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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUTLDER DELCARATION I haeby affim unda pmalty of pojury thal I m cxcmpt from thc Contracton' Licruc tiw for thc following rwn (56.7031.5 Busines md Prcfcsion Codc): Any City or County which requirs a pcmit to coNlruc1, alt6, improvc denolish or repair uy structuc. prior to its issumcc. also requirc thc applicilt for such pcrmit to file a signcd statmfit thar he or shc is licqEcd pmwt to thc Eovisiore of thc Contmctor's Liccnscd taw (Chapt6 9. Comcncing with Setion 7000 of Division 3 of thc Bsins ud PrcfcsionsCodc)orthathcorshciscxmptthsc{romildthcb6sisforthcallegcdcxmflion. AnyviolatiotrofSctionT03l.5bymy applicant for a pcrmit subjets thc applicut lo s civil pcmlty ofnol more tha fivc hundrcd dollds ($500). _1, as owner ofthe property, or my employees with wages as their sole compensation, willdo the work and the structure is not intcndcd or offered for sale (Sec.7M4, Busincss and hofessions Code: The Contractor's License [,aw does not apply to an owner of the properly who builds or improves theron. and who does such wort himself or herself or through his or her own employees. provided that such improvonents are not intended or offered for sale. If. howerrer. the building or improvernent is sold within one )car of complaion. the Ovrner Builder will have the huden of proving tha he or she did not build or improve the propoty for the purposc of sale). -1. as owner of the propefiy. am exclusively contracting with licensed contractors to construct the project (Sec. 7M4, Business and hofcssion 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) licersed pursuant to the Contractor's License Law). -l am exempt under Section-. B. & P.C. for this reason. WORKERS'COMPENSATION DECIdEAIIAN I hocby aflim undo pcnahy ofpo'jury onc ofthc following delaatioro: -l havc ud will mintain 8 Ccnificate of CoMt to SclfJrcurc for work6' compcnsdion. 6 providcd for by Sction 3700 of thc Labor Codc, for the pgfomce of thc wo* for which the pqmit b issucd. NE havc and will maintain works' compcmation imurance, a rcquircd by S*tion 3700 of the labor Codc, for thc pofomucc of thc work for which this pcmit is isued. My work6' compensation irormce mie md policy numbo rc: cria: UtL*r\v\.- Policy W-{]@Lt to' t' zl $21 ""nify tfr"t in the poformancc of thc work for which this pcrmil is issued, I shall not flploy any pmon in any manr rc s to bâ‚¬come subjet to thc work6' compffiation laws of Califomia, md agrc tha if I should becomc subjct to the work6' compeetion pmvisioro of Scction 3700 of the l2bor Codc. I dtsll, fonhwith comply with thorc prcvisioro, WARNING: Failurc to sw workm' compcnsation covaage is unlawful, od shall subjet il mploys to qiminal pquhics ud civil fina up to onc hun&cd thoMd dollffi ($100.000). in addition to the cost of compcmtion. damags s providcd for thc attorney's fees. O,'\<r-j I hcrcby affrrm under penalty of perjury that I arn liccnsed 9 (cornmencing with Section 7000) of Divisioir 3 of the Business and Professions Code. and rny license is in full force and effect. License C Nurnber: q13.1 5v\/l 4r CONSTR,UCTTON LENDING AGENCY I hmby affm und6 poalty of pcrjury that thqc is 8 comtrudbn lording agocy for thc pofomcc of thc wrk for which this psmh b i$ucd (Ss. 3097, Civ. C.). l:nds's Nme: Lender's Address: APPLICANT DECI.ARATION I hodry affm undq paalty of prjury onc of thc following dclestions: Dcmolition Pmit&Asb6tos Notification Fedml Regulations (Titlc 40, Pan6) _Rcquircd lEltq of Notificdion -l cdiry that thc fcdqal rcgulstio$ rcgsding sbetos moval re not applicablc to this prcjct. l9.otiry tf,* f n"u" rcad this application ild state thal thc abovc infomatior b coret. I sgre to @mply with all City ild County ordimc6 md Stste laws Elrthg to building co$tructior\ ed hdcby authorize rcTrffitativB of this City ild County to @tq upon tlE above mentioncd propedy for Applicant or Agent Pernritee nAnre O-ea-r- Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/VenUl nsu lation Roof Sheathing Shear Wall Framing !nsu Iation/Energy Dnnryall Ext./lnt. Lath Brown Coat Jt/asonry Pool Fence T-Bar Handicap Req. Deputy Final Report Enqineer Final Report Flood Zone Certif n -fz(XA ,+HJs{tt .1.[fl-2'))RYLB{)Ur\ FINAL 1-0vzl hlY[/rN Certificate of Occupancy V \L/ Notes, Remarks, Etc. Contracto r, Vl ,,r,, I lztl fzl