Laserfiche WebLink
t <br />BUILOING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG. <br />Set Backs .-/--n <br />COMMENTS <br />Forms/Steel/Holdowns ,IMU1F <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/Vent/l nsulation A <br />Roof Sheathinq .l -l{+,7r;lj <br />Shear Wall yJ.mfr <br />Framinq U}4ufrfA <br />lnsulation/Enerqy ?.LIi&J, <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 />Enqineer Final Report <br />Flood Zone Certif <br />FINAL lO Ll1/)Dft fVlan *r5 <br />Certif icate of Occupancy ll <br />Noteg, fiemarks, Etc./ <br />lrI <br />I he('hy allirm undcr pcnrlty ol pcrjury that I am cxcmft liom thc Gnilrack)rs' Liccnse l-aw li)r thc li)llowing rea\on (Scc.?0-11.5 <br />Busincrs akl Prolassion (i)dc): Ahy City or County which rcqurcs a Jrrmit lo construcl. allcr, improvc, dcmrlish or rcpair any <br />struclurc, prf,)r k) ils issuancc. also rcquircs thc applicant ti)r such frcrnrit b lilc a signcd slxtcmnl that hc or shc Ls liccnscd pursuanl <br />k) thc provisirnrs ol'thc Cr)nlracl(,r's [,icenscd Law (Chaplcr 9. Comnrcncing with Seclior 70U) ol Division J of thc Busincss and <br />Proltrst)nsCod.)orthalh(orshciscxcmptthcreliomandthcba{istbrthcallcgcdcxc[rpti(m. AnyviolationofScctionT0-ll.5hyany <br />applicanlti)rapcrnlitsuhjcclsthe applicantk)dcivilpcnallyofnolmorcthantivchundrcddollds($500). <br />_1. ts r)w[('r ol'thc prol^-f,y. ()r my ctrlpk]yccs wil h wascs {s I hcir solc (otrrpcnsrtion. will do lhc work dnd thc slnEturc is not <br />trilcRlcd or oll'crd li)r salc (Scc.T044, Busirrcrs anrl Prolcssrms Crxlc: l-hc' Conlraek)r's l-iccn\c Law docs nol apflv k) an owncr of <br />thc pn)pcny who hurlds or rmprovcs tlErc()n, rnd who rlocs surh work hinrsclfor hcrscll (,r through his or hcr ()wn cnlployccs. <br />pr()\,iddl lhat such itnprovcnNnts trc not intcndcd orolltred li)r s{lc. Il. howcvcr. thc building or improvcmnl is $kl wilhin onc ycu <br />ol conrplct()n. tlE ()wncr ltuildcr will havc thc burdcn ol p(]vrn8 thal hc or shc did not huikl or intprovc thc pn)[Ef,y lor thc puryDsc o[ <br />srlc). <br />_1. ils owncr ol thc pirparly. rm cxclusivcly conlracling wilh licol\cd eon(ractus k) c()nsln,cl the projcct (Scc. 7044. Bu\iilcts <br />rnd th)lissinCo(lc:Thc(-()nlrnclr)r'\l,icctr\cl-awdoclnrilapplvk)anowncrofpropcrlywhohuili.jsorimprovcslhcrcon. <br />tnd who contrrcts fi)r such pfi)iccts wilh u (i)ntrilcfu)r(s) liccns(l purlurnt k) lhc Crtrlrack)r's Liccnsc l-aw). <br />lrnlcrcntplUllJcrscetion-'B.&P'C.lbrthisreas()n, <br />l)stc:- <br />TVORKERS' COI\,I PENSA'I'ION <br />DECLARATION <br />I hcrchy all'irrr undcr pennlly of pcrjury oDc ol lhc l'r)llowins dcclrrntiurs: <br />_lhavcilrdwill nuinlrinaCcrtitjcatcofConscnltrSclt:lnsurclorworkcrs e()mpcnsation,as providcdlorbySectt)n-lT0Oofthc <br />lrbor Crxlc. lirr thc prlbrntancc oflhc work lirr wlrich thc pcrmit is issucrl. <br />_lhavcandwillnrrinlainworkcrs'compcnsati{}ninsurancc.as rcquircdhyScclionJT00ofthcLahorCodc,l'or(hepcrti)manccof <br />thc work fi)r which this Frmit is rssucd. My workcrs compcnsati{)n insurancc canicr and lblicy numhcr uc: <br />Policy Numhcr: Expircs <br />_l rcf,ily that in the pcrli)rmnncc ol lhc work lbr which lhis pcrnrit is issucd, I slull trol cntpkry any pcrson in any manncr <br />so rs t() hcconrc srhicrt t() thc work('rs e()nrl--nsati(n hws ()l Callarnia. rnd aercc thrl il I sholld hcsom sulicct k) thc <br />work(.rs cotrpcnsxtionprovisionsofScctir)n.17001)llhcLiltx)rCrxjc.l(hnll.t(xlhwilhcomplywilhlhosprovisiilns. <br />WARNIN(;: Fnilurc t) *curc workcrs'compcnsali(ln c()vcrxgc ir unlawlitl. and shall Fnallics and <br />civil lines up k) ()nc hundrcd thousand dollars (X).UX)), ilr rdditi(n (o thc cosl li'r lh(' <br />Sccli(D .1076 r)l lhc htx)r C(xlc.tccs. <br />l)alc:u /"- 147-- ( <br />I hcrchy allirm undcr pcnally ol Frjilry lhnt I an liccn*d provision ofChaplcr 9 (comnrncing with Scction 7fi)0) of Division -1 <br />r)l' thc Busirlcss rn(l Proltssirus Codc. and nty licensc is i[ llll lbrec iltr| clttcl <br />Liccnsc Class: <br />I hcrcby nllirnr undcr [Enally ol lErjury thlt is ion lcndinl the pcrti)rmanec of lhc work li)r whrch this l--rnril ls <br />issucd (Scc. .\097. Civ. C.). <br />Iandcr'\ Nxma: <br />s Addrcssl <br />APPLICANT D!]CLARATI()N <br />I lrcNhy rtiirn undcr pcnrlty ol pcijury onc of lhc li)ll()winp rlccldral ions: <br />Dcmol(k)n l'cflnit\-A\h(stos Nolilicat!)n Fcdcral Rctulattrrr\ (l illc ,10. I'xn6) <br />_Rcquircd t ltcr of Notilicdlinl <br />-I <br />lhxl lhc tidcr{l rcgulaliills rcgtrding xrhslos r(aB)vrl arc not applicahlc k) this lft,jc(|. <br />I hrvc I lri(ilrd slxtc that thc ilx)vc inlrrrrlrtion is eorccl. I agrcc lo comply with all City and County <br />rclxting to <br />Ior insl--cl <br />,ukl herchy auth)rizc rcprescntnlivcs of this City and County t) cnter uFln tlE <br />Applicatrt or <br />dirraScs xs <br />Itcrntilet' <br />Stntc <br />,^*,4- lo^(1 <br />t,,ll.( <br />1-lel <br />-11'-l9l <br />\iY <br />.t) <br />I