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BUILD!NG. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hreby affm undo pcnalty of pcrjury that I ar cxcmpt ftom lhc Contracto6' Licâ‚¬e kw for thc following reen (54.7031.5 Busincs od Prof6sion Codc): Any City or County which rcquire a pannit to @Ntruct, alts, imprcvq donolifh or rcpair uy structuc, prior to its issumcc, slso requirB thc applicmt for such pcmit to lile I signcd stal@mt that hc or shc b liccnscd p$uilt to thc prcvisiorc of thc Contrctor's Licoscd kw (Chapts 9, Commcncing with S(tion 7000 of Division 3 of the Buinc ud Prcfsions Codc) or that hc or shc is qcmpt thqefrom ild thc bssis for thc allcgcd cxmption. Any violation of S6lion 7031.5 by ey applicut for a pqrnit subjcts thc applicut to a civil pcmlty of not morc thu fivc hundrcd dollm ($500). r _1, c owns ofthe prcpcny, or my cmployG with wag6 6 thcir $lc compecation. will do thc rcrt ed thc stndrc b not intqrdcd or offsed for slâ‚¬ (Se.7044, Bwins ud Profsioro Codq The Contractor's LiceN Law do6 not apply to s ownq of thc prcpsry who builds or impovG th@n. ed who do6 such wrt hirnsclf or hcelf or through his or ho om mploye, providq! that such improvmts rc not intqrded oroffclcd for elc. If, howq, thc builditrg or improwrcnt is rcH within onc )m s of comphion, the O*Tq Buikb will havc thc hdgl of Foviig thal hc or drc dil rct build or improve thc prcpqty for thc ptrpos of ele). _1, as owner of the propeny, am exclusively contracting with liccnsed contractors to construct the project (Scc. 7M4, Business and hofcssion Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improves thereon. and who contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's License Law). -l arn exempt under Section-. B. & P.C. for this reason. Owner:Date: I WORKETIS' COM PENSATION DECLARATION I hereby affrrm under penalty of perjury one of the following declarations: _l have and will maintain a Certificate of Conscnt to Self-lnsure for workers' compensation. as provided for by Section 3700 of the for the pei'fonnance of the work for which the pennit is issued.Labor Code, t k#;x will maintain workers' compensation insurance. as by Section 3700 of the Labor Code, for the performance of and policy number are:is issued. My workers' lbtT:L( _l ccrlify that in the perfonnance of the work for which this pennit is issued, I shall not employ any person in any manner so ils to becorne subject to the workers' compensation laws of California. and agree that if I should beconte subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall. forthwith cornply with thosc provisions. WARNING: Failure to secure workers' cornpensation coverage is unlawful, and shall subject an anployer to criminal penalties and civil fincs up to one hundred thousand dollars ($100.000), in addition to the cost of compensation. darnages as providcd for the Section 3076 of the labor Code. interest and attorney's fees. ell 4l I hereby affirm under pcnalty of perjury that I am licensed under 9 (commencing with Section 7000) of Division 3 of thc Business and Profcssions Code. and my license is in full force and effect. )/o<g 7iNurnbcr: .2 I hwby affm mda pcnalty of pcrjury that the is a corgruction lcnding agmcy for thc pofomcc of thc rcrk 6r which this pqmh b isucd (Sc. 3097, Civ. C.). [:nds's Nme: Lendcr's Address: APPLICANT DECLARATION I hocby affinn under penalty of perjury one of the following declarations: Dernolition Permits-Asbestos Notilication Fedcral Regulations (Title 40. Part6) -Rcquirod Later of Notilication - I ccrtifiv that the ,&"k,nu," federal regulations regarding asbestos removalare not applicable to this project. reatl this with all City and County and County to enter upon the abovc mentioned properry for or Agent state above inflonnation ,,r", lO -l-? I Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloo r/Ve nUI n s u Iatio n n Roof Sheathing i0-{Lf 4('L<:'.2 ,T7 Shear Wall Framing lnsulation/Enerqy Drywall Ext./lnt. Lath Brown Coat / Masonry 4 Pool Fence \ T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif n FINAL l0-lt,'Zl 'Ll) n ) Certificate of Occupancy \.7 Notes, Remarks, Etc.