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INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS Reroof Roof (Diaphragm Sheathing/Frame) Structural Final IOlZSlLI DITtr s2 Plumbing I Under Floor I Under SIab Rough Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test Plumbing Final Electrica! Service (Meter I Panel) Grounding / Bonding Rough Electrical Final Mechanical Gas Air Pressure Test Rough Piping (HW, CW, etc.) Exhaust Ducts Mechanical Final Notes, Remarks, Etc OWNTR BUILNER DELCARATION lherebyaffinrrunderpenaltvofperlurvthatlanrexenrptfornrtheContractors'Lrcensel-au'forthefollowrngreason(Sec.70.ll 5Bustness and Professron Code) Any Crty or ('ounty which requtres a pernut to construct. alter. rnrprove. denrolish or repatr any structure. prtor to tls issuance. also requires the applrcant f<rr such pernrrt to file a srgned statement that he or she is licensed pursuanl to the provtsions of the Contractor's l.icensed l,aw (Chapter 9. Conrnrencing wrth Section 7000 of Drvision 3 of the Business and Professions Code) or tltat he or shetse\enlpttherefi'onrandthehasisfortheallegedexenrptron AnyvrolationofsectionT03l 5byanyapplicanlforapernttlsub.lectsthe applicant to a crvil penaltv of not more than five hundred dollars ($5001 [1. ". o\ nerof rhe property. or my enrployees r+rth wages as therr sole conrpensalron. wrlldo ther.r,ork and fre structure rs not tnlended or offered for sale (Sec 7044, Brsrness and Professrons ('ode The Contraclor's License Larv does not appll' to an o\\ner of the propcrty wtro burlds or improves thereon. and rvtro does such rr,ork himself or herself or through hrs or her own employees, provrded that such tmprovemenE are not rntended or offered for sale If. houever, tre btuldrng or rmprovement rs sold wrtrin one vear of completron. dre Ouner Burlder rvrll have the burden of provrng that he or she drd not burld or improve dre properw for dre purpose of sale) I$. ,r owner of the property. am exctusively contracting wrth lrcensed contractors to construcl the pro.lecl (Sec 7044. Busrness and Profession Code The ('ontractor's l.icense Larv does not apply to an o\rner of property who builds or rnrproves thereon. and who contracts for such projects rvrth a Contractor(s) licensed pursuant to the C'ontraclor's Lrcense Law) No I ., exempt untler Sectron . B & P (' for this reason WORKE' RS' COMPENSATION DECLAITATION I hereby affirnr under penalty of perlury one of the followrng declarafions: \l h.r. and will marntarn a Certificate of ('onsent to SelGlnsure for u,orkers' conrpensalron, as provided for by Sectton 3700 of the l.abor Code. for the perfornrance of the work for which the pernut rs issued. YES _l have and will marntain workers' conrpensation rnsurance. as requrred by Section 3700 of the l,abor Code. for the perforntance of the work for r,r'lrrch this permrt rs rssued. My uorkers' conrpensalton rnsurance carner and polrcy number are FrmkCrum('arrrer urc14ac-317{1 Polrcy Number. Exprres NO 06t01t2022 _l certifv that rn the perlirrnrance of the work for whrch thrs pernut rs rssued. I shall not enrploy any person rn any manner so as to lrecorrre sub,;ect to the workers'compensation laws of ('alifornra. and agree that if I should lrecortre subject tothe workers' compensatron provisrorrsof Sectron.lT00of tlre l,nbor Code. I shall. forthwrth conrply with those provrsrons WARNING Farlure to secure workers' conrpensatton coverage rs unlarvful, and shall subject an enrplover to crrnrinal penaltres and cn'il fines up to one hundred thousand dollars ($100.000). rn addrtron to the cost of compensatton. damages as provided for the Sectron 3076 of the Labor Code. rnterest and attome'/'s fees LICENSED CONTRAC:TOR DECLARATION I hereby affirnt under penalty of perlury that I anr ltcensed under provlsion of Chapter 9 (conrnrencrng wrth Section 7000) of l)rvtsron.] of the Busrness and Pro{bssrons ('ode. and nry license rs rn full force and effect c39 l-rcense ('lass 1007E46 l,rcense Nunrber (.ONSTRU('TION LENDING AG ENCY I herebv affirnr under penalty of per1ury that there ts a construction lending agency for the performance of the work for whrch thts pernril ts issued (Sec .3097. Crv C ) [.ender's Nanre l,ender's Address APPLICANT DECI.I\RATTON I herebry affimr under penalty of per1ury one of the followrng declarations Denrolrtion Pernrrts-Asbestos Notrfication Federal Regulafions (Trtle 40. Part6) rc Requrred Lener of Notrficauon YEg f cerrrfu that the federal regularions regarding ashestos removal are not applicable ro this proJect I I cenrfu that I have read thrs apphcatron and state that the atnve rnformation is correct t agree to conrply with all City and C'otnty ordinances and State Laws relatrng to burlding constructton. and hereby authorize represenlatrves of this Citv and County to enler upon the above nrenlioned propertv for rnspeclron purposes