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BUILD:NG- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DEI,CAfo{TION <br />I hoeby ailirn undo penally of pojury that I an exempt holn thc ContiactoB' License Law for thc followrng reason (Sec.7o] 1.5 <br />lJusinds dd Profmion Codc): Any Cily or County rvhich rcqurrs a pmrit to consttuct. alto. irnprove. dmolish or rcpair my <br />structure, prior b its isumce. also rcquiro the applicmt for such pmnit to filc a signcd statqnflt that he or sh€ is licosed pGuilt <br />lo the provisions ofthe Contraclor's Licensed kw (Chapler 9, Comrnencing with Sstion 7000 of Divisron 3 ofthe Busine$ <br />Profc$ions Codc) or that he or she is exempt thqeliom md the b6is for the alleged cxmption. Any violatron of Setbn 703 I .5 by <br />applicantforapennitsubjetsthe applicantkiacivilpenaltyofnotnNrelhilfivehundreddollars($500). <br />and .o'il <br />I. s oM( of the profErty, or my cmployes with wags 6 their sole compensatiol. rvill do rhe work ild thc struclue is not <br />intodcd or offcrcd for vle (Se.7M4. Busines md Profssions Code: 'i he Coillraclor's l-icsse l-au' dos not apply to il o'nncr of <br />thepmpdy rvhobuiltisorimprovethson,ardwhodossuchrvo*himselforh6elforthrouShhisorhros'nemployec. <br />providedthatsuch improvmentsaenotintmdlalorolltredforsale. lf,howwclthebuildingorirnprovsnfltissoldwithrnonelu <br />ofcomplaicn. the Orvns Builds will have the budm ofproving tha he or she did not build or i,nprove the prcpqry for the purpo*of <br />$le). <br />l. 6 osnd oithe propsty, an exclusively contraclmg with licensed contracloB to construct the projcai (Se. 7C44. llwinss <br />od ProfcssionCode:TheContraclor'sl-icense[,awdosnotapplytodown6ofpropertywhobuildsorimprovesthqrcn, <br />and who conlracts for such prcjets with a Contracb(s) licensed pursuml to the ( onlraclor's Licmse Law) <br />_l m cxcmpt under ts. & P.C. for this reason. <br />D6le:()rvilcr: <br />WORKERS' COMPENSA'TION <br />DECLARATION <br />I hqehy alfrrur under pcralty ofpojury one ofthc follorving dcclaralic'ns' <br />--_l have md rvill mainlain a Ccrtificate of Consfit lo Sclf-lNure for rvorkm' compmatioc, 6 providEi for by Sation 3700 of the <br />Labor Codc, for the pqfomdce of thc eork for which thc pmnit is issued. <br />_l hdve and will mainlain workas compeNation iNurance. 6 required by Sction -3?00 of the tak)r Code. for the lvfomoce of <br />the work for which this pmit is issug5l.lrty workss' compensation insurilce cffiis dd policy numbr ae: <br />cmiq: r dLr(4 <br />a <br />Pohcy Numbcr:--Erprres: <br />_l ceniry rhal in thc psfonnance of thc rvork fo. uhich this pcnnil is issued. I shall not qrploy any person rn any nlonq <br />so as to beconre subjel to lhe work6s' compensation laws of Califomia. md agre that if I should tsome subJ(l lo lhe <br />work6s' coilrpssation provisions ofSetion 3700 ofthe Labor Code, I shall. foilhwith compiy !vith those provisions. <br />WARNING: l:ailurc lo sue workers'compmstion cov64te is unlarvful. and shall subjet d qnployer lo oirninal pqraltie md <br />ciril frncs up lo onc hundred thousand dollas ($100.000). <br />Section .1076 ofthe Latxrr Code. intqest and atlorney s fces. <br />in addition to thc cost of compeNtion. damages o providcd for the'2 <br />o rt", 2-:-=_!-.s-'Zz>-2.2,t Applimnt:LLICI]NSEDCONTRACTOR I <br />DECLARATION <br />I hoeby affrrn undu pflalty of perjury that I ar licensed undo provision ofChaptq 9 (commmcrng with Setion 7000) of Division 3 <br />of thc Businru od Profsions Code. md my licme is in full force md effrr. <br />f,Licecse Class:License Number: <br />contrsctor: U(- <br />CONSTRUCTION LENDINC ACENCY <br />I hqeby affrm unds tEnahy of p6juD lhd th6e is a coNtruction loding agmcy for the perfommce of the work for which this permit is <br />issued (Ss 3097. Civ. C.). <br />Lends's Name: <br />Lcnds's Addrs: <br />- <br />APPLICAN'T DECLARATION <br />I hueb-v affm unds pqralty of pcrjury one of the tollowing declilationsl <br />frcmolition Ptrmits-Asbcstos Notiftcation Fsderal Reguldtions (Title 40, Pa16) <br />Requrred t.dt6 of Notificalion <br />w(h all City and County <br />ard County to mts ufDn the <br />above mmtioned propeny for iNpectiorl purpos6. <br />Applictrnt or Agen(-Dele:.L I e, -2o L.,-, <br />---J-lu '),Pcrnrilce trrme (print):-.7, \ <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bfloor/VenUl nsu lation <br />Roof Sheathing <br />Shear Wall <br />Framinq <br />lnsulation/Energy I <br />Drywall a 75 *.8"/ <br />Ext./lnt. Lath lr <br />Brown Coat <br />ltlasonry <br />Pool Fence <br />T-Bar <br />Handicap Reo <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />I <br />FINAL t lo 7.0 ),Q./tf '-.#87 <br />Certificate of Occupancy ll' <br />Notes, Remarks, Etc <br />,b I have rcad this appliciiliorl ed slate lhal lhc atxrvc infirrnrattrn is correcl <br />;l'?u <br />I <br />I