, CW, etc.) Exhaust Ducts Mechanical Final Notes, Remarks, Etc.