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BUILDING. INSPECTOR RECORD A,I SITE.WORK DATE ID/SIG.GOMMENTS Owner-Bui lder Decl aration I hwby affim uda p68lty of pcrjuy lhrt I m ampt fm thc Coltrac1m' Limsc Law for thc following rcam (!.c.7031 5 Bsin6t sd prcfBsim Codc): Any City tr CNty which rcquie a pcmit to cooltud, rltq, imprcvc, dmolish or rcprir ey 3tructuc, Fitr to it! iss**, Aso *quiri Ojapptirut fc dctr pannlt io ntc a iigrrcd starmat thst hc q shc is timsed Punuat to thc FoYi3iw of thc CmEaclc's Licmsrd Law'(-ChAta 9, Comin3 with Scaio ?000 of Divilim 3 of thc Buinq ad Profesim Codc) c that hc c shc is cxqnpt thefrom md itc 6st fc Oc Atcgpd amptim .Any violction of Scstio 7031.5 by my appliwt for s prmil subjccts thc sp,plicmt to 8 civil pqrdty of trot morc dre fivc hu&cd dollm ($500). lr/u *n ot lp 6wrty, o rny orgloye with a.gs a thcir iol. cmpanruion, will do thc work ad thc smctuc is not irtcndcd c+oftqcd fc salc ( S.'..ZOll, S*io;s da ircfsim Coac, Thc Cmtrrctu's Licmc L8w ds aor apply lo m ownc of thc propcry who builds c imFovc thm, ud who de srch wo(t himclf q hcclf c thrcugh his u hc m mployc, prcvidcd that tuch improvmot! e not intodcd or offmd fc aalc, If, howrycr, thc building or imprcvmot is sold within onc ycr of complction, thc ownq-Buil<tcr will havc thc burdm of prcvin8 that hc or 3hc not build o improvc for thc purpcc ofsalc). thc project ( Scc. 7044, Brsiness and_I, rlr owner of the propctty, am Profession Code: The Contractor's cxchuively contracting with licansed of who builds or improves thereon , and whoLicense Law does not apply to an owner contracts for such projects with a Contractor(s) licaued pumuant to the Law.). _I am exempt under Section (, Datc: Ovmer:/ I hereby affirm under penalty of pcrjury _I have and will maintain a Certificatc of Consent to Self-Insure for workers' Labor Code, for the performancc of the work for which the pcrmit is issucd. compcnsation, as Provided for by Scction 3700 of the t havc md will miatsin wqta' qnFraim iN|me, a rcquircd by Setio .370O of thc Labor Codc, fd thc Pcrfmcc of thc iqk for which thig pqmit is isucd My worko' cmPdrtid imrrue cmi6 ed policy nmbcr rc: Cuiq: Policy a(This section need not be complacd is for One hun&ed dollars less) I certi$ that in the performancc of thc work for became subject to the workem ' compensation laws which this pcrnrit is any of California, comparation provisions of Scction 3700 of the Labor t L a e and civilWARNING: Failure to secure workers' fines up to one hun&ed thouand dollars rs and shall subject an to addition cost of composation, damage as provided for the Section 3076 of thc Labor Code, interest and anornry's fees. LICENSED CONTRACTORS DECI.ARATION I h@by 8ffim ud6 paraty of pcrlury O*IE ii6ca uaa provisio of Chaptq 9 (comacing with Scction 7M0) of Divisi@ 3 of thc Buins ud Ptofeims Codc, md my limsc ig in full fqe md cffet. Licensc License Number CONSTRUCTION LENDING AGENCY t hftby sffm sdtr pcnslty of pcrjury rhal O* iwmmr"tion rcnaiag agocy fm thc pcfmcc of thc wck fq which this pcmit is isucd (Sc. 3097, Civ. C.). Lcnder's Name: APPLICAIYT'S DECLARATION Demolition Permits-Asbestos Notification Fedoal Rcgulations (Title 40, Part 6) - Required l-etter of Notification _l certify that the federal regulations removal are not applicable to this project. _ t certify that I have read this that the above I to comply with all City and County ordinances and Statc Laws of this City and County to enter upon the above mentioned Applicant or agent Permittee name (print) : L ls Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloorNe nUI ns u !ation Roof Sheathing Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Requirements Deputy Final Report Engineer Final Report Flood Zone Certificate I t\ FINAL 10 u L1 rnxr ICertificate of Occu pancy V Notes, Remarks, Etc.I as those