Laserfiche WebLink
BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.QOMMENTS o OWNER BUILDER DELCARATION <br />I hcrcby afllrm undcr FEnahy of pcrjury thfl I am cxcmpt fmm thc Contraclon' Liccnse law for lhe followinS rca$n (Str.70.j1.5 <br />Busincss anl Profession Codc): Any City or County which rcqui.es d lErmit lo conslruct. {lter. improvc. dcmlish or rcpair any <br />structurc. pri)r k) its issuarcc. also rcquircs thc applicrnl firr such lrernrit to fih r signed sldcmnl lhal hc or shc is liccnscd pursuunl <br />to thc prcvisions of lhc Conlrrclor's Liccnrcd hw (Chtrplcr 9. Comrncncing wilh Scclion 70fi) of Division 3 of thc Busincss and <br />Pmtbssions Codc) or thdt hc or shc is cxcmpt thcrcfrom und thc basis for thc alhgcd cxcmilion. Any violation of Scclion ?0.1 I .5 by any <br />applicrnlforalrermitsubjcclslhc applicantloacivilpcnaltyofnotnxrrcthilnfivehundrcddollars(3500). <br />_1. as owncr of the propcrty. or my enlployccs with wagcs as lhcir solc conrpcnsalion. will do thc work ilnd lhc slnrcture is n()l <br />intendcd or ofl'crcd lbr sale ( Scr.7044. Business and hol'cssions Code: Thc C--ontraclor's Licensc Law docs not apply lo an owncr of <br />thc prcpcrty who builds ()r improvcs thcrqrn. and who docs suclr work himsclf'or hcrsclf or through lris or hcr own cnlployecs. <br />providcd that such inrprovenrcnls are lmt intcndcd or oflt'rcd for sah. If. hrwcvcr. thc buildirtg or improvenrcnl is sold within onc ycar <br />of cotnplction. thc Owncr Buildcr will havc tlrc burdcn of proving that hc or she did rxrt build or irnpnrvc the pnrprty ftrr thc purplse of <br />salc). <br />-1. <br />as owncr of the propcrty. amexclusively contracting with liccnsed conlraclors lu conslruct lhc pnrjccl (Scc. 7041. Busincss <br />and Profcssion Codc: 'l'hc Contractor's l-icensc [-aw docs not apply to .ul owncr of propcrty who builds or intprovcs lhcrcott. <br />and who conlracts for such projccts with a Contract<l(s) liccnscd pursuant lo thc Contractor's Liccnsc [aw). <br />-lanrexcmptundcrSection-.B.&P.C.forthisreason.I)alt:( )rvner. <br />WORKERS' COTTTPENSATION <br />DECLARATION <br />I hcrcby alTinrr undcr ;rcnalty of pcrjury onc of lhc folkrwing dcclarations: <br />-lhavcandwill <br />rnaintainaCcrtificatcofConscnttoSclf-lnsurclbrworkcrs'cornpcnsali()n.as providcdlbrbyScclion3T(X)ofthc <br />Labor Codc. ltrrthe pcrlbrmancc of thc work ftrr which thc pernrit is issucd. <br />A:.lbr is issuccl. My cornpcnsalion insurlncc carricr and policy nurnhcr iuc: <br />Policy *2o-b <br />_l ccrtify that in thc pcrfornunce of thc work lbr which lhis pcrnrit is issucd. I shall not crttploy any pcrson in arty manncr <br />so as to bcconrc subjccl lo lhc workers'comJrcnsalion laws of Calilbrnia. and agrcc lhat if I should bcconrc subjcct to lhc <br />workcrs' colrrpcnsalion provisions of Scction 37(X) of thc Lahrr Code. I shall. tbrlhu'ith conrply with thorc provisions. <br />WARNING: f;ailurc to sccurc workcrs' colnpcnsatioll covcragc is unlawl'ul. and shall subjcct an crnploycr to crirninal Jrcnaltics and <br />civil lines up to onc hundrcd thousand dollars (SlU).(ruO). in addition lo lhc cost ol'cornpensalion. darnagcs as providcd for thc <br />Section 3076 of the Labor Codc. intercsl and attorney's fccs. <br />,^r,. l-21 -,4) Appricanr: <br />I hercby affirnr undcr Jrcnalty of pcrjury that I arn licenscd under provision of Chaplcr 9 (conrnrcncing with Section 7firu) of Division -1 <br />of thc Busincss and Professions Codc. and rny liccnsc is in full force and cffect. <br />Licensc ,ro".' 'L Lice.sc <br />D^r", f - H'- 2>U) conrracror* <br />I hcrchy uff rrrn urrdcr pcrralty ol'pcrjury lhat thcrc is a agency ltrr thc pcrlorrnuncc of thc work for which this pcrtnit is <br />issued (Sec. 3097. Civ. C.). <br />lrndcr's Name: <br />[.endcr's Addrcss: <br />APPLICANT DF'CLARATION <br />I hcrcby affirnr undcr pcnalty of pcrjury onc of thc fbllowing dcclaralions: <br />Derrxrlition Pcrnrits-Asbcstos Notificati<xr Fedcral Regulalions ('I'itlc 40. Part6) <br />-Rcquircd <br />lrtter of Notification <br />_l ccrtify lhat thc fcdcral rcgulations regarding asbcslos renxrval arc nol applicablc to lhis projccl <br />stalc that lhc atxrvc itrtbrrrmtiorr is corrcct. I agrcc to conrply with all City and Courtty <br />authorize rcpresenlalivcs of this City and County to cntcr uf)n tlrc <br />abovc nrcrrtioncd propcrty for inspcction <br />Applicant or Agent Sign"tr..X- <br />Permilee name @nntlz L <br />*r", l*21 -fu) <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/Ve nt/l n s u I atio n <br />Roof Sheathinq <br />Shear Wall <br />Framing <br />Insu lation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />JVlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif . <br />FINAL /ZA-D tLCte rur*s -, <br />17 <br />Certificate of Occupancy <br />Remarks Etc. <br />L ;o c <br />;7 <br />C