Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/S!G.COMMENTS <br />Set Backs a <br />Forms/Stee!/Holdowns <br />Erection Pads \ ?'lvlh a/r <br />UFER Ground <br />SLAB Floor <br />Su bfloor/VenUl nsu lation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drvwall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Poo! Fence <br />T-Bar <br />Handicap Req <br />Deputy Fina! Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL 1o'R^'tL 5/V <br />Certificate of Occupancy <br />Notes, Remarks, Etc.ny0&A o c,.- <br />d-..rE, Ll€ <br />-l <br />OlVNER BUILDI:R D}:I,('ARA'I'IoN <br />I hereby aflirm undcr pcnalry of perjury lhal I arr exenrpt fior the ('ontraclors' I-icense l-as for thc fofio$irrg rttson (Sc.7031.5 <br />Businos and Profmion Codc): Any Cily or County which rcrpits a lnrnit lo conslrucl. alto. iruprolc. rlcmrlish or tcpair my <br />struc1ure. prior to its isuucc. alm reluira the opplicant for such lrrnil 1o lile. signd sl.lenrqrt thal he or she h licesed pureuant <br />to the provisions of the Contractor's Liccnsed Larv (('haptcr 9. ('onunencing sith Scction 701)0 of Dilision I of the lhsincs and <br />ProfcsionsCodc)orthatlrcorshciscxempllhqcfiornendthclnsisfirlheallegcderentption. Ar1'r'itrlatirrtofSe-tion70!l.5by6ny <br />applicant for a pemit subjets the applicant to a civil penalty of not rnore than lite hunrlrcrl dollnrs ($500). <br />_l.as o\r'nerofthepropeny.ornlyemployeess'ithrvagesastheirsolccornpcnsatiort.rvill&rllrcsorkarttltlrcstruclrrrcisnol <br />sale). <br />-1. <br />as o\\'ner of the propc'r1y. arrr exclusively contracting rvith liccnsctl conlraclors lo c1r11s1111gt tlrc pro.icct (Sec. 70-14. l}rsirress <br />and hoflcssion ('ode: 'fhe ('ontractor's [.icensc Larv docs nol apply to an ou'r'rcr oIproperly n'lro builds ot'ittrpt'oves lltct'con. <br />and s'ho contracts for such projects u'ith a C'ontract()r(s) licerrscd put'suanl lo Iltc (irtlraclor's I.icettsc' I.arr'). <br />I :rrn crcrnpl rrntlcr St'cliorr . I|. & l'.('. lirr tltis rcitsort <br />l)itlt: ( )rr ltcr: <br />w0 RK l: Rs' ('01\l Pr.Ns^'l'l()N <br />DI.,CLARA'I'ION <br />I hereby alTirrn under penalty of perjury one of the fltrllorvirrg tlcclarations: <br />_-l have and rvill rnaintain a Certificate of Consent to Self-lrrsure ftrr s'orkers' compensation. as pror itlerl ftrr h1'Seclion ,1700 of the <br />l-abor Code. for the po'forrnance of the s'ork for s'hich the po"rnit is issued. <br />issued. My rvorko's'c()nlpensaliorr irrsul'ancc canicr arrclpolicy nurulrcr atc:the work for which thip perrn[5is <br />,orr,rr' 'Shb <br />Policy Nurnber: ' <br />Fr--d-_ <br />-l <br />cerrify that in the lrrfonnance of the rvork fior shich this perrrrit is issuerl. I shall nol enrpl()] ant l)crsort itt attr nlilnncr <br />so as lo becorne subject to the rvorkets'cornpcnsaliorr lau,s o[('aliltrrrria. arrd agrec that iil should bccorrre sulr.iect lo lltt: <br />u'orkers' cornperrsation provisions of Section .1700 of thc l-alxrr Codc. I shall. lorthrr ith cornpll rvith llrose pror isions. <br />civil fines up t() one hundretl thousantl dollars ($100.(X)0). in atltlitiorr to tlre cost of corrrglensaliort. darttagcs as ptovitled for the <br />Section -3076 of the l-abor ('otle. interesl and attomey's fees. <br />,rrr", k-o?^lQ Appricnnr:*/1.<4bo, /ae(O-Q4O44 <br />of the []usiness and Professions ('ode. and rrry licerrse is in full ftrrce arxl effcct. <br />_ _l ccrrify that I have reacl this applicat <br />ordinances and State l.aws relatirrg to bui <br />above rnentioned property ftrr <br />Appliurnt or Agcrrt Sigrrnlrrre: )( <br />lirpircs: <br />ion antl state thal the alxrve irrfrrnnatiorr is corlet'l. I agrtr <br />conslrucliorr. antl hcrchv arrllrorizc rcgrrcsr-rtlalivcs o <br />rr ith all ('itr arxl ('ounty <br />arrd ('orrrrlv lo crrlcl' upon the <br />t.icensc('lass: 'fi r.iccrrscNurrrl^-r: -S 7 <br />"{ <br />r)nre: --g--9A<Ce ('orrrrRcro,' o(. ylaloC*.rtE 71.*"A <br />CONS'I'RUC'IION LENDING ACENCY <br />I hercby allirm undu pof,lty ofperjury that thqe is a construction l6di[g a8ency for the psfonnance oflhe \ork fur nhich this lrmh is <br />issued (Sa. 3097. Civ. C.). <br />Lendq's Name: <br />- <br />l.enclcr's Addless: <br />APPLICA N't DEC LARA'I'ION <br />I hercby allir:n under penalty of perjury one of tlre frrllos'ing declaral iorrs: <br />I)ernolition Perrnits-Asbestos Notification Federal Regulations ('l'itle 40. I'ar-t(r) <br />- <br />Requircd l.etterof Notilication <br />_l cerf ifythat the federalrcgulations rcgartling astrslos rcrnoralarc nol applicrhle lo lltis pro.icct <br />Io cotrrPlv <br />l'this ('it;- <br />l)ale ( -4-u <br />pernritee ncme rp,inrr,-LAE(&forl N - frAaa /2q v^/a hl