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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloor/VenUl n su latio n Roof Sheathing Shear Wall Framing lnsulation/Enerqy Drynrvall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif FINAL F,v"ra L,I t4 0an1 Anrcl ,n SXAM .>v\ Certificate of Occu 2 Notes, Remarks, Etc. OWNER BUILDER DELCARATION I haclry affm undo penalty of pcjury thst t m qmpt ftom thc Conttrtots' Licre lrw for thc following wn (5*.7031.5 Buincs sd Prcfesion codc): Any city or Couty which rcquirc a pcmit to @Btruct, alto, imprcvq danolish or rcpeir uy structue, Fior to its ismcc. also rcquiE thc applimt for such Frnit to filc a sigircd srarmQt thal hr or slE b licdsod plNrd to thc provisioN of thc Contmtor's Liccnscd t,w (Chapt6 9, Comocirg with Sctiotr 7000 of Divisioo 3 of thc BNiK ed PrcfcsioB Codc) or thst hc or shâ‚¬ is qmpt thqâ‚¬&om ud thc bdb for thc alcacd cxmption. Any violation of Scdioo 7031.5 by my applicilt for 8 pcmit subjcts thc applicut to a civil pculty of not morc thu fivc hun&cd dollus (5500). -1, u oms of thc proFrty, or my mployG with wag6 6 thcir $lc @mpertsdion. will do tlE mrk ad thc srudrc b rct intqrdcd or offcrcd for salc (Se.7044, Bwin6s md Profeiom Codc: Thc Contrctor's Licre l:w doc not apply to u ow of thc ptopsty who builds or imptov6 th@G ed who do6 ruch wrt himclf or hwlf or thrcugh his or hc om qnploye, prcvidâ‚¬d that such imprcmts rc rct inodod or olfqod for glc. lf, howo. thc hrilding or imporcnant b mH vithh oDc )ar of complrbD. thc OM6 Buiklr will lurc thc hudo of prcving M hc or shc dil rct hriH or inForc thc popary frr the p4os of slc). -1, 6 om6 of thc pIopqtn m ucluivcly ontraclirg with licascd conuactoF to cons{ruct thc pojel (Se. 7044. Buine atd PDftssbn Codc: Thc Contraclor's LiccN Law doB rol apply lo u owtro ofprcpcrty who builds or imprcvc thson. and who ontmcis for such Fojets with 8 coilracto(s) liccrEcd pm@t to thc Contraclor's Licffi hw). -l m cxmpt udq Serion-. B. & P.C. for this rcen. I)o t a.{ lt, rr or. WO RI(EtrIS' COM PENSATIO N DECLARATlON I hereby alfinn under pcnalty of poju.y one of the following declarations: _l have and will maintain a Ccntificate of Consent to Self-lnsure for workers' comporsation, as provided for by Section 3700 of the for the performance of the work for which the pcrrnit is issued. t and will rnaintain workers'3700 of the l^abor Code. for the performance of for t\is ls and policy numbcr are: !-2,( Policy -l certi$ that in the pcrformance of thc work for which this permit is so as to become subject to the workâ‚¬rs'compensation laws of California, workers' compensation provisions of Section 3700 of thc Labor Codc. I I shall not employ any person in any manner that if I should become subject to the with those provisions. WARNTNG: Failure to workers' compcnsation coverage is and shall criminal pcrralties and civil fines up dollars in the cos of for the Sc.ction and I hereby affrm under penalty of pcrjury that I am licenscd with Section 7000) of Division 3 of the Business and Professions Code, and my license force License 1 I hereby affrm under penalty of perjury that there is a issued (Sec. 3097, Civ. C.). lending performance of the work for which this pcr-mit is lrnder's Name: l,cnder's Address: APPLICANT DECLARATION I hercby affinn under penalty of pcrjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Required Lctter of Notification asbcstos rcmoval are not applicable to this project. state that the above with all County Permitec name construction, I agrre to and to tugrn the -J an that the fbderal regqlations certi$ that I have read this and Statc [:ws relating to property or Agent