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BUILDING. INSPECTOR RECORD <br />I <br />SITE.WORK DATE ID/SIG COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUl nsu lation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <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 />Engineer Final Report <br />Flood Zone Certif <br />FINAL 729eo2o r-ld e)l t >@ <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />i-{l-(e €,^)1(- -46-aa, ,^ /*!,It-=(--s, ^\,)\rLI <br />o _-GWUt <br />I hreby affirrn unda pmalty of psjury thal I m excnrpt fiorn thc ('ontracto6 l,icose larv for the follorving r6)n (5(.7031.5 <br />Businss and Profssion Code): Any City or ('ounty $'hich rcquire a permit lo construcl. alta. improve, demolish or repair any <br />stmctrre. prior b ils issuance. also requirs the applicant for such pmnit to file a signed statoumt that he or she is licffsed pursuant <br />to the provisions ofthe Contractor's L-icenscd l:rv (Chapts 9. Cornmencing rvilh Seclion 7000 ofDivision 3 ofthe Busincs and <br />ProfessionsCode)orlhatheorsheiseremptthsefromandlheb6isfortheallegedexonplion. AnyviolationofS6tionT0:ll.5byany <br />applicant for a pmnit subjccts the applicanl lo acivil pcnaltyofnot morelhm five hundred dollus ($500). <br />l.as orvnooflhepropcf,y.ormyeillploysrvithrvagestheirsoleconlpmsation.willdothervorkmdtheslruclueisno( <br />intmded orofTeredformlc(Se.7044.BusinesandProfcsionsCode:l-he('onlraclor'sl-icense [,awdo6notapplytoanowrerof <br />lhe prepefry who hril<ls or irnprovc lh6@n. Md who doc such rvor]< hirnselfor hersclfor lhrough his or her orvn employee. <br />providedthalsuch imprcvonenlsdenotintmdqlorofffredforsale. lf.howoo.lhcbuildingorimprovmotissoldrlithinone)fr <br />ofcomplaion. the Owner Builds rvill have the hrdfl offovinS lhal he or she did nol build or irnprove the Jrcpdy for the purpse of <br />mle). <br />I. as owncr oflhe propsty. am erchlsivcly conlracling wilh licenscd conlmctors lo constnlct lhe proiet (Src. 7044. Busines <br />and [1ofession Codc: l'he Conh'aclor's l-iccnsc [,aw doe not apply to an own6 ofprope(y who builds or improves threon. <br />and who conlracts for such frojecls wilh a Conhaclor(s) licensed pursuanl to the Conlractor's l,icense Law). <br />I an exempl tI <br />1q-0-owner:.- <br />t)t,t( t,,\R,\ I loN /04<.(E <br />I hcrctry alTirrn unrlcr pcnahy ol ptliury onc ol lhe dcchr rt ions:)reL''-AL- <br />I have md will maintain a Cmificale to Self-lnsure for rvofko's cornpcnsalion. as provided for bySection 3700 oflhe <br />lalxrr ('ocle. for lhe po'lbrnrance oflhe rvok which thc punrit is issuc<l. <br />I havc aml will maintain rvorkers' compensalion insurailce. as required hy Sslion 1700 oflhe Labor Code, lor thc peformance of <br />the rvork for rvhich this pmril is issued. My ulrkqs' comrrosation insurance canis md policy numbe <br />,*,*4A laa€'frrEzf 4t>>r4zz;'u 1,ac: <br />Policy 1 _Erpires: <br />Icdiry ptrmil is issucd. I shall not any in any mannd <br />so as kr becon:c suhjel k) the Norktrs' con{cnsalion larvs of(.ali[trmi., and agre that if I should become subitrl lo thc <br />sorkos' ctmpcnsation provisio)s ofSeclion 1700 oflhc t,nhrr ('odc. I shall. fonhrvilh conrply rvilh lho* provisions. <br />\YARNIN(i: Faihrrc kr sccurc *orkcrs'conrposalion colqagc is unla*'[ul. and shall subjsl an mploys to cirninal fumltis and <br />civil lines up lo one hundred thousand dollaB ($100.000). in to lhc cosl of cornpensation.as providcd for the <br />S(1ion.1076 intust md atomey s fe./z /7 <br />,o rvCE <br />I hrcby affinn undo poalty of perjury that I m undr provision of 9 (comrimcing sith of Division -1 <br />of the Busin6s and Pro[sioN Codc, md my is in full force od cfTet. <br />.? <br />License Clas: <br />I haeby aflirm undo pcnahy ofpdjury Ihat th6c <br />issued (Se. 3097. Civ. C.). <br />ltrdtr's Namc: <br />agocy the pqfomance of Ihe work for rvhich this pmnh is <br />Lmdo's Addrs <br />-APPLICAN'T DECLARATION <br />I hqeby affinn un<ls poalty of perjury one ofthe follorving dclaralions: <br />Demolition P6mils-Aststos Nolification Fedral Regulations (Title 40, Pa(6) <br />Rcquired Lettq of Notifi cation <br />I cefliry lhat lhe fdfral re8ulalions rcgmding rbslos rcmoval are nol applicable to tiis proj(t. <br />I colify thal I harc read this application and slate thal lhc ah)ve infonnation is corect. I conrply with all City and County <br />ordinancs and Stale Larvs relaling to oflhis City and County to mtfr upon the <br />atreve motioned propoty for inspection <br />Applicril( or Agrtrl Sigtr[(urc: <br />illilrc <br />anrl 'ii 7 <br />.-\i\o((tr <br />,4 <br />-)o 4 <br />!2 <br />v <br />I)alcl