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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS Ow"BuildqDclantion . <br />I hcrcby affum undcr pculty of pajury thet I m qcmpt fom thc Conrcdon' Liccmo Lrw for thc following roon (scc7031.5.Burinss <br />and Proferion Codo): Ary City or County which rcquirB r psmit lo @Ntruct,8hcr, improw, dcmolirh or rcprt uy 3tFrctuc, prior to rt <br />i$une, abo rcquirc tho applient for och pqmit to filo ! rignrd rt tmotrt thal hc or shc B liccrocd purtuot to lhc ,rovisior of thc <br />Conrador'5 Li@nrcd Lrw (Chf,ptq 9, Commlncing with Scction 7000 ofDivision 3 ofthc Burinss and Profcsioro Codc) or that hc or <br />shc is qcmpt ah€rcfrom and thc barir for rlr allcgcd ucmption .Any viohtioo of Scaion 7031.5 by my appliont for s pmt subjet! the <br />rpplient to e civil pculty ofnot morc than fivc hundrcd dollarr ($500). <br />_1, as oma of thc propaty, or my cmployq with Ega ss thcir rolo compcnutio4 will do thc uork rnd thc rtruduo L not htmdcd <br />or offcrcd for rdc ( SGc.7044, BuriEs rnd Profcrsions Codc: The Contrrctor'! LiccNc L.w do6 rct rpply ro rn omd of lho propcny <br />who buildt or inprov6 thaoq md who doc ruch work himrclf or hssolf or through hit or hq om cmployd, providcd thlt ruch <br />improvcm@ts Erc not intsndcd or offqcd for nlo. If, howv*, $c building or improvcncnt is sold withi[ onc yar of empletion, thc <br />Omcr.Buildq will havc thc burdcn ofproving that hc or rhc not build or improvc for thc purpore ofule). <br />_I, 6 oMd of thc l <br />Profdion Codc: Tho <br />propcrty, !m cxclurivcly cont rcling with li@B.d @DtrBctors to @Ntrucl thc projc€t ( Scc. 7044, Buinss lnd <br />Contntur'r Li@roc Irw dq mt rpply to m oM6 of propqty who builds or ths@n . rnd who <br />conulcts for such projd with I Contractor(s) Iiccns.d pursunt to thc k*). <br />_I m exempt &.for thir <br />Datc:2 <br />I hacby affrm undc pomhy ofpajury onc ofthc <br />_I havc and will mEhtrio a Ccnfieto of CoMctrt !o Sclf-IEurc for workqr' @mpcMtior\ u providcd for by Setion 3700 of thc <br />Lrbor Codc for thc pqforrone of thc wort for which thc pamit it isucd <br />_I hrve and will mrintain workdr' @mpcruation iilunm, r rcquicd by Scction 3700 of thc hbor Codq for thc pclformnm of thc <br />work for which thic pcrmit i! issucd. My workm' ompensation i$utane Bricr md policy numba rrc: <br />Policy Numbs: Expir6: <br />Ghi"roaion n ot t*1 <br />I stiry oBt in thc pcrformane of the work for which this pamit is isucd, I <br />bsmc subjcrt io tho work€[ ' @mpenlation lews of Crlifornia, and rgrco thst <br />shall not 8ny in any ma so r to <br />workss' <br />@mpensltion 3?00 of thc hbor Codq I rhlll, forthwith those <br />Frilurc to t4urc worl6r' compcEation covqaSc md shall subjcct <br />fin6 up ro ono hun&ed thourud dollur ($100,000),in rddition to <br />rhc llbor Codc, intqdt rnd.ttom.y't fq. <br />ort of ompcnsatiorl at <br />LICENSED CONTRACTORS DECLARATION <br />I hucby rffirm und< pcElty of pcrjury thEt I m lieucd undcr provisbo of Chapto 9 (ommcncing with Srction 7000) of Divirion 3 of <br />iha Businsr .nd Profqriou Codc, rnd my liccuc ir ir full fore and offot <br />Lieroc Chs:_ Li@nto Numb6 _ <br />Drtc: Contrrqlor; <br />CONSTRUCTION LENDING AGENCY <br />I hacby rfiirm undcr pcnalty ofpcrjury that th{c is i coutruction lcnding rgcncy for thc pcrformrnrc ofthc work for which rhis pcrmir is <br />Lcndq'r Addrc$: <br />APPLICANT'S DECLARATION <br />Dcmlition Pqmitr.Albgtor Notifietion Fcdcrel RcguLtioro (Titlc,O, Put 6) <br />_ R.4uircd l.tr6 of Notifiqtion <br />I ctrtiry thst thc fcdcrrl rcgulationr rcguding ubetor rcmoval rro not cppliclblo b thir project. <br />_ I Eniry dut I hvc rad thir rppliotion strd informrtion is conect I rgre to 6mply with all City and Couty <br />ordimnccs rnd Strtc [.w r€lrtiry to building to mtd upon tho <br />rbovs mationrd propcrty for <br />Appliont or agat sig. <br />Pcrmitt@ Dma (print): <br />and rcpr6cntltivcr of this City <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SI-AB Floor <br />SubfloorA/enulnsul. <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />isrucd (Scc. 3097, Civ. C.).