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BUILDING. INSPECTOR RECORD <br />Bev.08-07-2015 <br />SITE.WORK DATE ID/SIG.COMMENTS owNER lt(JILt)l,tR l)1LCAR '|'ION <br />Ihercbyaffirn)underpenrhyofpcrj!rythatIanrexenlptfromthc(:ontraaloN LicenseIrwforthefollowingreason(Scc.7031.5 <br />Busincss and Prolcssion Code): Any City or County which requires n lEtrnit h construcl, aller. irnprove, dcrmlish or rcpair any <br />stnlclorc. pri(,r lo its issuance. also requires the npplicaDl fi)r sucll pcrnril to filc x signed slatcment lhat he or shc is licensed pursuant <br />to lh$ provisioN ol t}k' Contractor's l,iccnscd lrw (Chnplcr 9. Comrncncing wilh Scclion 7(xn of l)ivision J of the Business and <br />Prolts\k)nsCode)orthalhcorshciscrcmplthcrclionlaDdtlEbasislirrtlEallcgedexenrpti(nl. Anyvi()lrtionofSectionT03l.5hyany <br />applicrnl for r pcrmil subjects the npplicant to a civil pcrrnlt!,ofnol nrore than llve hundred dollnrs ($5(X)). <br />_1, as owner ol thc proltnv. or my cmplovccs with wagcs as thcir $lc comFEnsation. will do the work and thc stretue i\ mt <br />interrded orofferedforule(Su.7(X4.BusincssandPrclessiousCule:TheClntrilclor'sLicenschwd@snotapplytoatrowncrof <br />thepropefly whobuildsorimprowstlrcrlr[ildwlbdoersuchworkhinrselforlNrselforthrouBhhisorherownemployees, <br />providcd lhal such imprevcrrcnts te mt hterxlcd or ollcNd lbr sb. Il. however. lhc building or improvcmnt is sold wilhin onc )ru <br />ofcon\)lerbn. the Owrer Buikbr will luve lhe burdcn of provinS lhat lE {)r she did Nt build or inpove thc pmpeny for the puqDs o[ <br />sale). <br />_1, ns owner of lhe propefly, am exclusirely contructinS c,ilh licensed conlrack)n b conllrucl llE pmjcd (Sec. ?(X.{. Business <br />antl [\ulissirr Codcr Thc Coiltrack)r's Licetrs. Law doe\ Dot afply to an owner ofpropcny who btrilds or impr)ves thercon. <br />and who contrlcls lor such proiccls with ! Conlrack]r(s) liccnsed pur\trant to thc Conlractor's Liccnrc Law). <br />-lrnrexemptsndefsccttln-'B,&P,c,titrlhisrc!\otr,Dalq- <br />woRKuRs' coNt PENsA'iloN <br />IX:CI,ARATION <br />I hcrcby nltirm undcr pcnaky of pcrjury onc of the lirlbwing (lcclarati()ns: <br />_lhaveardwill nuintainaCe(ificateofconsentloSelFl[sureforworlers'conrlxnsation,as providedforhySection]700ofthc <br />Inhor Code, for lhe Irdormrce of lhc work lor *hich rhc pcrmir ir i\sucd. <br />_lhrveatrdwilln)aintailworkers'conrpensali(ilinsurance,as requiredhySecli(D3T0OofthetihorCode,forlheprfornunceof <br />thc wo,k lbr which this pcrnrit is issuc(I. My workcrs' comlNnsrrion insurrncc crricr anl F)licy numhcr iuc: <br />Policy Nunrbc.: lixpircs: <br />_l ccnity that in the lrcrlornunce of thc work li)r which this pcrnrit is is$ucd, I shall not cmploy any pcrson in any manncr <br />s as to bccorrc subjcct to lhc workcrs'compensation laws ofcalifonlia. and agrcc lhat ifl slnuld becolrc subjccl to lhe <br />workers' compcnration provisions of S.ction 3700 of thc Llbor Cqle, I slull, fonhwith comply with rho* prcvisions. <br />WARNING: Fililurc to sccure workers'compcnsation covcrugc is unlawful, and shall suhject an empk)yer b miminal Fnalies ud <br />civil fincsuptoonchuildrcdlhousaf,ddollars($100,U)0),itraddiliurtolhccostofconrpcnsalion.daftrges{sprovidcdforlhe <br />Scction 1076 ofrhe Lrh)r Cule. inlerest and atk)rcy's fee\. <br />l)ate:_ <br />I,IL'ENSED C0NTRACT0R <br />DI]CLARATIoN <br />I hDrcby allirm undcr pcnalty of pcrjury that I arn liccn$d undcr prcvisi)n ol Chrptcr 9 (coilrrrcncing with Section 7(Nn) of l)ivision 3 <br />of thc Busincsr and Proflsstrns Codc. md nrv liccnse is in tull firrcc and cllcct. <br />Liccnsc Class:_Liccnsc Numbcr: <br />l)nle _ Conlrsalor: <br />CONSTRI.JCTION I,BNDING AGENCY <br />I heEby atllrm undcr Fnaly of perjury rhrr thcre i! a @nstnrcttnl leldilg agen-y tirr t he perfomrce of the work tbr which rhis trmir Ls <br />issued (Scc. 3097, Civ. C.). <br />Lendcr's Nnmc: <br />knder's Addrcss: <br />APPI,ICANT DECI,AR4.TION <br />I lmby aflm unrlcr penalty of perjury one of thc following rlrelarations: <br />Demolition Pern)ils-Asbestos Notification Federal Regulillions (Title 40, Pan6) <br />-Requted <br />lrttcr of Notification <br />_l certify lhat the federalregulatiors regudirrg asbest)s rennval are not applicahle to this projet. <br />_l cenify lhat I havc rcad this dpplication and slntc th.t lhe above infomulion is corccl. I ngre to crmply wilh all City and County <br />ordinaDces and Slatc Laws rchtiig to huilding coNlruclion, ilnd hereby autk)rize represeDtalives of this City and Couilty to entcr ulDn the <br />atxrvc nrntioncd prrpcny ti)r inspccti()n purposs. <br />Applicsnt or Agcnt Signaturc: <br />Pemillee mme (pdnl): <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsu lation <br />Roof Sheathinq <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lt/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif. <br />FINAL 2-Zab-Zo[t J t)Lz b(qr) <br />Certificate of Occupancy <br />Notes, Remarks, Etc