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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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� I HEREBV AFFIRM UNDER PENALiY OF PERIURV THAT I AM EJ(EMPT FROM THE CONTMCTORS LI� G8f89B/CBfpOrt
W CENSE UW FOR THE FOLLOWINO REASON(SEC.7031.6 BUSINESS AND PROFESSIONS CODE:ANV qTV OR (n �
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w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIHES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED W Patio/Deck
� STATEMENT h7AT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI� I
� CENSE UW(CHAPTER V(COMMENCWO WITH SECTION 700a)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB �,
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WILL DO THE WORK,AND THE STRUC7URE IS NO7 INTENDED oq OFFERED FOR SALE(SEC.7a1,BUSI- �
N NESS AND PROFESSIONS CODE THE CONTRACTORS UCENSE LAW OOES NOT APPLV TO M!OWNER OF j .
PROPEHTV NM1IO BUILDS OR IMPROVES THEREON,AND WHO�OES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER ONTI EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT WTENDED OR m
Q OFFEREDFORSALE�F,HOWEVER71iEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
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w ❑I.ASOWNEROFTHEPROPERTV,AME%ClUSNELVCANTRACTINOWfTHLICENSEDCONTRACTORS
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� NTiOCONTRACTSFORSUCHPRQIECTSWITHACANTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION
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� I HEREBY AFFIRM UNOER PENA�TV OF PERJURV THAT I AM IICENSED UNDEfl PROV ION CHAPTER �
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��� MV UCENSE IS W FULL FORCEAND EFFECT. m
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� WORKERS'COMPENSATION DECLARATION �
� I HEREBY AFFIRM UNDEP PENALTV OF PERIUHV ONE OF THE FOLLOWING DECLARATIONS: U �
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� _I FIAVE AND WILL MAMTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
COMPENSATION,AS PROVIOED BV SECTION 3700 OF THE UBOq CODE,FOR THE PERFORMANCE �U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTqN
Q 37o00F THE LABOR CADE,FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS -
ISSUED.MV WOR�KE,/R�S'�C(OMPENSA�TIOAN INSURANCE CAtRRI�ER AND POLICV NUMBER ARE: ONSTRUCTI N
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Z �CERTIFY THAT IN THE PERFORMANCE OF THE WORN WHICH THIS PERAl1T IS ISSUED.I MECHANICAL
C.�J SHALL NOT EMPLOV ANV PERSON IN ANV MANN 50 O BECOME SU&IECT TO THE
(/J WORKERS'COMPENSATIONLAWSOFCh11FORNl AN EETHATIFISFiOULDBECOME INSPECTIONFEE
SU&IECTTO THE WOFNERS'COMPENSATION PR VI51 F SECTION 370oOF THE LABOP �O�O U
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p DATE:�R� APPLICANT. IP _ �Jj��
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� SU&IECTAN EMPIOVER TO CRIMINAL PENALTIES ANO C FIN UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLURS(floo.oao),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
w SECT10N37080FiHEUBORCODE.INTEREST,ANDATTORNEV'SFEES. RETENTI NFEE: _ /��
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� 1 HEREBV AFFIRM UNDER 7ENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AOENCY �/� /-/D� �
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3a81,CIV.C.�. „�T-'�T
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� LENDER'S NAME
� LENDER'SADDRESS
� I CERTIFY TMAT I HAVE READ THIS MPLICATION AND STATE THAT THE ABOVE INFORMATqN IS CARRECT. TOTAL FE ES /�p/ ( O
� I AGREE TO COMPLV WITH ALL CfTV AND CWNTV ORDINANCES AND STATE LAWS RELATINO TO BUILDINO
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTA IVES OF THIS CWNTV TO ENTER UPON THE '
Z ABOVE-MEMqNED PROPERTV FOR INSPECTION R S. COMMENTS '
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� SIONATURE OF 7ERMITTEE DAT
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SET BACK FLOOR JOIST
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ELECTRIC GROUND UfJDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION '
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTlLATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POO�FENCIfVG
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIOfVS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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