Laserfiche WebLink
BUILDING. !NSPECTOR RECORD <br />S!TE.WORK DATE ID/SIG.COMMENTS OWNI:R IIUII,I)ER I)I]I,CARA'TIoN <br />I hercby aflirnr under pcnalty of perjury that I am c\cn)pt frcnr thc (lontractos l-icensc ljw for the following rcasn (Scc.703 1.5 <br />llusincss and Profession Codc): Any City or County which requircs a lErrnit to construct, altcr. irnprove. dcrmlish or rcpdir any <br />structure. pri()r rc its issuance. also requires the applicrilt fbr sucl Frnrit lo file a signed slatement that Ire or she is licansed pursuant <br />to rhc provisions ol lhc Conlractor's l-iccnscd liw (Chnpter 9, Comrncncing with Scclion 7(n) o, Division 3 ol the Busincss and <br />Protissions Codet or that lE or she is erenrpt therclil)m aDd the basis trrr tlE allcged exemptiotr. Any violation of Section 703 1 .5 hy any <br />rpplicrnlfornfEmilsuhjectsthe cpplicanltoacivilpeniltyofnolmorelhanfivehundreddollars($5(x)). <br />_1. as owncr o l'lhc prortny, or rny crnployees with wagcs as thcir solc compcnsllion, will do thc work and thc stnE(ure is m( <br />inteulerl orotferedforsle(56.TtN4,BusinessanrlPrufessionsCode:ThcConlractor'sLicenscLnwdcsnotDpplyloanowrcrof <br />th.pmFfly whobuildsorimprovesllEr$trurdw}x)dessuchwo*hinNelfortErselforthroughhisorherownenlployees. <br />prolidcd thnt srch irnprovcrrcnts re mt intcrdcd orollcred for salc. Il. howcver, lhc tNilding or ir{,rovcmil is sold within one }rar <br />ofcomplcri(nt. the Owncr Builder will Mvc th€ burd.n of proviDs lhat lE or she did not build or irprcvc the propery for lhe purposc of <br />sale). <br />_1. as owner ofthc p()pcdy, am exclusi!cly contrscling with licen$d con(raclors k) con\lrucl llt prcjccl (Sec. 7(N.1. Business <br />and PmtissinrCode:TheContractrr'sLicenseLawdoesnotapplytoanownerofproJrnywhobuildsorimproveslhercon. <br />and who conlracls lilr such preiccts with a Contractor(s) liccnsd pursumt to thc Conlracror's Liccnsc Law). <br />-Ianrc\emPlundersccti()n-.Il.&P.C,lilrthisrcason. <br />w()RKURS', ( ()NlPUNSA't I()N <br />t)ECLARAl'tON <br />l hcrchy alllrmundcr pcnahvof perjurv(,nc ol thc li)lk)win8 (lcclararit)ns: <br />_lhavciuxlwillnuinlainaCertificateofConsentloSelLlnsureforworlers'compensarion,ss pn)videdforhySaclion3T00ofrhc <br />Lshor C(xlc, for thc pcrformmc ol lhe work lbr which thc pcrmil ir i\sucd. <br />_l havc anrl will maintain workers' conrpensation ilsurance, as required by Secti(xr 3700 of the hbor Code, for thc perfomme of <br />thc work tar which thir lrrnit is isrucd. My workcrs' comltnsati()n insurance curicr el Nlicy ounltEr ue: <br />Policy <br />_l ccfliti that rn lhc pcrfbrnuncc of rlrc work for which this pcrnlit is issucd, I shall not enrpk)y any prson in any manncr <br />so as to hccorrc subjcct to the workcrs' compcnsatioil laws of Califon)id, and agrce lhnt if I should hccorrc subject to thc <br />workers'conrpensationprovisionsofSection3T00oftheLuborCbde,lshnll,fofihwithcomplywiththosprcvisioos. <br />WARNING: Failure to secure workcrs'compcNation covcftgc is unldwful, and shall subjecl nn cmployer to oiminal Fmlties aod <br />cilil fines up to onc huldrcd lhousand dollnrs (Sl(X).(XX]). in addilion to lhc cosl of compcnsation, damgcs !s providcd for lhc <br />Scction 1076 ofthe tllx)r (ixlc, ixcrest and a(toruy s fecs. <br />I)oacl- <br />I,I(:ENSFJD C0NTRACToR <br />T'ECLARATION <br />I hcrcby allinn undcr [Enall], of per.iurv rhal I am liccn$d undcr provision ol Chaflcr 9 (cr)rnmncing with Sccrirn 7fin) of Division 3 <br />of thc Busrncss and Profc$sir,ns Codc. ffkl mv liccnsc is in ftll forcc md clfccl. <br />I-iccnsc C Nurnhcr'_ <br />Ilrle'_ <br />CONSTRUCTION T,I]NI)ING AGI.)NCY <br />I hcEhy atlirnr under lEnlltyof perjury tlul there is u cu$tnrclioil lerkllrg agerEy li)r thc fErfomarrec of the work ,br whkh lhis fEmit is <br />issued (Scc. :1097. Civ. C.). <br />l.cndcr's Naillc' <br />[.ndcr's Ad(lrcss: <br />APPLICANT T'ECLARATION <br />I hereby aflimr under penalty of perjury onc of the following declarations: <br />Denmlition Permits-Asbestos Notification Federal RcEularioos (Titlc 40, Pa(6) <br />-Rcquirctl <br />lrtter of Ndification <br />_l certily thlr the federal regulationx reguding asbesbs remval arc trot applicable b this prujet. <br />_l cenify that I havc rcad thir application and statc thal lhc abovc informlion is corccl. I agr@ lo clmply wilh all Cily and County <br />ordioanccs and Slntc liws relalilS lo bttilding coNtrudiul atul hercby auhorize reprcrcntatives ofthis Cily and County to enid uF)n thc <br />uhove mntioncd propeny lbr inspection puqp*s. <br />Appli@nt or Ag6t Signaturc: Dale:-- <br />Pcmite Mme (prlnt): <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsulation <br />Roof Sheathing a-221-?o VFtt*{ la <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />ltrlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />FINAL 2-Ll'za u,rffttg <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />Bev. 08-07-20 1 5