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-BUILDING. !NSPECTOR RECORD <br />SITE.WORK DATE ID/S!G.COMMENTS <br />Set Backs I rl I h <br />Forms/Stee!/Holdowns ' ll'l , <br />,,H w <br />Erection Pads lf <br />UFER Ground lt ll t ,a <br />SLAB Floor D{MltrT 'rMl <br />S u bfloorA/e nUI n s u Iatio n I <br />Roof Sheathinq <br />Shear Wall It tl ,-u\ <br />Framing twtpt v6/ <br />lnsulation/Energy ,, <br />Drywall mle rau <br />Ext./lnt. Lath J I <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />///, ./A9rffitru7W-)FINAL /q.4 ,/a/ <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />OWNER I}UII,DER <br />I hocby aflirm unde pcnalty of perjury that I m exempt ftom the ContractoB' Licmsc Law for the following rcn (56.7031.5 <br />Bsioss ild Profsion Codc): Any City or County which requiG a p6mit to coNtruc1, alto, imprcvg donolish or rcpair my <br />strucluq prior to its isuucc, also rcquiE thc applicat for such pcmit to file I signed statmqt thal hc or shc is licaEcd pGuut <br />to the provisiom of the Contractor's Liccnscd trw (Chapt6 9. Comocing with Setion 7000 of Division 3 of thc BNin6 ild <br />Prcfc$ions Code) or rhat he or shc is crcmpt thqcfrom ild thc basis for thc allegcd ampion. Any violation of S€tbn 7031,5 by my <br />appliciltforapcmitsubjctsthc spplicanttoacivilpcmltyofnotmorcthmfivchundrcddollm($500). <br />_1. as owner of the property. or my employccs with wages as their sole compensation. will do the work and thc stnrcture is not <br />intended or offered for sale (Sec.7044, Business and Professions Code: The Contrac'tor's Liceruc l-aw does not apply to an owner of <br />the propa'ty who builds or improves thereon. and who does such work himself or herself or through his or her own employees. <br />provided that such improvonents are not intended oroflbred for sale. I[, hower/er. the building or improvernent is sold within one ]qr <br />of complaion, the Orvner Builder will have the burden of proving tha he or she did not build or irnprove the property for the purpose of <br />sale). <br />_1, as owner of the prop6ty, am exclusively contracting with licensed contractors to construct the project (Scc. 7044. Business <br />and Pnofcssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. <br />and who contracts for such projects with a Contracto(s) liccrrsed pursuant to thc Contractor's License Law). <br />-l <br />am exempt under Scction-. B. & P.C. for this reason. <br />I hereby aflirm under penalty of perjury one of the following <br />_l have and will maintain a Certilicate of Consent to Self-lnsure for workcrs' compcnsation, as provided for by Scction 3700 of the <br />Labor Codc. for the performance of the work for which thc pcrmit is issued. <br />D?#and willmaintain workers'compensation insurance. as rcquired by Section 3700 of the Labor Code, <br />G *ork for which this pennit is issued. My workers' compensation insuranie canier and policy number are: <br />for the perfonnance of <br />DAp4oF g^le o€ <br />Policy 4 <br />_l certi& that in the perforrnance of the work for which this permit is issued, I shall not employ any person in any manner <br />so .ls to become subject to the worters'compensation laws of California and agrec that if I should become subject to the <br />workers' compensation provisions of Secrion 3700 of the l-abor Code. I shall. forthwith comply with those provisions. <br />WARNING: Failure to sccure workers' compensation covcrage is unlawful, and shall subject an anployer to criminal poraltics and <br />civil fincs up to one hundred thousand dollars ($100.000), in addition to the cost of compcnsation, damages as provided for the <br />Section 3076 <br />I hereby affrm <br />of the Business and Professions Code, and rny license is in full force and effect. <br />CONSTRUCTION LENDTNG AGENCY <br />t hrcby affm undo penalty of pojury that thqc is a onstructioo lcnding agocy for thc pqfoIrmce of thc wort for which this pqmit b <br />issucd (Sa. 3097, Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />APPL ICANT DECLAITATION <br />I heEby affrnn under penalty of perjury one of the following dcclarations: <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) <br />_Rqu ired Letter o f Notification <br />removal are not applicable to this project. <br />the <br />above mentioned property for <br />Applicant or <br />oo <br />Permitee <br />,,,", q/zq/z.L_ <br />Carrier: <br />a <br />Expires: <br />3 <br />111foe <br />6.czc:)€ea 5 <br />- <br />/z{