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GRADING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS I Ownd-Buildcr D€cluarion
<br />I I hcreby aflim und6 poalty of pdjury th.t I m cxcmpt fm thc Conmcto6' l.iccnsc Law for thc following }joon (scc.tJl I 5 Buiin.t s
<br />I md Profasion Codc) Any City or County which rcquircs a pcmit lo construcl, altcr, improvc, demohsh or rcpair ony strucrure, pnor to its
<br />I issuucc, also rcqurre thc applicilt for such pmit to filc a signcd slatcmcnt that hc or shc is liccnscd punuut to lhc provisions of lhc
<br />I Contractor's Licoscd [.aw (Chaptr 9, Commmcing with Scction 7000 of Division ] of thc Busincss md Profasions CLitc) or that hc or
<br />I shc is cxmpt thercfrom ud thc buis fq lhc allcgcd cxmplion Any violation of Sccrion 703 I 5 by any applicant fd a pcr mir subjccts thc
<br />applicmt to a ciul pcnalty ofno morc thm fivc hundrcd dollm (9500)
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<br />c owncr of thc propcrty, or my cmployce with wagc r thcir solc compmsation, will do thc work and thc structurc is nor rntcndcd
<br />or offed fc salc ( Scc 7044, Bsinc$ md Profcsions Codc: Ttc Contractor's Liccnsc Law dG not spply ro u owncr ofthc propeny
<br />who builds or improvc lhs@n, ed who dq such work himsclf or hmclf r through his o ha own cmployccs, providcd lhst such
<br />improvmmts sc not iniqdcd or offcrcd for salc lf, howcvq, thc building or improvcmcnl is sold within onc ycu of complcrion, lhc
<br />Owncr-Buildcr will hsve thc burdcn ofproving thst hc or shc not build or improvc for the purposc of salc)
<br />_1. I owno of thc propctty, m cxclusivcly contEctins with licmscd cont acloE lo construct th. pmjcct ( Scc ?044, Burincss ud
<br />Profqsion Codc: The Contsactor's l,icasc Law dm not apply lo o omq ofpropcrty who builds or improve thcrcon , od who
<br />confrets for such projecr wirh s Conractor(s) licoscd puBudt lo thc (-'onractor's Licmsc law )
<br />_l m cxcmpt undo Scctio ___.8 & P.C for rhis rcuon(o^,",1lzufE__o*^%__
<br />I WoRKERS COMpENSATION DECLARATTON
<br />I I hacbl aflim undcr pcnalty of pajury on" of lh" fo.llo",ing d.cl*ariom
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<br />-tlavcmdwill
<br />mrintainaCcnificatcofConsmttosclf-lnsurcforworkm'compensarion,a providcdfsbyScctifflTo0ofrhct-
<br />I l.abor Codc, for thc psfmmcc of thc work for which rhc psmit is issucd
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<br />| -lhavcudwill
<br />maintatnwctm'compqsrtioninsumcc,ro rcquiredbyScctionlTo0oflhcLaborCodc,forthcpcrfommccofrhc
<br />I work for which this pqmir is issucd My workcn' compcnsation insurucc cria ud policy numbo uc
<br />I c*,i,, €war.<l *)a.P,q-r,,,l f-rsor^rto Co.
<br />eoti"yNunucr, ?LoOOl4?Of l(al r.6.e,
<br />(ThiE sGtior n.rd not b€ complctcd if th€ pqmir is fq Onc hun&cd dollm ($t 00| r ls)
<br />hl tlfi
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<br />cctify thal in thc pqfmue of thc qqk for which thii pcmit is issucd, I shall not mploy uy pmon in my ;6nr so a to
<br />beare subjccr to thc wckm ' ornpansatio laws of Cdifmie md rgrc thrt if I should bccomc suhjet to rhc wortm'
<br />@mpcmation providm of Sction 3700 of thc trbor Codc, t shall, fmhwith comply with thwc provisions
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<br />WARNING: Fsilurc lo rmrc worko' cmpcrsation covragc ir unlawful, ud shrll subjcct u mploya to ciminsl prnalti6 ud civil
<br />fina up ro oc hu&cd thouod dolln (l I oo,ooo),in sddirion to thc cot of ompcnsation, damage r prcvided fa thc Scclim 3076 of
<br />thc kbor Codc, intelt md .ttmcy's fc6
<br />LICENSED CONTRACTORS DECLARATION
<br />I hmby rffim undcpcodty of p6jwythrt I m licmcd undrprovirio of Chapa 9 (commacing with Setio 70oo) of Dvisim 3 of
<br />thc Bwine ud Prcfa:imr Codc, md my licruc ir in full fqe md cfrco.
<br />l,iccnsc Liccnsc Numbcr
<br />F*"'
<br />I hc@ aflim unda pcrdty of Frjuy thar rh@
<br />isucd (Sa. 3097, Civ. C.).
<br />ladr's Nmc:
<br />rgmcy fr thc pcrfommcc of thc work fq which this tcmit is
<br />[,cndcr's Addr6s:
<br />APPLICAI\TT'S DECLARATION
<br />Dcmolition Pmir-Asb6r6 Notification Fcdcnl RcSularions (Tilk 40. pan 6)
<br />_ Rcquircd Lcn6 ofNotificatioo
<br />_l cdify thrt thc fcdsal rcgulations rcgeding 6b6tc rcmoval arc not applicablc to this prejcct
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<br />I ccrtiry that I hsvc rcad this application md ststc that thc abovc infomation is concct. I agrcc lo comply with 8ll City md County
<br />ordinuc6 od Statc Law! rclating to building construction, and hqcby authorizc rcprcscntativcs of this city Md County to cntcr upon thc
<br />abovc motioncd propcrty for inspcction pu.poscr.
<br />r Appli@t tr sgmt
<br />\Pmin@ nmc (print):
<br />tlzclt-t
<br />Preliminary Soil Report
<br />Excauation
<br />Fills
<br />Sub Drains
<br />Buttresses
<br />Soils/Geology Report
<br />Contractors State of Comp
<br />Compaction Report
<br />Flood Drainances Cert.
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<br />Paving
<br />Sub Grade
<br />Aggragate Base
<br />Water Test & Seal Coat
<br />Asphalt Concrete
<br />Soils Eng. Cert.
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<br />Rough Grading Release
<br />Final Civil Cert.
<br />FINAL 6-?A-@ (Lc-t:$zte #Lrl
<br />Notes, Remarks, Etc.
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