Laserfiche WebLink
BU!LDING. INSPECTOR RECORD <br />S!TE.WORK DATE ID/SIG.COMMENTS owNER ltt,Il,l)Et{ t)ul.cARA't.toN <br />Iherebyaffirnrunderpenaltyofperi!rythatIamexcnrptfromthe(lontractors Licensc[-awforthefollowingreasoD(Sec.7031.5 <br />ljusincss And Proltssion Codc): Any City or County which requires a pcnnit lo conslnlcl, nllcr, irnprovc, dcrnolish or (-Iair any <br />stnrcxrrc,priorloits issuance.alsorequirestheapplicrtrlfi)rsuchlErnlill)fileasiSnedslatenEnt lhatlrcorsheislicensed pursuant <br />to lhc provisionr ol lhc Conlraclor's l-iccnscd Iaw (Chaplcr 9. ComrncncinS wilh Scclion ?(fn of l)ivision J ol thc Busincss and <br />P()les\i()trsCodc)orthathcorsheiscremptlhcrefionrandtlEbasisti)rthcallcgedcrenrpti(tr1. Anyviolati(ilofSection703l.5byany <br />ilpplicaDrlbrapcflnilsubjeclslhe npplicanltoacivilpcDnhyofnot[]orethanl'ivehundrcddollars($5(X)). <br />_1, is owncr ol-lhc proFEnv, or my cmployccs with wagcs as lhcir solc' c()mpcnsalion. will do (hc wo* and thc structure is mt <br />iilculed orofferedforMlc(Sc.7{N.l.BusinessandPft)fcssionsC{xle:ThcConlractor's[-icenschwdoesnoltpplyloanownerof <br />the popcny wlxr boilds or improws lheron, iuld who d(Es such uork hinrselfor hcrselfor through his or lEr own employees. <br />providcd that such improvcrftnts de fl{ intcnded orolltrcd lor slc. II, howcvcr. lhc building or improvcmnl is sld wirhin onc ycar <br />of.onl)leli(r, llE OwDer Builder will hrve the burden of proving llut he or she rlitl not build r)r inrp()ve the propdy for lhe puqmse of <br />sale). <br />_1, as owner of lhe prcpeny, am cxclusivcly contrsclinS wilh lic€nsd conlraclors to cnnrlruct lhc prcjcct (Scc. 7(X4. Busincrs <br />arxl [trrflssinCirdcr'l'hcContnck)r'lLicenseLawdocsnotapplytoanownerofpropenywhobuildsorimproresthcreon. <br />and who conracts for such p()jccls with a Contrack,r(s) lice[*d pur\uant to thc Conlractor's Liccnsc kw). <br />-IlnlexemntUndersection-'B,&P,c,li,rlhisrea\oil,Dsle:_ <br />woRKI.tRS' COM Pt:NSA'rION <br />DT]CLARATI0N <br />I hcrchy ltlirm undcr ncnrhy of pcrjury onc of thc l'olk)wing dcclnrnti()ns: <br />_l have ard will nBintairr a Cenilicate of Consent (r SelLlnsure for workers'compensrli(nr, al prcvided for hy Section J700 ofthe <br />tffi,for thc pcrformrcc of the work lbr which lh! pcrmit is issucd. <br />will nraintain workers' conrpensati)n irr\urnnce, as required hy Section 3700 ofthe llbor Codc, lbr lhe perf(,rnuilrce of <br />which lhis is issuc(l. My workcrs' c()nrl)cnsatiotr crtricr lxrlicy numhcr arc: <br />Policy <br />_l ccrtity lhat in thc Frtbrnuncc ()l'thc work for which lhis pcrnrit is rssucd, I shilll nrtr cnlploy rny lErson in <br />so as to hccorrc suhjcct lo lhc workcrs'conlpcnsalion laws ofCalifonria, nDd agrcc lhat if I should becorru suhjcct to thc <br />workcrs' contpensatioD provisions of Sectiotr 3700 of thc Labor Code, I shall. fonhwith conrply with thos provisioDs. <br />WARNING: Failure k, scure workcrs'compcnsilioo covcrdge is unlawful. dnd shall subjcct m (, (riminul pnaltrs und <br />civil fines up to one hundred t dollirs (Sl()0,(xX)). in <br />and atbmey s lce\. <br />additiil to the cost as providcd for ll. <br />Sectrr 1076 ofthe <br />I hcrcby al'firm under <br />DDCLARATION <br />ofperjury rhat I am licen$d undcr proyirion ol Chapter 9 (cornrroncing wirh Sccrion 70fi)) ofl)i!ision 3 <br />ol rhc Rusincs\ fln(l l'rolcssir)ns C((lc. md nry liccnsc ir in lirll l'trrcc atrd cl'ti.cl. <br />[,iccnsc <br />3r <br />a <br />I herhy atlirnr under fEilaIy ofpcrjury tlut lhere <br />issucd (Scc. 3097, Ci!. C.). <br />trnddr's Nanrc: <br />r crnrstnlcliflr lendir8 a8ercy for thE pcrilrturce of lhe work tbr whicll this pemril is <br />lJn,lcr's Ad,lrcss: <br />APPLICANT DECI,ARATION <br />I tBrcby affmunder penahy of pcrjury one of the following delarations: <br />DenDlition Permils-Asbcrtos Notification Federal ReSulntions (Title.l0, Pan6) <br />_Rcquired lrttcr of Notificalion <br />renmval trc not applicable to this p()jerr. <br />with all City anrl County <br />and Courily to eoter uIxn the <br />atx)\'c mcntioncd propcny lilr inspccti()n <br />Applicnnl or AEcnt <br />I <br />,o*, ' Z-Zs-? <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsu lation <br />Roof Sheathino <br />Shear Wall <br />Framinq <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Jt/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL 6-?Za /L Cr.,.{€/As (Zr) <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />D <br />Rev.0B-07-2015 <br />!