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) tsUILUING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS oWNERBUTLDERDELCARATTON LI hseby affum unde pcnalty of perjury thst I m qmpt fiom thc ContracloE' Licw law for thc following rcen (Se.703 ! .t Buine ud Profsion Codc): Any city or County which rc{uir6 8 p6mit to @mtrucl altq, imprcvc dcrnolish or rcpair uy struc{uq prior to its isuocc. also rcquirc thc applicut for such pcf,nit to filc a signcd statmot thst hc or shc is licascd pGuut to the Fovisioru of thc Contnctor's Licenscd Law (Chapt6 9, Commocing with Setion 7000 of Division 3 of the Bsins ud Pmfsioro Codc) or thst hc or shc is q@pt thqcftom md thc b6sis for thc allcgcd oopion. Any violation of Scrion 7031.5 by ily appliciltforap6mitsubjetsthc applicmttoacivilpcnaltyofrctmorcthafivehundrcddollm($500). _1,6 owner or my employees with wages as their sole compensation, will do the work and the structure is not and Professions Code: The Contractor's License [,aw does not apply to an owner of(Sec.7044. Business the property who builds or improves thcron, and who does such work himsclf or herself or through his or hcr own employees. provided that such impnovanents are not intendâ‚¬d or offcrod for sale. I[. howorer. the building or improvernent is sold within one ]&ar of complaion the Or,vner Builder will have the hrdcn of proving ttat hc or she did not build or improve the propcrty for the purposc of sale). _1, as owner of the propertyr arn exclusively contracting with licensed contractoni to construct the project (Sec. 7044. Buiness and hofession Code: The Contractor's License Law does not apply lo an owner of propcrty who builds or improves thereon, and who contracts for such projects with a Contraoo(s) licerscd pursuant to the Contractor's Licensc l-aw). -l am cxcmpt under Section-, B. & P.C. for this reason. WORKERS' COMPENSATION DECLARATION I hereby affrrm under penalty of pcrjury one of thc following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers' compeosation, as provided for by Section 3700 of the Labor Code, for the performance of thc work for which the perrnit is issued. _l havc and will maintain workers' compensation insurance, as requircd by Section 3700 of the [abor Codc. for the pcrformance of the work for which this pa'mil is issued. My workcrs' compensalion insurance carrier and policy number are: Policv Number: Exoires: _l certi$ that in the performance of thc work for which this pcrmit is issued. I shall not employ any person in any manner so rui to bccome subject to the workers'compensation laws of California. and agrec that if I should become subjcct to the rvorkers' compcnsation provisions of Section 3700 of the l"abor Codc, I shall. forthwith comply wilh thosc provisions. WARNING: Failure to secure workers' compcnsation coverage is unlawful, and shall subject an anployer to criminal panalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compcnsation, damages as provided for the Section 3076 of the Labor Code, intercst and attorney's fees. I hereby affrrm under -1 of the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Ilol o. W I hsEby affm undq paalty of pGjurythat thqc is a constructbn knding agmy for thc pqfolrrucc of thc rcrk for *hich this Frnh b i$uâ‚¬d (56. 3097, Civ. C.). Lender's Name: Lender's Address: AfI!.ICANLDECI.AEAITON I hq6ry sffm urd6 paalty of pGjury onc of thc followiag dalarations: Demolition Pmits-Asb6tos Notificstior Fcdqal Rcgulatiore (Tillc 40, Parr6) -Rcquircd trtts of Notifi@tbn -l cqriry thd thc fcdqal rcgulatioro rcgrding sbctos rmoval uc not epliâ‚¬blc to this prcj6{. -t cqtiry that I hsve red this applic8tion 0rd statc that the abovc infonnarion is cor6t I agr to omply with all City od Couty ordimG md Statc ttw rching to building congruclion, ed hcby authoria reprMtativ6 of this City md County to mtq upon thc above mationed prcpcrty for impetion purpos. Applicant or Agent I'ermitee name Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfl oor/Venul ns u latio n Roof Sheathing Shear Wall Framing Insu Iation/Enerqv Drywall I I It E9.nnt. Lath 0lwlv L ?Z Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif I A t@TtrUS ro\r&la'*>ttb,aw (J I ^4 t I t -- FINAL Dn0tz\r I .fr Certificate of Occupancy I J Notes, Remarks, Etc. ) Contractor: