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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE !D/S!G.COMMENTS Oma-Buildr Dclmtion <br />IthmbyafrimundopcnaltyofperjurythsllmcxmilfmthcCstractm'LicrucLawfqthcfollowingmm(sc.703l.5Bwincss <br />I od Prcfasio Codc): Any City q County which rcquic s pqrmit to c@Euct, altcr, impovc, dmlish or rcpair ily stsuctw, pritr to its <br />I isswcc, also rcquin thc applimt fo ruch pcrmit to filc r signcd cts&mqt thar hc q shc ir limscd puEmt to thc provisioni of thc <br />lCmts4tor'tLi@cdkw(CllaSE9,Cmmcing*ithSetionT00oofDivisim3ofthcBuinsmdPrcfsiNCodc)ortharhctr <br />I shc is cxmpt thcfrm md thc bsir fq thc allcgcd cxmpim .Any violation of Scction 7031.5 by my applimt for 8 pmit subjccb thc <br />I Eppli@t to I civil psnrlty of nd m@ thu livc huncH dollm ($500). <br />I <br />| <br />-1, <br />s ma of thc popcrty, o my oploya with *aga u rhcir rclc ompqruuim, vill do thc wok ud thc rtructuc is not inrodcd <br />I c offacd fr ralc ( Se.704.1, Buind ed Prcfeiru Codc: Thc Cqtractq's Li@rc Law de ncr apply to e oma of rhc propcrty <br />who builds o irnPrcvq thm, md who de !rch wqk hiruclf tr haclf o through his or hc wn mployc, prcvidcd that such <br />imprcvoqts rc not intmdcd tr off@d fG 3alc. lf, howcv6, thc building u imprcvmot is sold sithin onc ycr of complction, thc <br />Ovmq-Buildq will havc thc burdm ofprcving thrt hc or rhc not build o imprcvc for thc purpoc ofrlc). <br />-I, <br />o ma of thc popcrty, m cxcluivcly mtacting with licrucd onFctm to cmstrucr thc proj@t ( Scc. 7044, Businos ud <br />Prcfcsim codr: Thc currtq'r Licre I:w doa not apply to u omq of propqg who builds q imprcvo thqo , ud who <br />coEsca fq tuch pmjccts with a Cobrcto(s) lierocd puumt to thc Cqtrrctor,s Licmsc Law.). <br />_I m cxmpt undo Scction & P.C. for this rcoon. <br />Darc: Osac <br />WORXERS COMPENSATION DECIARATION <br />I hocby allim u&r pcnalty of pcrjury oc of thc following delmtionr: <br />-I <br />havc md will mainiain a Cenificatc of Coruot to Sclf-Insurc fo workcn' compmrdion, I prcvidcd for by Scction j7o0 of thc <br />Labq Codc, <br />4,,** <br />for thc pcrfmoa of thc wqk for which thc pmit is issucd. <br />work for <br />will mintain wako' cmpcBdio iBllme, u rcquircd by Sction 3700 of thc Lsbor Codc, for rhr pcrfmm@ of thc <br />this p6mit ir isuod.gF,etrj-My wort6' cmpcnution isurucc cmicr ud policy numbo uc: <br />Policy 7-tz-?i -o/ <br />(This setion mplacd if thc pcmit is for Ooc hun&cd dollm 0O) or les) <br />_l csrtiry thst in thc pafmucc of thc wqk fs which this pmit <br />bccmc subjcct to thc workm ' compmsation law of Califmi4 md <br />is isuc4 I shall not mploy in my muna so o to <br />thc w6kcB'agrcc rhat if I rhould <br />prcvisios of Sctim 3700 of thc Labor <br />tr-ZD <br />compcnstio <br />(s100,000),in <br />cov@gc is unlawful, ild sha.ll mployq to niminal [Enalrie and civilfine up to onc hun&cd r <br />thc kbor Codc, intaet <br />thouod dollG addition to thc cqt ofcompcosation,damgc s providcd fo thc Scction 3076 of <br />ud anmcy'r fe. <br />LICENSED CONTRACTORS DECI-ARATION <br />I hmby allim un&r pcnslty of pcrjury that I m lic@scd unda prcvisim of Chaptr 9 (commmcing with Setion ?ooo) of Dvision 3 of <br />thc BBins md Prcf6siw Codc, ud my liqrc is in full focc and cffer. <br />Liccuc Licmsc <br />D6tr: <br />I hcby ahm un&rpcnalty of pajury thar <br />isucd (Se. 3097, Civ. C.). <br />Lod6'3 Nmc: <br />CONSTRUCTION LENDING AGENCY <br />thm is a mstructio lmding agocy fo thc pcrfmmcc of thc wqk fq which this pcmit is <br />Lada'r Addus: <br />APPLICANT'S DECLARATION <br />Dcmolition Pmitt-Asbetq Notiticrtiq Fcdcnt Rcgulariru (Titlc 40, Pan 6) <br />_ Rcquircd lrtta of Notifiqtio <br />not applicablc to thii prcjct. <br />to comply with all City ad County <br />abovc motioncd <br />of this City md County to mtcr upon thc <br />Applicut or agcnt sig. <br />Pmincc nmc (print)i <br />corcct. I <br />Q <br />(2(X4 <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfl oorA/enVl nsulation <br />Roof Sheathing <br />ShearWall a) ,/1 <br />Framing ///56 .L <br />lnsulation/Energr/l <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Requirements <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certificate <br />I /-. n <br />FINAL q z-r lts{PRes t*<,affiz <br />Gertificate of Occupancy \/ <br />Notes, Remarks, Etc.