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SITE.WORK DATE ID/SIG.GOMMENTS OWNER BUILDER DEI,CARATION I hocby affm undr pmalty of pcrjury that I m cxmpt from thc Contreto6' Licmc kw for thc following lwn (56.7031.5 Buines md Profsion Codc): Any City or County which rcquirc a pemil to coNtruct. altc, imprcva dqnolish or rcpgir my r struclw, prior to its isumce, alrc rcquirB the applicilt for such pcrmit to filc a signcd statmal thar he or dE b liccf,scd psuet to thc prcvisioN of thc Contnctor's Licensâ‚¬d Law (Chaptd 9. Commacing with Setion 7000 of Division 3 of thc Buins od Prcfcsions Codc) or that he or she is cxcmpt th@from ed the basis for thc allcged cxopion. Any violation of Sction 7031.5 by ey applicmtforapcrmitsubjGtsthe applicilttoacivilpemltyofnotmorcthefivchundrcddollc($500). _1. as owner of the property, or my employees with wages as their sole compensation. will do the work and the structure is not intendod or offered for sale (Sec.70t4, Business and hofessions Code: Thc Contractor's License law does not apply to an owner of the propcrty who builds or imFnoves thereon. and who does such w'ork himself or herself or through his or her own employees. provided that such irnprovonents are not intended or oflbred for sale. I[, howener. the building or improvement is sold within onc ]er of complaion. the Or,nner Builder will have the hrden of proving tha he or she did not build or improvc the property for the purpose of sale). _1, as o\^'ner of the property, am exclusively contracting with licensed contractonr to construc't the project (Sec. 7044, Business and hrcfessbn Codc: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a Contractor(s) licensed pumuant to thc Contractor's Licensc l-aw). -l am exempt under Section-, B. & P.C. for this reason. ) Date: WORKERS' COMPBNSNTION DBCLARATION I hereby affinn under penalty of perjury one of the following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers'compensation. as provided for by Section 3700 of the Labor Code. r (*'.^ro ttre work for for the perfonnance of the work for which the permit is issued. 3700 of the Labor Code, for the performance of and policy number are: Policy u1 1t)l LL _l certify that in the pcrfonnance of the work for rvhich this permit is issued, I shall not employ any person in any manner so ils to become subject to the workers'compensation laws of California. and agrec that if I should bccorne subject to the rvorkers' compensation provisions of Section 3700 of the tabor Code. I shall. forthrvith comply wilh thosc provisions. WARNTNG: Failure to secure workers' compensation coverage is unlawful. and shall subject an onployer to criminal po'rahies and civil fines up to one hundred thousand dollars ($100.000). in addition to thc cost of compqsation. damages as provided for the Section -3076 of the Labor interest and attorney's I hereby affirrn under penalty of perjury that I arn licensed under provision 9 (cornrnencing with Section 7000) of Division 3 of the Business and Profcssions Code. and my license is in full force and effcrct. License Number: L4\ 15-xL Dalc:^.9t 0tlLl't CONSTRUCTION LENDINC AGENCY I hrcby affm undo pcnalty of pqjury that thm is a connruction lcnding agocy for thc psfolrmcc of thc rcrk for which this pqrnit is issucd (Se. 3097. Civ. C.). Lender's Name: I-cnder's Address: AfII,ICANLDECIdSAIION I harby alfim unds penalty of pcrjuy onc ofthe following delrations: Demolition Pmit$Asbctos Notification Fcdqal RegulatioB (Title 40, Pan6) -Rcquired trti6 of Notifi @tbn -l cGriry that thc fcdBal rcgulatioro rcguding ubctos moval ae not applicablc to lhis prcjer. 4fccti& tf,at t lu"c red this application {d statc that thc abovc infomation is cor6t. I agrc to comply with 8ll City ed Couty ordimcB md Statc lrw rclating to building constructiotr ild h6eby authorirc rcpreslaivG of this City ud Couty to 6tq upotr thc above mentioned propeily for Applicrnt or Agent Pcrmitee nlnre Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/Ve nUI n s u I atio n Roof Sheathinq Shear Wall Framinq lnsulation/Energy Drynruall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputv Final Report Enqineer Final Report Flood Zone Certif FINAL Certificate of Occupancy Notes, Remarks, Etc. BUILDING. INSPECTOR RECORD a C*ro, {\. I I ,^.", oof/crl /Z(