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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hueby affrm unda pmalty of pojury thar I m excmpt ftom the Contractoc' Licmrc Law for the following rcun (Se.7031.5 Busine and Profsion Code): Aoy City or County which rcquirs a pornit to conslruct. alts. improvc, dorolish or rpair uy structue, prior to its isumcc, alrc require rhc applicilt for such pemil to filc a signcd st8tm@t that lE or shc is ticmcd pmuet to thc lrovisioN of thc Conractor's Licoscd Law (C.haptq 9, Commcncing with SetioD 7000 of Division 3 of the Buine md ProfsiomCodc)orthsthe orshciscx@ptthEcfromildtheb6sisforthcallcgedcxmpion. AnyviolationofSâ‚¬{iotr703l.5byany applicutforapcrmirsubjctsthc applicanttoacivilpcnaltyofnotmorethativehundrcddollus($500). _1. as owner of thc property, or my employees with wages as their sole compensation. will do the work and thc structure is not intcnded or offered for sale (Sec.7M4. Business and hofessions Code: The Contractor's License law does not apply to an owner of the property who builds or improves thereon. and who does such work himself or herself or through his or her own employees, provided that such improvonents are not intendetl or offered for sale. l[, howsver, the bnrilding or irnprovernert is sold within one year of complaion. the Or,vner Builder will have the hrden of proving that he or she did not build or improve the p,roperty for thc purposc of sale). -1. as owner of thc property, am exclusively contracting with licensed contractors to construct the project (Scc. 7M4, Buincss and Profcssion Code: The Contractor's l-icense Law does not apply to an owner of property who builds or improvcs thereon. and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's Liccnse taw). -l am exempt under Section-, B. & P.C. for this reason. f)o I rr' WO RKER.S' COM PEN SATION DECLARATION I hereby affrnn 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 Section 3700 of thc Labor Code, for thc po'formance of the work for which the perrnit is issued. _l have and will rnaintain workers' cornpensation insurance, as required by Section 3700 of the Labor Code. for the perfonnance of the work for which this permit is issued. My workers' compcnsalion insurance carrier and policy number arc:\ Policy ( 16cco l5 5I,IS IZZ fft ""rrify tn"t in the pqformncc of thc work for which this psmit is issued, I shall not mploy any pffin in uy mm6 s 6 to beome subjet to the works' ompensation laws of Califomia ud agrcc that if t should bsorne subjst to thc work6'smpsationprcvisiomofScrion3T00ofthckborCodc,lshall,fonhwithcomplywiththosprcvisiorc. WARNING: Failurc to sw workeB' compwtion covmgc is unlawful, ud shall subjet u ilployq to qiminal pqEhiâ‚¬s ild civil fme up to onc hutrdrcd thousd dollm ($100.000). in addition to the cost of compcNtion. dm8g6 I providcd for the Section 3076 of the Labor Code, interest and attornâ‚¬y's L DECI.ARATION I hereby affrm under penalty of pcrjury that I am licensed under provision of Chapter 9 (commcncing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full forcc and effect. License Nurnber: q o,,", 4/Z 1/zl CONSTRUCTTON LENDING AGENCY I hcby affm unda paulty of pcrjury that thqc is a oretruaion hoding 8g6cy for thc pqfomcc of the work for which this pcmh is issued (Se. 3097, Civ. C.). knds's Nme: Lcnder's Address: AfIIICANI.DECI.ABAIIAN I horry atrm und6 poalty of pqjury onc of thc followitrg dslaratio$: Dâ‚¬molitiotr Pmits-Asbetos Notification Fâ‚¬d6al Rcgulatiom (Titlc 40, Pan6) ("*uir"a -,oof Norificarbn t rNr cariry tU)tr: fedoal rcgulatioro rcgrding cbctos moval re not appliâ‚¬blc to this prcj*t. d( t cutiry tmt t nave red this application and statâ‚¬ that thc abovâ‚¬ information is conet. I agre to comply with all City lttrd Couty ordimcB ild Statc llw rclating to building coNrrucrion ad hscby surhori4 rcFMtativ6 of this City ed Couty to otc upoo thc above rnentioned property for inspcction Applicant or Agent Pernritee nrnre o,r". SlzLf /zl Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloor/VenUl nsu Iation Roof Sheathing Shear Wall ,tl Framing u ru r lnsulation/Energy Drywall -A- Ext./lnt. Lath rL")l( 5: Brown Coat Masonry I v Pool Fence T-Bar Handicap Req. Deputy Final Report Enqineer Fina! Report Flood Zone Certif. tl .n F!NAL o '[rU I -[ Dll 'u&7 Certificate of Occupancy Notes, Remarks, Etc. t4 I tll rut Nr+.Yd 'ot floVl/