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INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BTIILDER DTLC {RATION I hereby affirm under penalty of periury that I arn exempt form the Contractors' License Law for the following reason (Sec.7031.-5 Business and Profession Code): Any City or County rvhich requires a pennit to construct. alter. improve. demolish or repair any structure. prior to its issuance. also rcquircs the applicant for such pcrmit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's Licensed Larv (Chapter Q. Commencing with Section 7000 of Division -1 of the Business and Professions Code) or that he G she is exempt therefrom and the hasis for the alleged exemption Any violation of Section 7031 .-s by any applicant for a pcrmit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). No l. ,. o\\'ner of the prope-rty. or my emplo-,-ees rvith u,ages as their sole compensation, rvitl do the wort and the stnrcture is not inrended or offered for sale (Sec.7044. Business and Professions Code: I'he Contractor's License Larv does not apply to an owner of the fopcrty rvho builds or improves thereon. and who does such s,ork himself or herself or through his or her orvn onployees. provided that such irnprovements arc not intende<l or offered for sale. If. howel'er. the building or improvement is sold rvithin one year of complaion. the Orvner lluilder rvill have the burden of proving that he or she did not build or improve tfre propfi for the purpme of sale). YEt. as owner of the property. am exclusively contracting rvirh licensed contractors to construct the proiect (Sec. 7044. Business and Profession Code: T'he Contractor's l.icense l-arv does not apply to an owner of property who builds or improves thereon. and rvho contracts fur such pro.iects rvith a C'ontraclo(s) licensed pursuant to the Contractor's License Law). No I .,tr exempt under Secrion B. & P.C. for this reason. \T'ORKFRS' ('OM PT'NS{TION NFCI ARATION I hereby'affinn under penalty'of grcrjury one of the follon'ing declarations: tttt hur'. and rvill maintain a Certificate of Consent to Self-lnsure for rvorkerc' compensation. as provided for by Section 3700 of the [.atxrr'('ode. for lhe perfirnnance of the rvork for rvlrich the pennit is isstred. NO I have and rt,ill rnaintain s'orkers' cotnpensation insurance. as required by Section -1700 of the l-abor Code. for the performance of the rvork for s'hich this permit is issued. My'rvorkers' compensation insurance carrier and policy number are: Starr lndemlnlty('an'ier': r0(xn0tE36 Policy Number: NO _Expires: o8t31t2022 I certify that in the perfonnancc of the rvork ftrr *'hich this pennit is issued. I shall not ernploy any percon in any mannâ‚¬r so as lo bec'orrre suhiec't to the s,orkers'cornpensation larvs of ('alifornia. and agree that if I should become sub.iect to the workers' compensalion provisions of Section .1700 of the l.abor Code. I shall. forthrvith comply s'ith those provisions.. WARNING: Failure lo secut'e rvor*ers'compensation coverage is unlarvful. and shall suhiect an ernployer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section 1076 of the l-abor Ccxle. interest and attomey"s fees. LI('I'NSFN ('ONTRACTOR NTCI AR^TION I hereby afl]rm under penaltl ol'per.iury that I arrr licensed under provision of Chapter I (commencing s,ith Section 7000) of Division 3 of the llusiness and Professions ('ode. and rny licen:.e is in full force and effect. B I-icense ('lass:630879 l.icense Numher I hereby affrnn u:rdel penalty of periury that there is,r construction lending agency for the performance of the work forwhich this pennit is issued (Sec. -1097. ('ir'. C.). Lender's Name: l-ertdcr's Address: APPI IC{NT NFCI ARATION l lrerc'lry allinn undc't penalry of pc'r luw one of thc' followrng declarations [)enrrllrlron Pernrils-Asbestos Notrfication Federal Regulalrorrs (Trlle 40, Part6) N! Required I.etterof Notificution YEs I cenify rhat rhe federal regulations regarding asbestos removal are not applicable to this project. YEs I certi8/ rhat I lrave read this application and state that the atxrve infonnation is con'ect. I agree to comply with all Ciry and Cotrnty ordinances and State Laws relatirrg to building construction. and hereby authorize representatives of this City and County to enter upon the ahove mentioned property for inspection purposes. Reroof Roof (Draphragm Sheathrng/Frame)//tl /^a Structural Final D /0/ I t7/hW,'rcoJ Plumbing Under Floor I Under Slab Rough Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test Plumbing Final Electrical Service (Meter I Panel) Grounding / Bonding Rough Electrica! Final Mechanical Gas Air Pressure Test Rough Piping (HW, CW, etc.) Exhaust Ducts l/echanical Final Notes, Remarks, Etc.