Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />tlev. 08-07-201 5 <br />SITE.WORK DATE ID/SIG.COMMENTS owNER ltull,l)1lR l)ut.cARATIoN <br />I h€reby affirnr under peDalty of perjury that I anr exenrpl from lhe ('ontrack,n' l-icense Lap for the following reaton (Sec.7031.5 <br />Busincss and Prolcssion Codc): Any City or Counly which requires a ltrmil k) constnrct, allcr. irnprove, dcmlish or rcpair any <br />slruclurc. prior to its issurnce. also requircs thc applicant tbr such ncrnit r, filc a signcd slalenrnl lhat hc or she is licenkd pursuanl <br />lo thc'nrovisions ol'lhc Conlraclor's l,iccnscd lrw (Chhptcr 9. Cornrncncing with Scclion 7(Xn ol Division 3 ol lhe liusincss and <br />Prolessioils Code) or that he or she is exempt therekom and the basis tbr the ulleged exenrptitD. Auy violation of Section T0S l .5 by any <br />applicant for a pernrit subjccts rhc applicnilt ro n oivil penillty of nol more thrn llve hundred dollars ($500). <br />_1, as owncr ol lhc profrly, or my cmployces with wagcs a\ thcir solc cornpcnsation, will do thc work and thc stMturc is mt <br />irlendetl or offcred for sale (Se.7Gl4. Busirrcss nnd Pmfcssions Codc: The Conlraclor's Licensc I-sw does nol spply to sn owncr of <br />theprupefly whotf,lildsorimprowslherd)trufilwk)dftssuchworkhinrseltorlrcrsclfortlrou8hhisorltrownenrployees. <br />providcd that such impmvcrrcnts dc nor inlended or olLred for ML'. II. howcver. thc building or inprovcmnt is sld wirhin onc yce <br />ofconrdelion, the Owner Builder will lnvc the burden of prcvin8 lhd lE or she did not build or improve the pn)peny for lhe puryrse of <br />slc). <br />_1. asownerolthe pn)peily, unrcxclusivelycontractitrg with licensed conlraclors!) conslrucl lhc project (Sec.7(Hrl. Dusiness <br />aNl [\{)ti\\ionCodc:TheContrrctor'sl,icense[-awdocrnotapply&ranownerofpropenywhi)buildsorinrprovesthcrcon. <br />nnd who conrraclr lbr $uch prqiccts with a Conlrach(s) liccnsdl pur\uant kr thc Contrlclor's l-iccnse ljw). <br />_l anr e\empt under Sectirrn-. R. & P.C. fbr this rearrn. <br />WoRKl.:RS' ('ONIPENSA'I l()N <br />DECLARATI0N <br />I hcrchy allirm undcr pcnalty of lcrjury one of lhc Ibllowing dcclurtio[s: <br />_l have and will nuhtain a Cedificate ofConsent to Seltlllsurc f<)r workcrs' compensation, as provided for by Section 3700 ofthc <br />Latpr Codc, for lhc perforroncc oflhc work li)r which lhc pcrmit i\ i\sued. <br />_lheveaMwillnlaintairworkem compensaliotrirsurance,as requiredbySectiol3T00oftheLaborCode,fortheperf()rnuNeof <br />thc work li,r which rhis lcrnrit is issucd. My workcrs' compcnsati()n insurancc cunicr ul lxrlicy oumhcr uc: <br />Policy Nunrbci F:xpircs: <br />_l ccnity thilt in lhc Frfbrnunce of thc work fi)r which this pcrnlit is issucd. I shrll ftx cnuloy any Frcrson in any manncr <br />so as Io bcconr subjcct to thc workcrs' compcnsat ion law\ ol Crlilbrnia. aDd a8rcc thal if I should bccorre subjcct to thc <br />wodiers' .onrlrnsation pruvisions of Section ]700 of the l,ahx Code, I shnll, fo(hwith comply with tlDE provisioos. <br />WARNING: |ailurc Io $curc workcrs'conpcnsati{)n covcrrgc is unhwful. xnd shall subjcct an en)phycr b simind lEmhiqs ud <br />c,vil fines uI to onc hundred lhouxand dollilrs ($l(nl.(Xx)), in nddiliur h lhc cosl ol conrpensrlion. dnrnages rs providcd for lhe <br />Secti([ :]{)76 of the trh)r (ixle. interest and otlorrey s fee\. <br />Datc!- <br />LIC-ENSED CoNTRA(:ToR <br />DECLARATION <br />I hcrcby al lirm undcr plnahy of pcrjury that I am liccn*d undcr provision ol'Chaplcr 9 (commncing wirh Section ?000) of I)ivision 3 <br />of thc Busincss and Pmfossions Code, arxl nly liccnsc is in full fbrcc md clfcct. <br />l-irr'nrc Nurnhcr: <br />CONSTRI.]CTION I,1]NDING AGI]NCY <br />I heEhy alllrD undcr penalty of perjury that lhee is a construclion Lrtdiog aSerEy fbr the perfo@rcc of the work for which this pemril ir <br />issued (Scc. 1097. Civ. C.). <br />[Indcr's Nhmc: <br />kndcr's Addrcss: <br />APPLICANT DECI,ARATION <br />I hcrcby affim !nder penalty of perjury onc of the followinB dalilntions: <br />Denrelitiotr Permits-Asbestos Notification Federal ReSularions (Tille.l0, Pnn6) <br />_Required Irtter of Notification <br />_l cerlily lhilt rhe lederrl re8ulnlioils resudin8 il\bcsk)s renx)villrre ftn applicahle k, rhis proiecl. <br />-l <br />cenify thrt I h^vc rcrd this applicalion and stntc lhat thc atDvc infomralion is concct. I agre to mmply <br />) rcPrerntalivcs ofthis city <br />with dll City and County <br />ordiilances and Statc lnws rckling co$lructtD and herchy authorize ylo cnler <br />atxrvc nrcntioncd propcny firr <br />Lppliconr or Agcnt <br />/Prmritee name 77t (^r <br />ud <br />o <br />llE <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsulatio n <br />Roof Sheathing <br />Shear Wall <br />Framinq <br />lnsulationi Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lMasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />I I <br />FINAL vlqlT,o -fkhil4 etJ <br />Certificate of Occu <br />Notes, Remarks, Etc. <br />-L