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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATTON I hocby affm unda poalty of pcrjury that I m cxempt from thc Contmctor' LicN lrw for thc following Iton (56.7031.5 Buinss and Profssion Code): Any City or County which rcquirs a pornit to construct, alta. improvq dmolish or rcpair ay structuc, prior to its isuocc. also rcquirs thc applicat for such pqmit to file a signcd statmot that hc or shc is liccnscd plltswt to thc provisiorc of thc Contractor's Licoscd Law (Chapts 9, Commcncing with Sction 7000 of Division 3 of thc BGitrs ild hofsions Codc) or that hc or she is exempt thcfrom od thc b6sis for the allcged cxmpion. Any violation of Sarion 7031.5 by my applicmtforapamitsubjatsthc applicattoacivilprultyofnotmorcthefivchun&eddollus($500). -1. as owner of the propcrty, or my cmployecs with wages as their sole compensation, will do the work and thc structurc is not intended or offered for sale (Soc.7044, Business and hofessions Code: The Contractor's License Law does not apply to an owncr of the property who builds or improvcs thereoru and who does such work himself or herself or through his or her own employeâ‚¬s. provided that such improvunents are not intcndcd or offered for sale. I[, howwer. the building or improvement is sold within one )â‚¬ar of cornpletion the Orvner Builder will have the hrden of proving tlra he or she did not build or irnprove thc property for the purposc of sale). -1. as owner of the property. am exclusively contracting rvith licensed contractors to construct the project (Sec. 7044, Business and hofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a Contracto(s) licanscd pursuant to the Contractor's License taw). -l am under P.C.reason. ?l I hereby affrrm under penalty of perjury one of the following -l have and will maintain a Certificate of Consent to Self-lnsure for work6s' compensatior, as provided for by Section 3700 of the Labor Codc. for the performance of the work for which the permit is issucd. -l have and will maintain workers' compensation insurance. as requirecl by Section 3700 of the l-abor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: ? Policv Number: Exoires: _l cerri& that in the pcrformance of the rvork for which this permit is issued, I shall not so as to become subject to the workers'compensation laws of California, and agree that if I ernploy any person in any manner should become subject to the provisions of Section 3700 of the tabor Code. I slnll. forthrvith comply with those provisions.workers' compensation WARNING: Failure to secure workers' compâ‚¬nsation coveragc and shall subjett an to criminal and civil fines up to one hundred thousand dollars ($l to of for the Section of the Labor Code. interesl and 6 I hc'reby affirrn under penalty of perjury that I am liccnsed 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effert. License Class: License Numbcr: f)olo' CONSTRUCTION LENDTNG AGENCY I haeby affirm unds pcnalty of pqjury thal th@ is a @Ntruction lcnding agocy for the psfonrocc of thc wrk for which this pqmit is issucd (Se. 3097, Civ. C.). kndd's Nmc: Lendcr's Address: APPLICANT DECLARATION I hercbyaflirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) _Required Lrttc-r of Notification -l certi$ that the federal regulations regarding asbestos removalare not applicable to this project. _l certi& that I havc read this and state that the above information is corrco. I agrcc to comply with all City and County ordinances and Statc Laws representatives of this City and County to above rnentioned property for Applicnnt or Agent Pcrnritee nirnrc and 2l upon the Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloorA/e nU! n s u !atio n Roof Sheathins Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif FINAL lo 5,2 I 2c/ st /2rt61 "217 Certificate of Occupancy Notes, Remarks, Etc.