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t . â‚¬UIIoING. INSPECToR REcoRD S!TE.WORK DATE ID/S!G-COMMENTS OWNER BUILDER DELCARATION I hcrcby afiirm undo penalty of pefury that I m qempt from thc Contractos' Licw taw for thc foltowiry @n (56.?0315 Buincs and Profeion Codc): Any City or County which rcquic 8 pqmh to construct, 8llq, imprcvg dsnolish or r.psir ily struduq prior ro its isuilcc. also requirG thc applicmt for such pcnnit lo 6lc a signcd stdetMt thar hc or shc b licoscd pmuut to thc prcvisiqns of tlrc Contractor's Liccnsed law (Chaptq 9, Commcncing wilh Setion 7000 of Division 3 of the Bwins md Prcfessions Code) or that hc or she b qemp thqâ‚¬from ud the b6is for the allcgcd cxmpion. Any violation of Srction 7031.5 by uy appliciltforapcnnitsubjetsthc applicanttoacivilpcnsltyofnotmorcthofivchundrcddollm($500). -1, as owner of the propeny, or my employe$ with wages as their sole compensation. willdo the work and the structure is not intended or oflered for sale (Scc.7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of the property who builds or improves theron. and who docs such wort himself or hersclf or through his or her own employees, provided that such improvancnts are not intended or offcrod for sale. If. howetrer. the building or improvernmt is sold within one )ear of complaion, the Ourner Builder will have the burden of pncving tlrru he or she did not build or improve the property for the purposc of sale). -f . as owner of the property. am exclusively contracting with licensed contraclors to construct thc project (Sec. 7U4, Business and hofession ('ode: The Contractor's License Law does not apply to an owner of property rvho builds or improves thereon, and who contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's License l-aw). _l am under B. & P.C. Z 2_l DECLARATION I hereby affirm under penalty of perjury one of the following declarations: -l havc and will maintain a Certificate of Consent to Self-lnsure for workers' compcnsation. as provided for by Scction 3700 of the Labor Code. for the performance of the work for which the perrnit is issued. -l have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code, for the performance of the work for rvhich this permit is issued My workers' compensation insurance carrier and policy number are: Policy Number: Expires:, _l ccrti& that in the performance of the work for which this permit is issued" I shall not employ any person in any manner, so as to become subject to the work6s' compensation laws of California, and agree that if I should become subject to the 7- s workers' cornpensation provisions of Section 3700 of the Labor Code, I shall, forthwilh comply with those provisions. WARNING: Failurc to secure workers' compcnsation coverage is unlawful. and shall subject an anployer to criminal polaltics and civil frnes up to one hundred thousand dollars in to of compensation. damages as provided for the Section 3076 Labor Code. interest and IL;L/ DECI.ARATION I hcteby affrnn under penalty of perjury that I am licensed under provision of Chapter 9 of the Business and Professions Code, and my licensc is in full forcc and effert. with Section 7000) of Division 3 License Class: Licertse Number: Date: W I hrcby affm unda pcmlty of perjury thal thtr is 8 coEtruclion Lnding agacy for thc psfomacc of thc rcrk br which this pannh is issued (Se. 3097, Civ. C.). lrndq's Nmc: Lendcr's Addrcss: APPLICANT DECLARATION I hereby affimr under penalty of perjury one of the following declarations: Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40, Part6) _Required Letter of Notification -l certi& that the federalregulations rcgarding asbestos removalare not applicable to this project. ___l cati$ that I have read this application and state that thc above inforrnation is correct. I agree to comply with all City and County (.ordinances and State Laws relating to building hereby authorize rep,resentatives of this City and County to enter upon the above mentioned property for ( Applicant or Agent I)crnrilce nanre t,,/8 Z Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/VenUI n s u latio n Roof Sheathinq Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Fina! Report Engineer Final Report Flood Zone Certif I i FINAL J^,{ilo lolu,a Certificate of Notes, Remarks, Etc. Owner:_ Carrier:- Contractor:_