Laserfiche WebLink
BU!LDING- INSPECTOR RECORD <br />SITE.WORK DATE !D/SIG COMMENTS Owner-tluilder <br />I hereby aflirm under penahy of perjury thal I am exenrpt form the Contractors' License Law for the followinS reason (se 703 1.5 Businds <br />and Profession ('ode)r Any ('ity or Counly which rcquires a peflnit to construct. altcr. improvc. demolish or rcpair any structure. prior to its <br />issuance. also requires thc applicanl for such pennit to filc a signcd statemcnt that hc or she is liccucd puGuant to the prolisions ofthc <br />Contractor's Lrcensed Lsw (Chapler 9. Conrmencing w[h Section 7000 of Division ] of the Rusiness .nd Professions Code) or lhal hc or <br />shc is excmpl lh.r.from and lhc basis for thc rllcgcd cxemption .Any violation of Scction 70-l L5 by any applicant for a pcmit subjccts thc <br />applicanl to I civil pcnally ofnol morc lhan fir,c hundrcd dolla6 ($500). <br />_ -1. as owncr ofthe propcny, or my cmployees with w6ges as thcir sole compensalion. will do thc work and thc structurc is not intcnded <br />or offered for sale ( Sec ?044. Business and Professions Code: The Contractor's License Law does nol apply to an owner of the propcny <br />who builds or improvcs lhcreon. and who docs such work himsclfor hersclfor through his or hcr own ernployecs, provided thal such <br />improvcmenls tre not intended or offcred for sale. lf. howcvcr. the building or irnprovcment is sold within one ycar ofconlplclion, the <br />Orvncr-Buildcr will have thc burden ofprovinB lhat h. or shc not build or improve for lhc purpose ofsale). <br />I. s own.r ofthc propmy, 8m cxclusivcly contraoing with licenscd contractoF to coNtrucl thc projccl ( Scc. 7044, Buinos aod <br />Profession Code The Contrador's License hw do6 not apply to an owner ofpropedy who builds or improves lhercon . snd who <br />contracts for such proJects wilh a contractor(s) licensed pursuant to lhe contractor's Law.) <br />I am cxcmpt undd Scclion &lhis rcason. <br />Date:()s'ner: <br />WORKERS ('OMPENSATION DE('LARA'IION <br />I hereby aftlrnr under peralty ofpc{ury onc oflhe following declarations: <br />I hav€ and will maintain a Ccnificatc ofConscnt to Sclf-lnsure for workers' compenetion, as provided for by Section l70o ofthe <br />trbor Codc. for the pcrfonnancc ofthe work ior which thc pcrmit is issued. <br />I have and wrll maintarn workers' conrpenstion insurance. as required by Section 3700 oflhe tlbor Code, for the performancc ofthe <br />work for which this permit is issued. My workers' compenstion insurance carier and policy number are: <br />Policy Numbcr:_____Expircs: <br />('l his scction necd not b" .o,npl"t"d if th" p"r.it i. f* On" h,.d*d d.k, 1il 00l or lcss) <br />I cenify lhal in thc perfonnancc ofthe work for which lhis permit is issucd. I shall nol li anv manner so 6 to <br />became sublect to lhe workers @mpenstion laws ofCalifornia, and ifr <br />compensation provisions ofSection 3700 oflhc tabor Codc. I shall. <br />Datc: Applicant <br />lVARNING: Failure lo secure workers' compensation coverage is and subJect an employer lo criminal pcnalties and civil <br />fincs up to onc hundrcd thousand dollars ($l 00.000).in addition to lhc cost of compcnsarion. damaSes 6 provided for the Section 3076 of <br />the Lsbor Code. interesl and sttorney's fees <br />LICENSED CONTRACTORS DECLARATION <br />I hercby affrm undcr pcnalty ofpojury that I m liccnscd undcr povision ofChaptcr 9 (commcncing wirh Scction 7000) ofDivision I of <br />th€ Busincss and Profcssioru Codc, md my license is in full forcc md cffect. <br />Licesc <br />I)atc: <br />License Numbcr _ <br />Contractor: _ <br />CONSTRUCTION LENDING AGENCY <br />I hcreby affirm under penalty ofperjuy that lhere is I coNtruclion lcnding agcncy for the perfomance ofthe work for which this pcrmit is <br />issucd (Scc.3097. Civ. C.). <br />Lender's Name <br />Lender's Address: <br />APPLTCANT'S DECLARATION <br />Dcmolition Pcnnils-Asbeslos Notificarion Federal Rcgulations ('fitlc 40. Paa 6) <br />Required Lctter of Notificatioo <br />_l ccnify lhal the fcdcral rcgulations regarding 6bestos rernoval are applicable to rhis proj€ct <br />_- I ccniry thal I havc rcad this lhat the above corecl. I agrce to cornply wilh all City and Counly <br />ordinanccs and State laws relating to <br />abovc mcntioncd propeny <br />Applicanl or aSent <br />Pcmittec name (print), _ <br />and ofthis City and County lo enter upon thc <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUlnsul <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL ll / t1/ rt/^t'\44, <br />Certificate of Occupancy rl <br />Notes, Remarks, Etc. <br />Canier:_ <br />*n